Selective dorsal rhizotomy

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A selective dorsal rhizotomy (SDR), also known as a rhizotomy, dorsal rhizotomy, or a selective posterior rhizotomy, is a neurosurgical procedure that selectively cuts problematic nerve roots in the spinal cord.^{[3][note 1]} This procedure has been well-established in the literature as a surgical intervention and is used to relieve negative symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy.^[4] The specific sensory nerves inducing spasticity are identified using electromyographic (EMG) stimulation and graded on a scale of 1 (mild) to 4 (severe spasticity). Abnormal nerve responses (usually graded a 3 or 4) are isolated and cut, thereby reducing symptoms of spasticity.^[3]

Spasticity is defined as a velocity-dependent increase in muscle tone in response to a stretch.^[5] This upper motor neuron condition results from a lack of descending input from the brain that would normally release the inhibitory neurotransmitter gamma amino butyric acid (GABA), which serves to dampen neuronal excitability in the nervous system.^[6] Spasticity is thought to be caused by an excessive increase of excitatory signals from sensory nerves without proper inhibition by GABA.^[7] Two common conditions associated with this lack of descending input are cerebral palsy and acquired brain injury.^[6]

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