The Cerebral Palsy Research Network congratulates Dr. Brandon Rocque of Children’s Alabama and the University of Alabama at Birmingham, along with many others* from the network’s surgical spasticity study group and all contributing sites on the publication of a landmark new study, “Selective Dorsal Rhizotomy for the Management of Spasticity in Children with Cerebral Palsy: A Description of Patient Selection and Surgical Technique Across the Cerebral Palsy Research Network,” published in the Journal of Neurosurgery: Pediatrics. This article is the most extensive use of data from CP Research Network’s clinical registry — a database that has been collecting information from the medical records of people with cerebral palsy (CP) seen at CP Research Network member hospitals since 2016.

Selective dorsal rhizotomy, or SDR, is a surgery used to reduce spasticity — the muscle stiffness and tightness that many children with CP experience. During the procedure, a surgeon cuts a portion of the nerve roots in the lower spine that are sending overactive signals to the muscles. Research has shown that SDR, combined with physical therapy, is more effective at reducing spasticity than physical therapy alone. However, surgeons don’t all perform SDR the same way, and until now, no one had looked across multiple hospitals to describe just how different those approaches can be.

Researchers analyzed data from 564 children who had SDR surgery at nine CP Research Network member hospitals between 2016 and 2024. They found significant variation in nearly every aspect of the surgery — from which children were selected for the procedure, to how the surgery was performed, to how pain was managed afterward.

Key findings include:

• Who gets the surgery varies by hospital. The average age at surgery ranged from about six to nine years across centers. Notably, one-third of the children who had SDR were non-ambulatory (Gross Motor Function Classification System [GMFCS] levels IV or V) — a group that has not traditionally been the focus of this surgery. This finding suggests that surgeons may be expanding the use of SDR beyond improving walking to also help with pain and ease of care.
• The surgical approach differs widely. About half of surgeries used a single-level approach (accessing one area of the spine) and half used a multilevel approach (accessing multiple spine levels). Both are accepted techniques, but no one yet knows if one leads to better outcomes.
• How many nerve roots are cut varies. On average, surgeons cut about 60% of the nerve roots they tested. However, children with more significant motor impairment tended to have a higher proportion of nerve roots cut.
• Pain management after surgery is inconsistent. Hospitals used very different combinations of pain medications after surgery. Approaches that reduce opioid use are being adopted at some centers but not others.

If your child has had SDR — or you are considering it — this study confirms something many families have suspected: the surgery can look quite different depending on where you go. That is not necessarily a problem, but it does raise an important question: does the way surgery is performed affect how well a child does afterward? Right now, we don’t know the answer.

This study is a crucial first step. By documenting how SDR is currently being done across the country, CP Research Network researchers have laid the groundwork for future studies that will connect surgical technique to outcomes — things like how well a child moves, their quality of life, and their long-term health.

The study authors call for future research to follow children over time to understand which surgical approaches lead to the best results. This is exactly the kind of work CP Research Network’s clinical registry was built to support. Having nine hospitals contributing data in a consistent way makes it possible to ask — and eventually answer — questions that no single hospital could tackle alone.

The Journal of Neurosurgery: Pediatrics has kindly provided open access to this publication so that members of the community can learn about this important publication.

*Congratulations to all the authors of this publication including: H. Caroline Davies, MS, Jeffrey S. Raskin, MD, MS, Jeffrey R. Leonard, MD, Virendra R. Desai, MD, Robert J. Bollo, MD, MS, Joyce Oleszek, MD, C. Corbett Wilkinson, MD, Sophia R. Blasco, BA, Charles B. Stevenson, MD, Patrick G. McPhee, PhD, Neena I. Marupudi, MD, MS, Joyce P. Trost, PT, PhD, and Paul Gross, BA