SDR is one of the most effective surgical treatments for spasticity in well-selected children with CP, with decades of outcome data and clear eligibility criteria. This article explains what SDR is, who is and is not a candidate, what surgery and recovery look like, and what long-term outcomes look like.
What SDR Is
SDR is a neurosurgical procedure performed in the lumbar spine. The surgeon exposes a small portion of the spinal cord and uses electrical stimulation to identify which dorsal (sensory) nerve rootlets are abnormally active. Approximately 50 to 75 percent of the abnormal rootlets are then divided. The result is a permanent reduction in spasticity below the waist. The motor (ventral) nerve roots are not cut, so muscle strength and voluntary movement are preserved. Sensation is largely preserved because only a portion of sensory rootlets is divided. The effect is permanent and does not wear off over time.
Who Is a Candidate
Strong candidates typically have:
- Spastic diplegia: spasticity primarily in the legs
- Age 3 to 8 (or up to 12) at surgery
- GMFCS level II or III: walking with or without aids, with reasonable underlying strength
- Pure spasticity (not dystonia or ataxia)
- Demonstrated functional limitation from spasticity, with good potential for therapy-driven gains
- Adequate cognitive ability to participate in intensive rehabilitation
- Family commitment to 6 to 12 months of post-operative therapy
Children with quadriplegic CP, primarily dystonic CP, severe weakness without spasticity, severe contractures, or limited rehabilitation capacity are usually not good SDR candidates.
SDR and the rehabilitation that follows are major investments. A free legal review can help clarify whether the underlying CP was preventable and what funding options exist.
Evaluation Process
SDR evaluation is multidisciplinary and rigorous. Components typically include:
- Pediatric neurology and physiatry consultations
- Comprehensive PT evaluation including gait analysis
- Imaging review including spine MRI
- Neurosurgical evaluation with the operating team
- Family discussion of expectations, risks, and rehabilitation commitment
Major centers (St. Louis Children’s, Seattle Children’s, Nationwide Children’s, others) have established evaluation pathways and accept referrals nationally. Many families travel for SDR; some centers provide travel and lodging support.
What Surgery and Hospital Stay Look Like
The procedure itself takes 3 to 6 hours under general anesthesia. The surgeon makes a small incision over the lower spine, exposes the cauda equina, and uses electrical stimulation to identify and selectively divide abnormal sensory rootlets. Hospital stay is typically 4 to 7 days, including initial recovery and the start of inpatient rehabilitation. Children leave the hospital with a clear rehabilitation plan and a follow-up schedule.
Rehabilitation: The Critical Six to Twelve Months
Spasticity reduction after SDR is immediate and permanent, but the underlying weakness it had been masking is now exposed. Children typically appear weaker in the first weeks. Intensive rehabilitation is essential to build strength, motor control, and function. The typical pattern includes:
- Inpatient rehabilitation for the first 1 to 3 weeks
- Intensive outpatient PT 4 to 5 times per week for 3 to 6 months
- Continuing PT and OT at slowly tapering intensity for 6 to 12 months
- Bracing adjustments as posture and gait change
- School accommodations as the child returns to class
Many families find this rehabilitation phase more demanding than the surgery itself. Functional gains accumulate over the year, and continue more slowly for years afterward.
Long-Term Outcomes
Published outcome data from major SDR centers show that for well-selected candidates:
- Spasticity reduction is sustained for life.
- Walking speed, gait quality, and endurance often improve significantly.
- Many children move from GMFCS level III to level II, or II to I.
- Hip surveillance findings often improve.
- Pain from chronic spasticity often decreases.
- Some adolescents and adults report continued functional gains years after surgery.
SDR is not without risks: bowel and bladder dysfunction, sensory changes, weakness greater than expected, and rare spinal complications. At experienced centers, complication rates are low. The decision is individualized and made jointly with a multidisciplinary team and family.
Steps to Evaluate SDR for Your Child
Use these steps to work through the evaluation process.
How does SDR compare with intrathecal baclofen pump?
SDR permanently reduces spasticity by selectively cutting sensory rootlets; baclofen pump continuously delivers medication to reduce spasticity but requires lifelong management of the pump. SDR is preferred for many children with pure spastic diplegia who can tolerate intensive rehab. Baclofen pump is often better for children with mixed CP types, generalized spasticity, or those who are not surgical candidates. Both can substantially improve quality of life for the right child.
Will SDR help my child walk who currently cannot?
Generally not directly. SDR works best for children who already have walking ability that is limited by spasticity. Children who do not walk because of severe weakness or non-spasticity factors usually do not gain walking after SDR. Realistic goal-setting with the surgical team is essential.
We help families across 38 states identify SDR centers and navigate referrals.
Related reading for parents
- Intrathecal baclofen pump for severe spasticity: a parent’s complete guide
- Botox injections for spasticity in children with CP
- Spasticity in cerebral palsy: causes, effects, and treatment
- Spasticity management in children with CP: from stretching to medication
- GMFCS levels explained: what your child’s classification means for the future
Our team helps families in 38 states understand the full clinical picture and what services should be in place. No cost. Answers first.
