27. Selective dorsal rhizotomy: Fixed or flexible criteria?

Spasticity in cerebral palsy results from decreased descending influence on segmental spinal synapses. Since most descending effects are inhibitory, the net result is loss of inhibition and hyperactive reflexes, leading to spasticity and abnormal gait. The aim of selective dorsal rhizotomy is to spare all motor rootlets and to section only the sensory rootlets showing the most evidence of lack of inhibition. Ideally, this results in a decrease in reflex hyperactivity while avoiding gross sensory or motor deficits, leading to improved functional status.

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