{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T04:17:15Z","timestamp":1781842635451,"version":"3.54.5"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Selective dorsal rhizotomy (SDR) is a proven surgical treatment of spastic diplegia to improve function in patients suffering from spasticity compared to physical therapy alone. Few studies have addressed the benefit for those with spastic hemiplegia. The aim of this study was to describe and evaluate the efficacy of SDR in patients with spastic hemiplegia.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A retrospective chart review was performed on pediatric patients (< 18 years of age) who underwent SDR at Monroe Carell Jr. Children\u2019s Hospital from July 2013 through January 2024 with a diagnosis of spastic hemiplegic cerebral palsy. Patients underwent pre- and postoperative physical therapy testing at approximately 1 year. Any patients found to have spastic triplegia with asymmetrical hypertonia in the lower extremities, or those without postoperative evaluations, were excluded. Outcome measures included the modified Ashworth Scale (mAS), Gross Motor Function Measure-66 (GMFM-66), timed (10 m) walk test, Gross Motor Function Classification System (GMFCS), and the Pediatric Quality of Life Cerebral Palsy (PedsQL CP) module. Pre- versus postoperative comparisons were performed using a Wilcoxon signed-rank test and the differences were considered statistically significant when p values were < 0.05.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Twenty-one patients underwent SDR for spastic hemiplegic cerebral palsy with pre- and postoperative physical therapy assessments. The patients were 52.4% male, 81.0% White, with a median age of 5 years at the time of surgery. The most common etiology for spastic hemiplegia was stroke (52.4%). All patients had a preoperative GMFCS level of I (85.7%) or II (14.3%). The median percentage of rootlets cut during the procedure was 60% on the affected side. The sum of the mAS extremity score was improved by 5 points (p < 0.001), the GMFM-66 score was improved by a median of 3.1 (p = 0.002), while the PedsQL CP module improved by a median of 12.3 percentage points (p = 0.003). Orthotic use was reduced from 90.5% preoperatively to 66.7% at follow-up.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n SDR is an effective treatment in patients with spastic hemiplegia resulting in significant improvement in motor function, quality of life, and tone.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.7.peds25256","type":"journal-article","created":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T02:04:19Z","timestamp":1759543459000},"page":"714-718","source":"Crossref","is-referenced-by-count":1,"title":["Selective dorsal rhizotomy for spastic hemiplegic cerebral palsy"],"prefix":"10.3171","volume":"36","author":[{"given":"Amanda N.","family":"Stanton","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Florida Health Shands, Gainesville, Florida;"},{"name":"Surgical Outcomes Center for Kids, and Departments of"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mallory R.","family":"Dacus","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, and Departments of"},{"name":"Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macey","family":"Martin","sequence":"additional","affiliation":[{"name":"Physical Therapy,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi","family":"Chen","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, and Departments of"},{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice P.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Pediatrics, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth N.","family":"Martin","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation, Monroe Carell Jr. Children\u2019s Hospital at Vanderbilt University Medical Center, Nashville; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert P.","family":"Naftel","sequence":"additional","affiliation":[{"name":"Surgical Outcomes Center for Kids, and Departments of"},{"name":"Pediatric Neurosurgery,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Dev Med Child Neurol","first-page":"178","article-title":"A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy","volume":"39","author":"Steinbok P","year":"1997","unstructured":"Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J. A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol. 1997;39(3):178\u2013184."},{"issue":"4","key":"b2","series-title":"Dev Med Child Neurol","first-page":"220","article-title":"Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial","volume":"40","author":"McLaughlin JF","year":"1998","unstructured":"McLaughlin JF, Bjornson KF, Astley SJ, Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol. 1998;40(4):220\u2013232."},{"issue":"4","key":"b3","series-title":"Dev Med Child Neurol","first-page":"239","article-title":"Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial","volume":"40","author":"Wright FV","year":"1998","unstructured":"Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S. Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 1998;40(4):239\u2013247."},{"issue":"1","key":"b4","series-title":"Dev Med Child Neurol","first-page":"17","article-title":"Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials","volume":"44","author":"McLaughlin J","year":"2002","unstructured":"McLaughlin J, Bjornson K, Temkin N, Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol. 2002;44(1):17\u201325."},{"issue":"1 Suppl","key":"b5","series-title":"J Neurosurg","first-page":"8","article-title":"Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy","volume":"105","author":"Engsberg JR","year":"2006","unstructured":"Engsberg JR, Ross SA, Collins DR, Park TS. Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy. J Neurosurg. 2006;105(1 Suppl):8\u201315."},{"issue":"2","key":"b6","series-title":"Neurosurgery","first-page":"186","article-title":"Selective dorsal root rhizotomy for spastic cerebral palsy: a longitudinal case-control analysis of functional outcome","volume":"87","author":"Iorio-Morin C","year":"2020","unstructured":"Iorio-Morin C, Yap R, Dudley RWR, Selective dorsal root rhizotomy for spastic cerebral palsy: a longitudinal case-control analysis of functional outcome. Neurosurgery. 2020;87(2):186\u2013192."},{"issue":"4","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"353","article-title":"Selective dorsal rhizotomy in children with spastic hemiparesis","volume":"6","author":"Oki A","year":"2010","unstructured":"Oki A, Oberg W, Siebert B, Plante D, Walker ML, Gooch JL. Selective dorsal rhizotomy in children with spastic hemiparesis. J Neurosurg Pediatr. 2010;6(4):353\u2013358."},{"issue":"11","key":"b8","series-title":"Childs Nerv Syst","first-page":"2171","article-title":"Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy","volume":"35","author":"Zhan Q","year":"2019","unstructured":"Zhan Q, Tang L, Wang Y, Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy. Childs Nerv Syst. 2019;35(11):2171\u20132178."},{"issue":"8","key":"b9","series-title":"Cureus","first-page":"e9605","article-title":"Selective dorsal rhizotomy for the treatment of spastic hemiplegic cerebral palsy","volume":"12","author":"Park TS","year":"2020","unstructured":"Park TS, Joh S, Walter DM, Meyer NL, Dobbs MB. Selective dorsal rhizotomy for the treatment of spastic hemiplegic cerebral palsy. Cureus. 2020;12(8):e9605."},{"issue":"2","key":"b10","series-title":"Neurosurg Focus","first-page":"e7","article-title":"Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy","volume":"21","author":"Park TS","year":"2006","unstructured":"Park TS, Johnston JM. Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Neurosurg Focus. 2006;21(2):e7."},{"issue":"1","key":"b11","series-title":"Arch Phys Med Rehabil","first-page":"51","article-title":"Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy","volume":"87","author":"Wang HY","year":"2006","unstructured":"Wang HY, Yang YH. Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy. Arch Phys Med Rehabil. 2006;87(1):51\u201356."},{"issue":"6","key":"b12","series-title":"Cureus","first-page":"e15530","article-title":"Parent-reported outcomes of early childhood selective dorsal rhizotomy for the treatment of spastic diplegia","volume":"13","author":"Park TS","year":"2021","unstructured":"Park TS, Joh S, Walter DM, Meyer NL. Parent-reported outcomes of early childhood selective dorsal rhizotomy for the treatment of spastic diplegia. Cureus. 2021;13(6):e15530."},{"issue":"10","key":"b13","series-title":"Cureus","first-page":"e3466","article-title":"Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy","volume":"10","author":"Park TS","year":"2018","unstructured":"Park TS, Dobbs MB, Cho J. Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy. Cureus. 2018;10(10):e3466."},{"issue":"9","key":"b14","series-title":"Cureus","first-page":"e17690","article-title":"Selective dorsal rhizotomy for treatment of hereditary spastic paraplegia-associated spasticity in 37 patients","volume":"13","author":"Park TS","year":"2021","unstructured":"Park TS, Joh S, Walter DM, Meyer NL. Selective dorsal rhizotomy for treatment of hereditary spastic paraplegia-associated spasticity in 37 patients. Cureus. 2021;13(9):e17690."},{"issue":"3","key":"b15","series-title":"J Neurosurg Pediatr","first-page":"278","article-title":"Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach","volume":"34","author":"Gadgil N","year":"2024","unstructured":"Gadgil N, Schwabe AL, Wright E, Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach. J Neurosurg Pediatr. 2024;34(3):278\u2013285."},{"issue":"6","key":"b16","series-title":"Dev Med Child Neurol","first-page":"442","article-title":"The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the Generic Core Scales and Cerebral Palsy Module","volume":"48","author":"Varni JW","year":"2006","unstructured":"Varni JW, Burwinkle TM, Berrin SJ, The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the Generic Core Scales and Cerebral Palsy Module. Dev Med Child Neurol. 2006;48(6):442\u2013449."},{"issue":"6","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"588","article-title":"Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy","volume":"12","author":"Gigante P","year":"2013","unstructured":"Gigante P, McDowell MM, Bruce SS, Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. J Neurosurg Pediatr. 2013;12(6):588\u2013594."},{"issue":"3","key":"b1","series-title":"Dev Med Child Neurol","first-page":"178","article-title":"A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy","volume":"39","author":"Steinbok P","year":"1997","unstructured":"Steinbok P, Reiner AM, Beauchamp R, Armstrong RW, Cochrane DD, Kestle J. A randomized clinical trial to compare selective posterior rhizotomy plus physiotherapy with physiotherapy alone in children with spastic diplegic cerebral palsy. Dev Med Child Neurol. 1997;39(3):178\u2013184."},{"issue":"4","key":"b2","series-title":"Dev Med Child Neurol","first-page":"220","article-title":"Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial","volume":"40","author":"McLaughlin JF","year":"1998","unstructured":"McLaughlin JF, Bjornson KF, Astley SJ, Selective dorsal rhizotomy: efficacy and safety in an investigator-masked randomized clinical trial. Dev Med Child Neurol. 1998;40(4):220\u2013232."},{"issue":"4","key":"b3","series-title":"Dev Med Child Neurol","first-page":"239","article-title":"Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial","volume":"40","author":"Wright FV","year":"1998","unstructured":"Wright FV, Sheil EM, Drake JM, Wedge JH, Naumann S. Evaluation of selective dorsal rhizotomy for the reduction of spasticity in cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 1998;40(4):239\u2013247."},{"issue":"1","key":"b4","series-title":"Dev Med Child Neurol","first-page":"17","article-title":"Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials","volume":"44","author":"McLaughlin J","year":"2002","unstructured":"McLaughlin J, Bjornson K, Temkin N, Selective dorsal rhizotomy: meta-analysis of three randomized controlled trials. Dev Med Child Neurol. 2002;44(1):17\u201325."},{"issue":"1 Suppl","key":"b5","series-title":"J Neurosurg","first-page":"8","article-title":"Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy","volume":"105","author":"Engsberg JR","year":"2006","unstructured":"Engsberg JR, Ross SA, Collins DR, Park TS. Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy. J Neurosurg. 2006;105(1 Suppl):8\u201315."},{"issue":"2","key":"b6","series-title":"Neurosurgery","first-page":"186","article-title":"Selective dorsal root rhizotomy for spastic cerebral palsy: a longitudinal case-control analysis of functional outcome","volume":"87","author":"Iorio-Morin C","year":"2020","unstructured":"Iorio-Morin C, Yap R, Dudley RWR, Selective dorsal root rhizotomy for spastic cerebral palsy: a longitudinal case-control analysis of functional outcome. Neurosurgery. 2020;87(2):186\u2013192."},{"issue":"4","key":"b7","series-title":"J Neurosurg Pediatr","first-page":"353","article-title":"Selective dorsal rhizotomy in children with spastic hemiparesis","volume":"6","author":"Oki A","year":"2010","unstructured":"Oki A, Oberg W, Siebert B, Plante D, Walker ML, Gooch JL. Selective dorsal rhizotomy in children with spastic hemiparesis. J Neurosurg Pediatr. 2010;6(4):353\u2013358."},{"issue":"11","key":"b8","series-title":"Childs Nerv Syst","first-page":"2171","article-title":"Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy","volume":"35","author":"Zhan Q","year":"2019","unstructured":"Zhan Q, Tang L, Wang Y, Feasibility and effectiveness of a newly modified protocol-guided selective dorsal rhizotomy via single-level approach to treat spastic hemiplegia in pediatric cases with cerebral palsy. Childs Nerv Syst. 2019;35(11):2171\u20132178."},{"issue":"8","key":"b9","series-title":"Cureus","first-page":"e9605","article-title":"Selective dorsal rhizotomy for the treatment of spastic hemiplegic cerebral palsy","volume":"12","author":"Park TS","year":"2020","unstructured":"Park TS, Joh S, Walter DM, Meyer NL, Dobbs MB. Selective dorsal rhizotomy for the treatment of spastic hemiplegic cerebral palsy. Cureus. 2020;12(8):e9605."},{"issue":"2","key":"b10","series-title":"Neurosurg Focus","first-page":"e7","article-title":"Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy","volume":"21","author":"Park TS","year":"2006","unstructured":"Park TS, Johnston JM. Surgical techniques of selective dorsal rhizotomy for spastic cerebral palsy. Neurosurg Focus. 2006;21(2):e7."},{"issue":"1","key":"b11","series-title":"Arch Phys Med Rehabil","first-page":"51","article-title":"Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy","volume":"87","author":"Wang HY","year":"2006","unstructured":"Wang HY, Yang YH. Evaluating the responsiveness of 2 versions of the gross motor function measure for children with cerebral palsy. Arch Phys Med Rehabil. 2006;87(1):51\u201356."},{"issue":"6","key":"b12","series-title":"Cureus","first-page":"e15530","article-title":"Parent-reported outcomes of early childhood selective dorsal rhizotomy for the treatment of spastic diplegia","volume":"13","author":"Park TS","year":"2021","unstructured":"Park TS, Joh S, Walter DM, Meyer NL. Parent-reported outcomes of early childhood selective dorsal rhizotomy for the treatment of spastic diplegia. Cureus. 2021;13(6):e15530."},{"issue":"10","key":"b13","series-title":"Cureus","first-page":"e3466","article-title":"Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy","volume":"10","author":"Park TS","year":"2018","unstructured":"Park TS, Dobbs MB, Cho J. Evidence supporting selective dorsal rhizotomy for treatment of spastic cerebral palsy. Cureus. 2018;10(10):e3466."},{"issue":"9","key":"b14","series-title":"Cureus","first-page":"e17690","article-title":"Selective dorsal rhizotomy for treatment of hereditary spastic paraplegia-associated spasticity in 37 patients","volume":"13","author":"Park TS","year":"2021","unstructured":"Park TS, Joh S, Walter DM, Meyer NL. Selective dorsal rhizotomy for treatment of hereditary spastic paraplegia-associated spasticity in 37 patients. Cureus. 2021;13(9):e17690."},{"issue":"3","key":"b15","series-title":"J Neurosurg Pediatr","first-page":"278","article-title":"Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach","volume":"34","author":"Gadgil N","year":"2024","unstructured":"Gadgil N, Schwabe AL, Wright E, Focal selective dorsal rhizotomy and concurrent deformity correction: a combined approach. J Neurosurg Pediatr. 2024;34(3):278\u2013285."},{"issue":"6","key":"b16","series-title":"Dev Med Child Neurol","first-page":"442","article-title":"The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the Generic Core Scales and Cerebral Palsy Module","volume":"48","author":"Varni JW","year":"2006","unstructured":"Varni JW, Burwinkle TM, Berrin SJ, The PedsQL in pediatric cerebral palsy: reliability, validity, and sensitivity of the Generic Core Scales and Cerebral Palsy Module. Dev Med Child Neurol. 2006;48(6):442\u2013449."},{"issue":"6","key":"b17","series-title":"J Neurosurg Pediatr","first-page":"588","article-title":"Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy","volume":"12","author":"Gigante P","year":"2013","unstructured":"Gigante P, McDowell MM, Bruce SS, Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. 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