Selective dorsal rhizotomy for spasticity in cerebral palsy

1 Guidance

1.1 Current evidence on selective dorsal rhizotomy for spasticity in cerebral palsy shows that there is a risk of serious but well-recognised complications. The evidence on efficacy is adequate. Therefore this procedure may be used provided that normal arrangements are in place for clinical governance and audit.

1.2 During the consent process parents or carers should be informed that selective dorsal rhizotomy for spasticity in cerebral palsy is irreversible, and that patients may experience deterioration in walking ability or bladder function, and later complications including spinal deformity. They should understand that prolonged physiotherapy and aftercare will be required and that additional surgery may be necessary.

1.3 Patient selection and treatment should be carried out by a multidisciplinary team with specialist training and expertise in the care of spasticity in patients with cerebral palsy, and with access to the full range of treatment options. This team would normally include a physiotherapist, a paediatrician and surgeons, all with specific training and expertise.

1.4 NICE encourages further research into this procedure. Long-term outcomes are encouraged. Outcome measures should include: the incidence of neurological impairment and spinal deformity; the need for additional operations; and assessments of disability, social inclusion, and quality of life.