Table 1. General selection criteria for SDR at GOSH.

History

No age restriction; typically, 3–14 years

At least six months after the last botulinum toxin A injection

At least six months after orthopaedic surgery

Cognitive and emotional ability to cope with intensive rehabilitation process

Supportive home environment

Access to rehabilitation facilities

Examination

Spastic diplegia with no significant ataxia or dystonia

A degree of ambulation with or without assistive devices, typically GMFCS grade II or III

Good trunk control and good lower extremity antigravity strength on clinical examination

No significant scoliosis

Investigations

No injury to basal ganglia, brainstem or cerebellum on MRI

Riemer’s index <40% on X-ray

SDR, selective dorsal rhizotomy; GOSH, Great Ormond Street Hospital for Children; GMFCS, Gross Motor Function Classification System; MRI, magnetic resonance imaging.