skin is typically now closed with glue, but there are sometimes stitches to be removed from the back after 3 weeks. the surgery takes approximately 4 hours and typically involves one neurosurgeon, one anesthesiologist, and possibly an assortment of assisting physicians (as in the new york city september 2008 case). the patient then goes to the recovery room for 1–2 hours before being transferred to the intensive care unit overnight. transfer from the icu to a recovery room in the hospital is then done to enable direct post-surgical observation by the neurosurgeon and surgical team, but this usually lasts only about 3 days, during which the team performs range-of-motion tests that they record and compare to pre-surgery levels. after that short period, the patient, depending on circumstances and appropriateness, is either transferred to inpatient recovery or is linked to an intense outpatient exercise program and discharged from the hospital. according to clinicians, it usually takes about one year from the date of surgery to achieve maximum results from sdr. however, videos from st. louis children's hospital website have shown continued marked improvement as much as five years post-surgery, and presumably, if the person keeps exercising intensely, potential for continued improvement and strengthening is, just as in a person born with normal muscle tone and range of motion, unlimited. selective dorsal rhizotomy can alleviate contractures caused by spasticity from before the surgery takes place; also it prevents any more contractures or spasticity from occurring in the future. with or without rhizotomy, the only way contractures can ever be relieved is via orthopaedic surgery. fixed orthopaedic deformities of the legs caused by the previous years of intense spasticity are also not relieved by the sdr and must also be corrected surgically. complications there is always abnormal sensitivity and tingling of the skin on the feet and legs after sdr because of the nature of the nerves that have been worked on, but this usually resolves within six weeks. there is no way to prevent the abnormal sensitivity in the feet. transient change in bladder control may occur, but this also resolves within a few weeks. if a certain degree of permanent numbness remains in certain leg muscles, such as the quadriceps, ankles, and feet, this is usually not enough to prevent feeling and sensation, sensing of changes in temperature or pressure, etc. the affected muscle areas simply feel less than before, and the trade-off in ease of movement is said to be immensely worth this change, should it occur. there is a risk of any of the following more serious risks happening as a result of sdr. permanent paralysis of the legs and bladder. sensory loss and/or numbness. wound infection and meningitis - usually controlled with antibiotics leakage of the spinal fluid through the wound, also repairable; the surgical team watches very closely post-surgery for this post-surgical rehabilitation outcomes following a sdr can vary based on the number of nerves cut during surgery, joint deformities, muscle contractures, and level of impairment before the procedure. following the procedure, the child will likely experience muscle weakness, which can be corrected with physical therapy (pt). pt is imperative to restore functional status in the shortest amount of time. physical therapy post sdr aims to promote independent walking, improved gait pattern, transfers, balance, and upper limb motor control. it is important to remember sdr does not cause permanent muscle weakness, rather it is temporary a few weeks following the procedure. a strengthening program is beneficial to combat this expected weakness and improve lower extremity range of motion and facilitate a near normal gait pattern. this leeds children's hospital website was used as a sample post-rehabilitation protocol. week 1 post surgery, the child will typically have 30 minute physical therapy sessions for the first four days followed by an increase up to 45 minutes during days 5–7. during the second week, sessions range from 45 to 60 minutes with a focus on stretching, strengthening, developmental milestones (if appropriate), and a standing program. if necessary, an orthotic assessment can be performed during the second week. weeks 3 through 6 focus on the previously mentioned items but adding gait training, assessment for the need of assistive devices, and preparing a home program for the patient. six weeks to three months following the procedure the patient will attend outpatient physical therapy 3 to 5 times a week for 45–60 minutes and focusing primarily on stretching, strengthening, ambulation, and assessing for the need for adaptive equipment such as a tricycle. three to six months focus on all previous therapies with emphasis on developing proper gait mechanics. at this point, frequency of the sessions will typically decrease to 2-3 times per week. six to twelve months post surgery focuses on all of the above with increased emphasis on movement patterns the child may be having difficulty with. one year post procedure, frequency of sessions is 1 to 2 times per week to continue working on strengthening and refining motor control and orthotic needs continued to be monitored.