Selective Dorsal Rhizotomy
This information is for you if you are a parent of a disabled child and are considering this treatment for your child, or you are a health or other professional working with children and parents in this situation. The information is based on UK practice and research.
Selective Dorsal Rhizotomy: introduction and history
Selective Dorsal Rhizotomy (SDR) was first developed in 1898 but has become more popular over the last 30 years as techniques have advanced. It is a neurosurgical procedure aimed at reducing spasticity (tight and stiff muscle tone) in the lower limbs. It is most commonly used for children with spastic diplegia (two limbs affected) which accounts for 25-30% of children born with cerebral palsy.
The surgery requires the bones of the spine (vertebrae) in the lower back area to be opened to reveal the conus (the end of the spinal cord) and gain access to the nerve roots. The traditional approach was to access these roots via a lengthy multi-level operation gaining access to the nerves by opening several vertebrae. However, some evidence suggests the multi-level approach may lead to other spinal problems such as scoliosis (curvature of the spine). Read more about SDR surgery.
Aims of SDR surgery
The surgery aims to:
- achieve a long-term reduction in spasticity
- improve function and mobility
- increase independence
- increase range of motion and improve positioning
In the UK, NICE (the National Institute of Clinical Excellence) has issued guidance demonstrating that SDR is most effective for children between four and 10 years of age. In America the surgery may be performed on younger children. Read more about suitability of SDR.
Who is not suitable for SDR?
In general, SDR in the UK is not possible when the following are present:
- hip dislocation and fixed muscle-tendon contractures (permanent tightness and shortening of muscle/joint)
- mixed type cerebral palsy with dystonia, athetosis or ataxia
- scoliosis (curvature of spine)
- acquired brain or spinal injury such as meningitis, congenital brain infection, head trauma or hydrocephalus (excess fluid on the brain)
- progressive neuro-degenerative conditions
Risks and side-effects of SDR
Like any medical procedure, SDR can carry risks and will not suit all children with cerebral palsy. Some will benefit and some may see no benefit or even experience deterioration in their condition. You should always discuss potential risks and side-effects with your child's neurosurgeon.
Whilst permanent complications are rare, risks include:
- temporary altered sensation although permanent numbness is rare
- constipation and urinary retention
- back pain
- weakness in the legs
- discouragement in the patient due to the length of on-going therapy
- SDR can highlight weaknesses elsewhere, for example, where muscles working alongside the spastic muscles have adapted to compensate for the increase in muscle tone
What else should I consider about SDR?
We would fully recommend discussing your interest in this surgery with your child's medical advisors. You may want to ask the following questions what does the procedure involve in detail?
- What are the benefits to my child and family as a whole?
- What is the likelihood of achieving those benefits?
- Could this procedure make things worse?
- What are the risks?
- Are there any alternatives?
- What care will my child need after the operation?
- What happens if something goes wrong? (This could be very important if you are having the surgery overseas)
- What may happen if my child does not have the procedure?
Since 1988, SDR has been available through the orthopaedic team at the Robert Jones and Agnes Hunt Hospital in Oswestry. The technique practised here is via a multi-level approach.
Since 2011, a number of British paediatric neurosurgery centres have started offering SDR surgery through the single-level approach. Some cases have been NHS-funded, others self-funded through the NHS hospital treatment top-up scheme. Read more about SDR availability.
"SDR is not a miracle cure by any means but is a huge step on the road towards some form of independence." Parent
For more information on Scope
This information complies with the requirements of the Department of Health Information Standard. For details about how we compiled this information, authors and peer reviewers or the research we have used to evidence statements, please contact our Helpline.
We acknowledge the help and support of everyone who has been involved in the production of this information. Although we have taken care to ensure the accuracy of this information, Scope cannot accept responsibility for errors or omissions. We always recommend getting independent advice from a professional before embarking on any process, therapy or medical intervention.
This information was produced July 2012, v.1.2.
Review due July 2014.