Will SDR be suitable for my child?

In the UK, NICE (the National Institute of Clinical Excellence) has issued guidance demonstrating that Selective Dorsal Rhizotomy (SDR) is most effective for children between four and 10 years of age. In America the surgery may be performed on younger children.

The decision as to whether SDR is suitable will be based on a formal physical examination by your child's multi-disciplinary team. The team will normally include specialist paediatric neurosurgeons, neurologists and physiotherapists. Further assessments may also be conducted by an orthopaedic surgeon. Only a small number of children with spastic diplegia will be suitable for SDR. An MRI scan of your child's brain may be required to exclude any injury to parts of the brain such as the basal ganglia, brainstem or cerebellum. Agreement by all involved in the child's care including parents is crucial.

In general, SDR surgery is most suitable for:

• children with diplegic cerebral palsy, although some children with hemiplegia (one side of the body affected) may benefit
• good control of the trunk and good muscle strength in the legs, usually indicated by the child being ambulatory (with or without devices)
• children on the Gross Motor Function Scale Level II, III or IV. GMFS is a formal assessment scale to indicate functional ability and independence. Level I reflects high level of mobility and independence whereas Level V represents no independent mobility and use of a wheelchair

If your child has had Botulinum Toxin injections, the neurosurgeon would normally wait three months before performing SDR to allow the effects of Botulinum Toxin to wear off. If your child has had orthopaedic surgery, SDR cannot normally be considered for one year as your child will need to regain strength.

After SDR, other procedures may still be necessary as your child continues to grow and develop. These may include bracing, further surgery on the hips, tendonotomies (shortening/lengthening the tendons) or surgery to correct limb rotation.