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SDR is not a miracle cure by any means but is a huge step on the road towards some form of independence.
Selective Dorsal Rhizotomy (SDR) was first developed in 1898, but has become more popular over the last 30 years as techniques have advanced. It's a neurosurgical procedure aimed at reducing spasticity (tight and stiff muscle tone) in the lower limbs. It's most commonly used for children with spastic diplegia (two limbs affected) which accounts for 25 to 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 get to these roots through 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).
The surgery aims to:
In the UK, the National Institute of Clinical Excellence (NICE) has issued guidance demonstrating that SDR is most effective for children between 4 and 10 years of age. In America the surgery may be performed on younger children.
In general, SDR in the UK is not possible when the following are present:
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.
Permanent complications are rare, but risks include:
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?
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.
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