What is Selective Dorsal Rhizotomy (SDR)?

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.

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, 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.

Is SDR suitable for my child?

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.

Permanent complications are rare, but 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 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?

Getting SDR in the UK

Since 1988, Selective Dorsal Rhizotomy (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.

How much does it cost?

Until recently NHS England had withdrawn funding for SDR surgery whilst it examined its effectiveness. There will be a trial of 120 children who meet specific criteria for the surgery. Results will be monitored and assessed. The trial will lead to a decision on future NHS funding for the procedure. It's thought that specialist centres will be designated under the Commissioning Through Evaluation scheme. This scheme will fund centres to undertake SDR with selected children to gather detailed information about clinical outcomes. 

If your child is attending a UK hospital, the hospital will usually make an application for funding to the Primary Care Trust. NHS funding may be granted in full, in part, or declined. If funding is granted in part, or declined, the procedure may still go ahead but parents will be asked to find the funds.

However, the costs will still be less than SDR in the USA and follow-up physiotherapy and monitoring of your child is easier.

The centres in the UK offering SDR via a minimal access single-level approach in the UK are:

SDR - more information

Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy, MacKeith Press

NICE Guidelines on Treatment of Spasticity in Cerebral Palsy by Selective Dorsal Rhizotomy. 

What's the Evidence? Selective Dorsal Rhizotomy published by Cerebra.
A number of research papers and clinical trials which have been published around SDR.

Support 4 SDR
A group aiming to improve clinical care around SDR and support parents. The organisation is run by parents whose children have undergone SDR.

Scope does not endorse or recommend any treatments or therapies.

Always consult a doctor or medical practitioner before starting or paying for any therapy.

For more information, please call 0808 800 33 33 or email helpline@scope.org.uk.