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.

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.

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?

Where is SDR surgery performed?

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.