Selective Dorsal Rhizotomy or SDR

Information for parents considering SDR treatment for your child

SDR is not a miracle cure by any means but is a huge step on the road towards some form of independence.
Parent

What is Selective Dorsal Rhizotomy (SDR)?

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 25-30% of children born with cerebral palsy.

What does SDR surgery involve?

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

Will SDR be suitable for my child?

In the UK, NICE (the National Institute of Clinical Excellence) 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. 

Read more on whether SDR will be suitable for your child

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 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?

Where and how is SDR available?

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.

Further information on 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