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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 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 recommend discussing your interest in this surgery with your child's medical advisors. You may want to ask the following questions:
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.
Until recently NHS England had withdrawn funding for SDR surgery whilst it examined its effectiveness.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:
Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy, MacKeith Press
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.
Discuss SDR in our online community
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