SDR is a surgical procedure. If your child has SDR, they will have a general anaesthetic so they are asleep during the operation.

Muscle spasticity can be caused by abnormal signals in the nerves between the spine and the muscles. In SDR surgery, a neurosurgeon cuts a small hole in one of the bones in the spine (vertebrae). They do tests to to find the nerves with the abnormal signals. The neurosurgeon cuts the abnormal nerves to make the signals stop.

After the surgery, your child will have physiotherapy. People who have SDR may have physiotherapy for months or years after the operation. Physiotherapy helps to improve muscle strength and mobility.

In the UK, the NHS may fund SDR for children with CP who:

• are aged 3 to 9
• have a diagnosis of diplegic spasticity cerebral palsy. This means they have have spasticity in both legs
• have been assessed as Cerebral Palsy Gross Motor Classification System (GMFCS) level II (walks with limitations) or level III (walks with canes or crutches)

GMCFS classification system (Cerebral Palsy Alliance Research Foundation)

Types of cerebral palsy

Some hospitals offer private SDR for children who are GMCFS level IV and V. You have to pay or fundraise for private SDR.

SDR is not usually possible for people who have:

• hip dislocation and fixed muscle tendon contractures (permanent tightness and shortening of muscle or joint)
• mixed type CP with dystonia, athetosis or ataxia
• scoliosis (curvature of spine)
• a brain or spinal injury, such as meningitis, congenital brain infection, head trauma or hydrocephalus (excess fluid on the brain)
• genetic or progressive neuro-degenerative conditions

The NHS has information about why these criteria were chosen. Selective dorsal rhizotomy for treatment of muscle spasticity in cerebral palsy (NHS)

SDR surgery and physiotherapy can:

• reduce spasticity
• reduce pain from muscle contractions caused by spasticity
• improve mobility in the legs
• increase range of motion in the legs
• improve walking 

For some children, this can help them feel more confident and have more independence.

SDR might not improve muscle spasticity for everyone.

In the short-term after SDR, muscles can feel weaker. This is because the spasticity is reduced. Physiotherapy helps to improve muscle strength.

There are some risks to having SDR surgery. These include:

• increased sensitivity to touch but this usually improves with time
• increased weakness which can cause difficulty with movement

Very rarely, the nerves to the bowel and bladder might be damaged. This could cause incontinence but it is very rare.

Ask your medical team about risks and side effects.

If your child meets the criteria, you will get an appointment for an outpatient assessment. Your child will have some tests to make sure that SDR is right for them. These could include X-rays, MRI scans and physiotherapy assessments. 

You can ask the medical team about any questions or concerns you have. It can help to ask about possible benefits, risks and alternatives.

Ask about possible benefits, for example:

• How will SDR help my child?
• How likely is it that SDR will help my child?

You can ask about possible risks, for example:

• Could it make things worse?
• What are the risks?
• What care will my child need after the operation?
• What happens if something goes wrong? 
• How will it impact my family?

You can ask about what could happen if your child does not have SDR, for example:

• Are there any alternatives, such as medicine and physiotherapy?
• What may happen if my child does not have SDR?
• What may happen if we delay SDR for a year or more?

Discuss SDR in our online community.

There are 6 hospitals that offer SDR in England:

• Alder Hey Children's NHS Foundation Trust, Liverpool
• Bristol Royal Hospital for Children
• Great Ormond Street Hospital for Children, London
• Leeds General Infirmary
• Nottingham University Hospitals
• The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Shropshire

In Scotland, you can get SDR at the Royal Hospital for Children, Glasgow.

SDR Strength

Thank you to SDR Strength for their help with keeping this content accurate.