Selective Dorsal Rhizotomy (SDR)
What is Selective Dorsal Rhizotomy (SDR)?
SDR is a surgical procedure aimed at reducing spasticity (tight and stiff muscle tone) in the lower limbs by dividing some of the lumbar sensory nerve roots, thus interfering with the reflex arcs that cause increased muscle tone. It's mostly used for children with spastic diplegia (2 limbs affected). Spastic diplegia 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
The National Institute of Clinical Excellence (NICE) has noted that most of the evidence for SDR relates to children aged 4 to 10 years. Some centres perform the surgery on children outside this age range.
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)
- genetic or progressive neuro-degenerative conditions
Risks and side-effects of SDR
Like any medical procedure, SDR can carry risks. It will not suit all children with Cerebral Palsy. Some will benefit and some may see no benefit or their condition may even deteriorate. You should always discuss potential risks and side-effects with your child's surgeon.
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.
Questions about SDR
You may want to ask your child's medical advisors 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, some 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.
Costs of SDR
NHS England has decided to fund SDR surgery for children whose CP mainly affects their legs. To be considered for SDR, your child will need to be:
- aged 3 to 9 years
- identified as potentially suitable by a paediatrician or paediatric neurologist
- referred to an NHS-commissioned SDR centre
If your child meets the criteria, the centre will invite you to outpatient assessments. These could include X-rays, physiotherapy and MRI scans. The purpose of these tests is to make sure that the surgery is right for your child.
Read Clinical Commissioning Policy: Selective Dorsal Rhizotomy (SDR) for the treatment of spasticity in Cerebral Palsy (children aged 3-9 years), which outlines the arrangements for funding of treatment for spasticity in Cerebral Palsy in children aged 3-9 years.