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 (two 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.

Is SDR suitable for my child?

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.

How much does SDR cost?

NHS England has withdrawn funding for SDR surgery whilst it examines its effectiveness via a process called Commissioning Through Evaluation. This has funded centres to undertake SDR with selected children to gather detailed information about clinical outcomes. A final report is due in Autumn 2018. This will lead to a decision on future NHS funding for the procedure.

If your child is attending a UK hospital, it will usually make an application for funding to the Primary Care Trust. Depending on the result of the Commissioning Through Evaluation process, NHS funding may be in full. If funding is granted in part or is declined, the procedure may still go ahead but parents will have to find the funds.

UK centres offering SDR

SDR - more information

Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy, MacKeith Press

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This page was last reviewed by Dr Christopher Verity in September 2017.
Scope does not endorse or recommend any treatments or therapies. Always consult a doctor or medical practitioner before starting or paying for any therapy.