Selective Dorsal Rhizotomy (SDR)
Selective Dorsal Rhizotomy is a procedure used to permanently eliminate spasticity. It has become the primary treatment for children with diplegic cerebral palsy.
An incision is made in the lumbar spine and laminectomy performed to expose the spinal cord and nerve roots. Electomyographic stimulation is used to distinguish between the sensory and motor nerve roots, and the sensory nerve roots, containing spasticity, are identified and severed. The motor nerve roots remain untouched and intact and as such the underlying muscle strength is preserved.
Children likely to benefit from SDR:
Children with spastic diplegia are most likely to benefit from SDR, although it has been shown to benefit children with spastic quadriplegia and spastic hemiplegia. Children with fluctuating tone or hypotonia would generally not benefit from this surgery.
MRI should show no significant damage to the basal ganglia.
Children from age 2 years old upwards may be considered for surgery. There are pros and cons for each age range. While a child aged two years is unlikely to display secondary complications such as contractures and deformities, they may be too young to be able to fully participate in the post operative rehabilitation programme. An older child is more likely to be motivated to participate in their programme, however is more likely to display contractures or have undergone orthopaedic surgery.
Children are required to display a certain level of muscle strength and independent functional movement, crawling or walking. This may be with or without a mobility aid.
A spinal scoliosis is likely to be made worse and should therefore not be present preoperatively. Similarly it is preferrable for orthopaedic surgery not to have been carried out preoperatively. If orthopaedic surgery has occurred, a period of at least six months should have lapsed in order to enable sufficient muscle strengthening post operatively.
Due to the intensity and prolonged period of post operative physiotherapy required in order to gain improvements in function, children must be motivated and able to participate in the rehabilitation programme.
Prolonged, intensive physiotherapy is required post operatively and this should be given careful consideration when deciding whether SDR would be of benefit to your child. Initial post operative treatment begins in hospital and varies in duration depending on the hospital.
Following discharge from hospital, your child will be required to continue with daily physiotherapy for a period of up to one year. Treatment continues after this, but the intensity is usually reduced.
Children with spasticity typically use their spasticity in order to gain stability and improve function. The underlying muscles are often extremely weak. A tailor made programme will be implemented in order to gain maximum benefit from surgery. This will include specific muscle strengthening exercises for the lower limbs, and often trunk muscles, and functional exercises and activities.
Children can attend the practice pre operatively for an intensive block of treatment focusing on muscle strengthening and function in order to minimise the difference between pre operative and post operative levels in strength. Specialised advanced handling techniques will be used to minimise any altered tone enabling specific strengthening exercises to take place.
Post operatively the practice will support your child in meeting the required intensity of rehabilitation. This can be carried out exclusively through the practice or in combination with NHS input.