Selective dorsal rhizotomy (SDR) is an operation used to improve / remove spasticity (muscle stiffness) in children with cerebral palsy.
Cerebral palsy occurs when a child sustains a brain injury early in life. It most commonly occurs at birth. Although the brain injury remains static throughout the child’s life, the difficulties associated with the condition can cause changes as the child is growing. In a child with cerebral palsy the damage to the brain tends to be in the area that controls muscle tone and movement of the arms and legs. There are several different types of cerebral palsy. SDR is a procedure which is increasingly being used to treat children with spastic cerebral palsy.
Spasticity refers to increased tone in a muscle. Normally, muscles have enough tone to maintain posture or movement against the force of gravity, while at the same time providing flexibility and speed of movement in order for us to move. In children with cerebral palsy the way in which the sensory nerve fibres work is abnormal, resulting in spasticity.
The basis of selective dorsal rhizotomy (SDR) involves dividing and cutting some of the sensory fibres in the spine to reduce spasticity, by decreasing the sensory stimulation whilst preserving voluntary movement.
What does it involve?
Selective Dorsal Rhizotomy (SDR) is a surgical procedure that involves making an incision in the lower back, to allow access to the end of the spinal cord and sensory nerve roots. It is performed under a general anaesthetic and the nerve roots that contribute to spasticity are divided. The reduction in spasticity is permanent.
Did you know?
SDR is most commonly used for children with diplegia (spasticity of 2 limbs).
Diplegia accounts for 25-30% of children born with cerebral palsy.
The technique was first developed in early 1900’s but is now much more advanced.
I’ve heard it isn’t available in the UK?
The surgery is not routinely commissioned by the NHS but is currently under review.
At present SDR is available in the UK. However, it is only commissioned in 5 hospitals:
– Alder Hey Children’s NHS Foundation Trust
– Great Ormond Street Hospitals NHS Foundation Trust
– Leeds Teaching Hospitals NHS Trust
– Nottingham University Hospitals NHS Trust
– University Hospitals Bristol NHS Foundation Trust
Each hospital where SDR is available, gather data and results from each SDR case within the UK. With these results hopefully SDR will continue to be commissioned in trusts within the UK. At present it is not a definite that SDR will continue to be commissioned.
SDR: United States of America
You may have heard of SDR surgery being carried out in America. A well-known neurosurgeon involved with the SDR procedure is Dr.Parks, who is based at St.Louis Children’s Hospital.
Is my child suitable?
A strict criteria is required for suitable candidates due to the intense nature of physiotherapy required post SDR. The UK criteria is much stricter than in America.
Children between 3 and 12 years of age with typical spastic diplegia.
Gross Motor Function Classification System (GMFCS) level II or III.
Children who demonstrate adequate muscle strength in the legs and trunk.
It is recommended that there needs to be at least three months from the last botulinum toxin injection and at least six months from orthopaedic surgery before considering SDR.
It is important to remember that not all children with Cerebral Palsy are suitable for SDR surgery. SDR is a definitive procedure and cannot be reversed.
How can The Physio Hub Help?
The SDR guidelines state intense Physiotherapy is required post SDR. Private funding is normally explored for children who undergo SDR. After discharge the aim of a physiotherapy programme is to continue to develop strength in the child’s lower limbs, trunk and pelvis increase range of movement in the legs and to develop and improve walking. The ongoing local physiotherapy, needs to be discussed and agreed preoperatively. Regular postoperative physiotherapy is essential to obtain the best results after SDR.
Here at The Physio Hub we are specialised paediatric physiotherapists who will help your child every step of the way through the SDR process. The Physio Hub offers physiotherapy to children in the Hartlepool, Stockton and Middlesbrough area. We also cover a broader area within the North East region. We currently have clients who have undergone the SDR who are at present going through the rehabilitation process with us.
The team use up to date evidence based practice and research to ensure the best possible treatment and interventions.
We also work closely with local NHS services following your child’s SDR to ensure joint goal setting.
We can also provide Pre-op physiotherapy for your child. It is recommended that before SDR takes place, a programme of physiotherapy is advised to ensure optimum muscle strength.
Imogen is one of our little superstars here at The Physio Hub. Imogen is now 1 year post-SDR surgery. Pre-surgery Imogen was mobile with her K-Walker and was unable to stand independently. A year of hard work and determination and she is now mobile with x 2 walking sticks. She is also practising her walking, unaided and is continuing to improve everyday.
Well Done Imogen! Keep up your super hard work!
If you require any further information then please don’t hesitate to get in touch.