What is Selective Dorsal Rhizotomy (SDR)?
Selective Dorsal Rhizotomy (SDR) is a neurosurgical treatment option for the management of spasticity. Spasticity is a clinical feature that is found in over 75% of cases of children with Cerebral Palsy and is often thought to be the major contributing cause of walking impairment, reduced function and discomfort (Burslem, Reid 2011).
Selective Dorsal Rhizotomy (SDR) is a non-reversible surgical procedure that involves dividing the posterior nerve rootlets from the spinal cord segments in the lumbar spine. An incision is made in the lower back and part of the vertebrae is removed to expose and test the small nerve rootlets which consist of sensory nerves. Normally 3-5 nerve rootlets are identified and tested and those with an abnormal response are selectively cut. The motor nerve rootlets remain untouched and leg movements are preserved (NICE guidelines, 2006). The result is a reduction in the spasticity whilst preserving sensation and movement.
Selective Dorsal Rhizotomy is only practiced in a few centres in the UK including Oswestry and Bristol. Dr Park and his team at St. Louis Children’s Hospital, USA are the leading centre and this is also where the majority of research has been conducted. More information can be found at www.stlouischildrens.org
Not everyone is suitable for the SDR procedure and to be considered as a suitable candidate the child needs to meet strict criteria, which are determined by each individual centre. Along with spasticity, muscle weakness is also a major clinical feature in children with Cerebral Palsy and therefore following the SDR procedure the child will require intensive physiotherapy over the next 9 months at least, to address muscle weakness and abnormal movement patterns. The recommendations are that this should include at least 3 sessions a week for 3 months, followed by two sessions a week for 6 months. Rehabilitation will include range of movement, strengthening, balance and functional exercises and does require a strong commitment from both the child and the family.
At Gateway Physiotherapy we have experience in treating children following this procedure and really appreciate the level of input and commitment that is required. Your therapist will work with you and your child to identify individual treatment goals and provide you with a comprehensive therapy programme.