Selective Dorsal Rhizotomy

Selective dorsal rhizotomy (SDR) is a surgical procedure which involves the cutting of parts of the nerves connected to the spine in the lower back. An incision or cut is made in the skin in the lower back and then the nerves leaving the spine are identified under the protective layers.

There are two types of nerves which leave the spine, one which sends messages to the muscles and cause muscles to contract and move and the other which sends information from the muscle to the spinal cord. The nerves sending information to the spinal cord are sensory nerves and, during the operation, they are tested to see how much electrical activity they contain. Those nerves which lead to excess muscle tone, or spasticity, are cut.

The protective layers and skin are then closed with stitches or skin glue. The procedure may take around 4 hours.

For some children with cerebral palsy, spasticity (or increased muscle tone) causes significant problems with the movement of their legs. SDR can help reduce spasticity and also can increase the range of movements of the legs.  This, in turn, can help with walking and posture. SDR can also reduce the chance of those with spastic cerebral palsy from developing deformities in their legs and the discomfort and difficulties related to these deformities. Where a child with cerebral palsy needs orthopedic surgery, performing SDR before this can improve the success of the surgery and prevent muscles from tightening afterwards.

With any operation there are risks of infection and risks that the procedure is not successful. With SDR specifically, there is also a risk that the nerves affecting the control of the bladder and the sensation in the feet and legs may be affected. Very rarely, a child may develop paralysis of the legs or meningitis following surgery.

More commonly, children may find that their legs feel weak in the weeks after surgery but this improves with time and they find that they have more strength than prior to the surgery. Many can start forms of exercise that were impossible before SDR.

SDR is usually covered by government health insurance plans, including MSP. However, a child will need to be assessed for suitability, and their suitability may depend upon the degree of spasticity in their legs and how their cerebral palsy otherwise impacts upon their health and movement.