What is SDR?
Selective Dorsal Rhizotomy (SDR) is a surgical procedure that aims to reduce spasticity in the lower limbs.
Spasticity is the result of an abnormal communication between the brain and the nerves. SDR is effective in treating spasticity, by cutting the nerve rootlets in the spinal canal that are sending abnormal signals to the muscles.
The most common cause of spasticity in childhood is the condition cerebral palsy. SDR is not a cure for cerebral palsy, but intends to improve quality of life and/or mobility in children affected by it.
SDR potential benefits
- Reduce spasticity
- Reduce painful spasms
- Improve ease of cares
- Improve functional mobility (transfers/ walking)
- Improve self-care activities, such as getting dressed
- Improve sleep pattern
- Improve energy levels and physical endurance
The procedure is irreversible, so the changes cannot be undone. This is why the selection of suitable patients is essential.
Children who have cerebral palsy are classified according to their motor ability as described in the Gross Motor Function Classification System. Fin out more at www.CanChild.ac/grossmotorclassificationsystem
There are 2 categories of children with spasticity who could benefit from SDR:
– GMFCS I-II-III, meaning the children can walk pre-operatively and are expected to continue walking after surgery
– GMFCS IV-V, meaning the children mainly use a wheelchair for mobility. The procedure could improve their comfort and make cares easier.
NHS England has collected data during a process called “Commissioning through Evaluation” and has set inclusion criteria for funding SDR.
The criteria are:
– Aged between 3 and 9 years
– GMFCS II-III
The spasticity service in Alder Hey has been commissioned by NHS England to provide SDR.
Alder Hey will continue to provide SDR for children outside the commissioned criteria who would benefit from this surgery. This would be provided on a self-funded basis.
SDR is a complex surgical procedure followed by an intensive rehabilitation period. Alder Hey provides a multi-disciplinary approach involving a neurosurgeon, neurologist, orthopaedic surgeon, physiotherapists, gait lab and specialist nurses. This means we are able to offer the best possible care for your child.
When your child is referred to Alder Hey for spasticity management, SDR may be identified as a potential intervention for your child.
An appointment will be given for a detailed Physiotherapy assessment followed by a joint consultation with Ms Pettorini, Consultant Neurosurgeon and the Clinical Specialist Physiotherapist, to determine if this is the most appropriate intervention for your child.
Other investigations may be required to further inform this decision (e.g. MRI, gait analysis, Baclofen test dose, botulinum toxin). At this appointment you will receive all the information you need to help you decide if you want to proceed with SDR surgery, if this is considered the most appropriate intervention
There will be a discussion at this time to ensure that the aims of the surgery are realistic. For some children the surgery may help to improve walking, or just make walking easier. For other children it will be for comfort or ease of care.
Communication with your child’s local team is an essential part of the process. This will include physiotherapists, consultant paediatricians and orthopaedic consultants.
If your child is not known to the team at Alder Hey, You can request that your consultant / physiotherapist refers you into the Spasticity service if you would like your child to be considered for SDR.
Contact to be sent to:
Children who are having SDR surgery will have a physiotherapy assessment here at Alder Hey 6 weeks before the date of surgery. This will allow the physiotherapist to identify any areas that the child needs to focus on (e.g. strengthening, movement patterns)to ensure their ability and fitness is optimised before surgery. This will improve the child’s ability to participate in the post- operative rehabilitation. An individualised written exercise/ activity programme (a Pre-hab Programme) will be provided. A weekly session will also be offered by the physiotherapist here at the hospital before surgery if required to support the child’s local physiotherapy team.
The SDR surgery is now commissioned by NHS England for Gross Motor Function Classification System (GMFCS) Grades II and III aged 3 to 9 years old; SDR surgery is still available for Grade IV and V at a cost of £16,000, however there is still a selection criteria to follow to see whether surgery is suitable for your child.
We provide selective dorsal rhizotomy in GMFCS level V patients in selected cases. The nature of these patients does not warrant three weeks of post-operative physiotherapy, so they are not included in the general SDR waiting list and the quote also reflects the different service provided.