Selective Dorsal Rhizotomy is a surgical procedure that is performed on selected patients with spastic cerebral palsy. Typically, a Neurosurgeon will perform the SDR surgery which aims to permanently reduce spasticity in Cerebral Palsy Patients.
The Procedure
The surgical procedure has been developed over many years and was initially performed by removing the lamina (laminectomy) from 5 – 7 vertebrae. However due to concerns about the consequences of removing such a large amount of bone from the spine an American Surgeon developed a less invasive surgical technique. In 1991 Dr T.S. Park a neurosurgeon from St Louis, USA adopted his surgical method which requires the removal of the lamina from a single lumbar vertebra. This technique has many advantages including decreased post SDR motor weakness, less intense back pain in the short term, reduced risk of spinal deformities in later life, reduced hip flexor spasticity by sectioning the first lumbar dorsal root and earlier resumption of vigorous physical therapy. Today the single level SDR technique is the preferred procedure and has been adopted by many surgical teams across the world including here in the UK.
Key Information:
- Surgical teams have different opinions on the best age to perform SDR (from 2 years old up to 12 years old).
- The surgery is performed under general anaesthetic and takes around 4 to 5 hours.
- Sensory nerve rootlets are divided and tested with EMG (electromyographic responses; which records electrical patterns from muscles in the lower extremities). The severely abnormal rootlets that cause spasticity are identified between spinal nerve L1 and S1/S2 and selectively cut. By balancing the nerve cell activities in the spinal cord spasticity is reduced or eliminated.
- When spasticity is reduced or eliminated the underlying motor weakness becomes more noticeable creating the opportunity to strengthen the muscles through therapy and exercise.
- Post Operative Therapy is key if you hope to improve motor function and you can expect to do hours of therapy each week for several years.
Complications after SDR are rare but there are risks with any surgery that you should be aware of. Complications can include infection, development of a fluid collection below the skin, leak of cerebrospinal fluid from the wound, severe leg weakness and incontinence.
The benefits of Selective Dorsal Rhizotomy include:
- Improved motor function in sitting, standing, walking and balance control.
- SDR has been very successful in removing or reducing spasticity in patients with spastic diplegia cerebral palsy and recurrences are rare.
- In patients with spastic quadriplegia, SDR has varied results and spasticity can return although it is generally less severe than before the operation. In spastic quadriplegic patients who are mobile with an assistive device prior to surgery the risk of recurrence of spasticity is less than a non-ambulatory patient.
- May reduce the need for corrective orthopaedic surgeries and interventions in the future.
Who can Benefit from SDR?
The best option for families considering SDR and it’s suitability for their child is to discuss it with your child’s doctor, consultant or physiotherapists. There are 5 regional centres across the UK that provide SDR and although NHS England has set out a criteria for patients who are eligible for SDR funded by the NHS. The criteria is aged between 3 – 9 years, and GMFCS II – III (Gross Motor Function Classification System) and live in England. It is still possible to have SDR in the UK if you don’t live in England or meet the NHS criteria but families would have to self-fund the surgery which costs between £15,000 and £36,000 depending on which hospital you choose. Many families fundraise the amount needed to cover the surgery cost plus the hours of therapy required post operatively.
The Hospitals that perform SDR in the UK are:
• Bristol Royal Hospital for Children
• Alder Hey Children’s NHS Foundation Trust
• Great Ormond Street Hospital for Children
• Leeds Teaching Hospital
• Nottingham University NHS Trust
• The Portland Hospital (Privately funded)
There is also St Louis Children’s Hospital, USA that accepts international patients and the benefit of seeking assessment by Dr T.S. Parks is that he has a different criteria for assessing patients and although he recommends SDR for children age 2 – 4 years he also treats older children, Adults and children with spastic hemiplegia, diplegia and quadriplegia that UK surgeons may not accept. It is therefore advisable to take some time to look at all your options and if necessary, seek advice and assessment from more than one team so that you can make an informed decision.
Selective Dorsal Rhizotomy is a surgery that can only be done once therefor you must be confident in your choice.
Links:
Bristol Royal Hospital for Children
Alder Hey Children’s NHS Foundation Trust
Great Ormond Street Hospital for Children
Leeds Teaching Hospital
Nottingham University NHS Trust
The Portland Hospital (Privately funded)
St Louis Children’s Hospital (America)
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