Selective Dorsal Rhizotomy (SDR)
Cerebral palsy affects how a child’s brain and muscles communicate. The disease varies in severity and can cause painful, often disabling, symptoms.
It’s common for kids with cerebral palsy to have trouble with muscle control, coordination, reflexes, movement, posture and balance. Many experience spasticity, ranging from mild stiffness to severe spasms. Your child may find it hard to move freely or perform normal activities like walking, dressing or eating.
Although there is no known cure, selective dorsal rhizotomy (SDR) can help some children with cerebral palsy or other disorders causing spasticity by making muscle stiffness in the legs more manageable. In addition, it can reduce the long-term effects of high muscle tone on bones, joints and function.
How It Helps
Selective dorsal rhizotomy (SDR) is a surgical procedure for muscle spasticity in the legs. SDR can improve how muscles move and function, increase ease of movement and comfort, and help prevent long-term structural deformities.
Over time, high muscle tone, or tightness, can cause muscle contractures (shortening) and joint deformities. In addition, reduced muscle tone gives children a better chance to develop muscle control, balance and improve walking (gait).
Evaluating Your Child
Specialists from the Barrow Neurological Institute at Phoenix Children’s Hospital will evaluate your child to see if this procedure might help. Our collaborative evaluation team may include the following experts:
- Movement disorders neurologist
- Orthopedic surgeon
- Physical medicine and rehabilitation physician
- Physical therapist
- Rehabilitation nurse practitioners
Our specialists look at these and other variables:
- Spasticity in the legs
- Leg strength and control
- Reasonable cognitive development and motivation to walk
- Ability and willingness to complete intense post-surgery rehabilitation
Doctors sometimes perform SDR as a palliative procedure to ease discomfort and improve care and quality of life without specific functional goals in mind.
After careful screening, testing and evaluation, doctors discuss potential benefits and risks and other details. For the typical patient, goals of SDR include:
- Improve flexibility of legs
- Decrease leg discomfort
- Enhance balance
- Improve gait
- Lower fall risk
- Reduce need for orthopedic surgery for joint and muscle deformity
What to Expect
SDR usually takes several hours. A neurosurgeon tests and cuts specific nerves to decrease the signal which the spinal cord sends to muscles. This decreases spasticity and stiffness without affecting other functions.
The neurosurgeon makes a small incision in the back, exposing and testing multiple nerve roots with an electrical impulse, while watching the electrical response and associated leg movements. Then the surgeon cuts those fibers that are causing excess muscle tightness.
Your child receives a continuous flow of postoperative pain medication through a small, soft catheter near the spine. Our care team will transition to oral pain medication as your child heals.
Your child’s doctors and care team will provide instructions and guidance about post-surgical care. For the first day or two, your child’s legs need to be kept as straight as possible, with hips and knees extended. Doctors may recommend devices such as knee immobilizers to help maintain this position and keep muscles stretched.
Some children need serial casts – short leg casts changed every three to seven days, repositioning the ankle each time. This helps to stretch your child’s calf and ankle area.
For several days after surgery, some children experience tingling or numbness in their legs or feet, which is usually temporary. If it is bothersome or painful, your child’s doctor can prescribe helpful medication.
Your child will need extensive therapy, which begins in our inpatient rehabilitation unit [link to Inpatient Rehabilitation landing page]. This typically includes physical and occupational (daily skills) therapies for at least three hours a day, six days a week. Depending on your child’s condition, the inpatient rehabilitation can take three to four weeks.
During physical therapy, our therapists work on stretching, strengthening and balance. It’s normal for children to find it hard to stand or walk at first. Our therapists encourage, guide and help as your child progresses.
Occupational therapists help your child to regain and strengthen self-care skills once SDR has reduced stiffness and improved the ability to move. Before going home, your child builds strength and relearns mobility skills. Some children require braces, walkers, wheelchairs or other assistive devices when they first go home.
Recovery and improvements continue through outpatient therapy with, on average, three weekly visits for at least six months. Our case manager will help you with arrangements, either through a Phoenix Children’s outpatient therapy facility or closer to home if that’s more convenient.
It might take a year or more until your child has fully improved. If there are still areas of tightness or deformity, your child’s doctor may discuss orthopedic surgery.