Selective Dorsal Rhizomtomy (SDR)

Selective Dorsal Rhizotomy (SDR) is a well established surgical procedure that helps to manage muscle spasticity (muscle stiffness) caused by Cerebral Palsy (CP). A reduction in spasticity can help enable greater mobility, balance and prevent muscle tightness. Liverpool Orthotics provides a comprehensive orthotic and physiotherapy program to aid rehabilitation after SDR therapy.

What is spasticity?

Spasticity is caused when the signal from the brain, which passes down the nerves to the muscles, is abnormal. In the case of Cerebral Palsy, this signal is abnormal as a result of the damage that has occurred to the brain.

How does SDR help reduce spasticity?

The nerves in the lower back that are responsible for the muscle spasticity are cut. This is done by a surgical incision in the central back just above the waist. By cutting the nerves this can reduce muscle spasticity.

What are the potential benefits of having SDR treatment?

There are many benefits to having SDR treatment, including;

What is the selection criteria for having SDR treatment?

SDR therapy is not suitable for every child who has Spastic cerebral Palsy. A multidisciplinary team should consider each child's case to ensure the surgery is suitable. Surgery is only offered to children between the ages of 3-9 years of age. Children who have cerebral palsy are classified according to their motor ability as described in the Gross Motor Function Classification System. This classification system helps the multidisciplinary team decide if a child is suitable for SDR.

It is important to note that SDR is irreversible so there is often a significant amount of deliberation and testing before the surgery is considered.

What happens after the surgery?

SDR is a complex surgical procedure which rapidly alters the function of the neuromuscular system. SDR must be followed with an initial intensive rehabilitation program. It is common that children will continue some form of therapy and home stretches and exercises throughout childhood and sometimes into early adolescence.

Children who have SDR treatment will also require a series of splints. The splints required will depend on a number of factors including;

How can Liverpool Orthotics help with SDR treatment?

Liverpool Orthotics have an experienced team that can ensure the best possible outcome for SDR surgery at any stage. We provide a comprehensive multidisciplinary approach to our SDR surgery programs, which includes:

Pre surgery assessment - Before the surgery our team of physiotherapists, occupational therapists and specialist orthotists will assess the child and plan a bespoke pre and post surgical therapy program.

Pre surgery therapy - Our specialist pediatric physiotherapist will ensure that all the lower limb muscles are as strong as possible with a therapy program that leads up to the surgery date.

Pre surgery orthotic assessment - Our specialist paediatric orthotist will assess the child’s current orthotic provision and set out the pre and post surgical orthotic treatment program. At this stage the orthotist may wish to take casts or scans and provide new splints just before surgery to ensure there is plenty of room for growth after surgery. Often stretching splints are provided to prevent any muscle tightness before or after surgery.

Post surgery therapy - After the surgery the physiotherapy and occupational therapy team can start implementing their specialist SDR programs.

Post surgery orthotic review - The orthotist will review the splints to ensure they are still appropriate. Our orthotist will be in close contact with the therapy team to track any progress as it is common for the splints to change in design as the child becomes stronger and more mobile.

Continued orthotic care - most children still require some level of orthotic input throughout childhood. This can be in the form of

Liverpool Orthotics can continue to provide the very latest in orthotic treatment as the child grows to enable the best possible outcome from the SDR treatment.

To arrange an appointment call Liverpool Orthotics now on 0330 088 3949, or email us at office@liverpool-orthotics.co.uk