Selective Dorsal Rhizotomy (SDR) Surgery

As one of the nation’s Best Children’s Hospitals for pediatric neurosurgery, Gillette Children’s Specialty Healthcare is one of the top providers of selective dorsal rhizotomy (SDR) surgery in the U.S. The procedure helps manage spasticity, particularly in children who have cerebral palsy. We attract patients from across the nation and world.

Our team of specialists offers comprehensive evaluations, including testing in our James R. Gage Center for Gait and Motion Analysis. We also offer one of the nation’s top pediatric comprehensive inpatient rehabilitation programs for patients following surgery. Through exceptional expertise and a commitment to research, we promote the highest standards of care.

Why Choose Gillette?

• Gillette is one of the nation’s Best Children’s Hospitals in pediatric neurosurgery, neurology and orthopedics.
• Our team of medical, surgical and rehabilitation specialists evaluates every patient before surgery.
• Ours is one of the world’s busiest and most respected clinical gait and motion analysis centers.
• We believe that comprehensive rehabilitation helps children reach their full potential following surgery.
• Our commitment to clinical research and measurable outcomes promotes the highest standards of care.

Definition of SDR Surgery

Selective dorsal rhizotomy (SDR) surgery is a procedure that treats muscle spasticity (tightness or stiffness) caused by abnormal communication among the brain, spinal cord, nerves and muscles.

Spasticity most commonly affects children who have cerebral palsy. SDR surgery corrects muscle spasticity by cutting the nerve rootlets in the spinal cord that are sending abnormal signals to the muscles.

Selective dorsal rhizotomy has been shown to:

• Reduce spasticity
• Improve gait (walking) patterns
• Help people use energy and oxygen more efficiently
• Improve range of motion and functional mobility
• Make it easier to perform self-care activities, such as getting dressed and grooming

Candidates for SDR Surgery

SDR surgery is typically performed on children who have spastic cerebral palsy. Because it is irreversible, careful patient selection is critical. At Gillette, every candidate for SDR surgery undergoes a spasticity evaluation, which includes a physical examination and testing in our world-renowned James R. Gage Center for Gait and Motion Analysis.

Our evaluation team includes an orthopedic surgeon, a neurosurgeon, a pediatric rehabilitation medicine physician and a physical therapist. The team considers many factors when evaluating patients for SDR surgery, including:

• Cerebral palsy type: The best candidates for SDR surgery typically have spastic diplegic cerebral palsy that affects the legs more than the arms.
• Gross motor function: Patients who can walk and are expected to continue walking generally are the best candidates for SDR surgery. Such children are generally at levels I, II and III on the Gross Motor Function Classification System (GMFCS).
• Gait analysis data: Gait analysis can indicate whether a child’s abnormal movement patterns stem from spasticity or another movement disorder. It also quantifies how much energy a child uses when walking by measuring oxygen consumption. Candidates for SDR surgery often require 200 to 600 percent more energy to walk than typically developing children do.
• Age: Children between 4 and 7 are typically the best candidates for SDR surgery, but older children can benefit from the procedure as well.
• Cognitive abilities: Because SDR surgery requires extensive rehabilitation, the best candidates are cognitively able to follow directions and participate in therapy.

What to Expect

SDR surgery involves a three- to four-hour surgical procedure and several weeks of inpatient rehabilitation. Once we’ve determined that a patient is a good candidate for surgery, we help families plan a time for surgery and rehabilitation that will work with their schedules.

Before the surgery date, patients undergo preoperative appointments. We typically schedule a hospital tour and education session. Our goal is to help patients and their families feel as prepared and supported as possible.

During SDR Surgery

During SDR surgery, a neurosurgeon makes an incision low in a child’s back and opens up the spinal canal. Through that space, the surgeon can access the sensory nerve roots that carry messages from the central nervous system to the muscles.

The neurosurgeon separates the roots into smaller rootlets and stimulates each rootlet with an electrical impulse. We then cut the rootlets that cause abnormal responses, leading to a permanent reduction in muscle spasticity. The procedure usually lasts three to four hours, during which we might test more than 100 rootlets.

When SDR surgery is complete, the neurosurgeon closes the spinal canal and incision. After about three days of recovery, children undergo comprehensive inpatient rehabilitation.

Rehabilitation Following SDR Surgery

SDR surgery reduces muscle spasticity permanently. As a result, children must learn new patterns of walking and moving. Because the first weeks after surgery are critical for establishing those new patterns, Gillette provides intensive inpatient rehabilitation care following every SDR surgery.

Children typically spend about three days in a hospital bed recovering from SDR surgery. Initially, pain medication and nourishment are administered through an IV. A catheter drains urine from the bladder. Nurses closely monitor patients to ensure safety and comfort. Later, nurses play an important role in helping patients practice what they learn during rehabilitation therapy.

Pediatric rehabilitation medicine physicians direct the rehabilitation plan, which begins about three days after surgery. Physical therapists work with patients on basic skills, such as head and trunk control. Later skills include crawling, standing and walking. Slowly building on skills is vital. If children perform advanced activities too soon, they risk reverting to the abnormal movement patterns they used before surgery.

Occupational therapy and therapeutic recreation services begin about five days after surgery. Occupational therapy helps children learn self-care skills (such as washing, eating and getting dressed). Therapeutic recreation services help children learn and practice skills using activities like sports or games. Some children also receive speech therapy while in the hospital.

In addition to undergoing comprehensive rehabilitation therapy, children have access to Gillette’s full range of child and family support services and to collaborative medical, surgical, rehabilitation and assistive technology specialists.

Going Home After SDR Surgery

We begin planning for a successful return home as soon as patients and families arrive at the hospital. Throughout the inpatient rehabilitation stay, a Gillette team discusses outpatient therapy plans with Gillette specialists or community providers.

Our team might recommend adaptive equipment—such as a wheelchair, a standing device or a walker—for patients to use when they first go home. (When most children leave our inpatient program, they are walking only during therapy sessions.)

Therapy schedules after SDR surgery vary, but we typically recommend starting with five sessions per week after leaving the hospital. Therapy might take place at Gillette or in a child’s community, depending on where the family lives and the available resources.

Whether or not a child has ongoing therapy at Gillette, follow-up visits with Gillette’s team are critical. A typical follow-up schedule includes:

• One month after surgery: A pediatric rehabilitation medicine physician performs an evaluation and updates therapy recommendations. The physician and family also discuss a schedule for additional follow-up visits.
• Three, six and 12 months after surgery: At each visit, a pediatric rehabilitation medicine physician might perform an examination and adjust therapy recommendations. In addition, a physical therapist might record video footage to track progress. Children who can walk might undergo motion analysis approximately one year after surgery to assess changes in movement and energy consumption. An orthopedic surgeon also will evaluate the child’s outcome approximately one year after surgery.

For information about planning for surgery at Gillette, visit Patient Preparation and Support.

Our SDR Services

Successfully selecting patients, performing surgery and providing rehabilitation care require the collaboration of a highly skilled team. At Gillette, our patients have access to a full range of services and extensive family support. Together, we promote the highest standards of patient care.

Services and specialties most often associated with SDR planning and rehabilitation include:

• Assistive technology
• Gait and motion analysis
• Neurosurgery
• Orthopedics
• Rehabilitation medicine
• Rehabilitation therapies
• Therapeutic recreation

In addition, Gillette offers a vast array of child and family support services to help patients cope with their hospital stays and make the most of their rehabilitation care. Some of our services include:

• Child life
• Music therapy
• Neuropsychology
• Psychology
• School services
• Social work

For more information about our collaborative services, search Conditions and Care. For information about our hospital amenities, visit Patient Preparation and Support.