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Suitability for Selective Dorsal Rhizotomy (SDR)

Children between 3 and 10 years of age, with a diagnosis of spastic diplegia, following premature birth, should be considered for Selective Dorsal Rhizotomy. Older children are also considered on a case by case basis.

Children with typical spastic diplegia, whether born prematurely or at term, should also be considered. There should be no significant damage to the areas of the brain involved in posture or coordination; this would be determined by a magnetic resonance scan of the brain.

Children suitable for SDR need to demonstrate adequate muscle strength in the legs and trunk. Their ability to support their full weight on their feet, to hold their posture against gravity, and to make appropriate movements to crawl or walk is evaluated. These children tend to have delayed motor development, and spasticity interferes with their progress.

Regular post-operative physiotherapy is necessary to obtain the best results after   SDR   and suitable children need to be motivated and show that they are able to cooperate with therapy. Although it is ideal that children undergo SDR prior to orthopaedic surgery, if the latter has already been performed, it is recommended to delay SDR by at least six months to allow muscle strength to recover.

Some causes of cerebral palsy are not suitable for SDR. Children who have a history of meningitis, congenital infection, hydrocephalus unrelated to prematurity or head trauma do not do well with   SDR. Similarly, children with severe muscle rigidity, poor muscle tone or dystonia do not benefit from SDR. SDR is also not very effective for children with severe cerebral palsy involving the whole body or when one side of the body is very weak. In children with severe scoliosis,   SDR   is not generally recommended as it may cause the existing spinal curvature to deteriorate.

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How to find out if SDR is the best option for your child

The first step is to obtain a referral for your child from your GP, paediatrician, orthopaedic surgeon or neurologist. On receiving this, we will first organise an appointment to see you with your child at the neurosurgical spasticity clinic with a consultant neurosurgeon and specialist physiotherapist. At this clinic, the benefits and potential risks of SDR   are discussed. We would also aim to have a full and frank discussion about your expectations, the consideration of other options and the need for post-operative physiotherapy.

Following that appointment, your child may well be referred on for a formal physiotherapy evaluation. Part of the evaluation is video recorded. You will also be invited to attend the nearby 3D Gait Lab, and we will arrange for these appointments to take place on the same day. This information then forms the basis of a further multidisciplinary team (MDT) discussion, attended by a paediatric neurosurgeon, paediatric orthopaedic surgeon, paediatric neurologist and specialist physiotherapists. At this stage, the brain scans, as well as the spine and hip x-rays, are reviewed. The aim of this meeting is to decide whether a child is suitable for SDR or whether other options may be potentially better. The neurosurgeon on the panel will be in touch following the MDT to discuss the outcome of the meeting and the recommendations the group have made.

(This information can also be found within the  paediatric physiotherapy SDR webpages.)