What is SDR?
Selective dorsal rhizotomy (SDR) is a surgical procedure that treats muscle spasticity by cutting the nerve rootlets in the spinal cord that are sending abnormal signals to the muscles. SDR surgery is a treatment for cerebral palsy typically performed on kids who are affected by spasticity. SDR surgery might help kids to:
- Reduce spasticity
- Improve walking patterns
- Use energy and oxygen more efficiently
- Improve range of motion and functional mobility
- More easily perform self-care activities, such as getting dressed and grooming
What is the evidence for SDR?
There is strong evidence for short and long-term reduction in spasticity and improvements in function for ambulatory children with spastic diplegia. There are mixed outcomes for long-term maintenance of function, this is likely related to variable selection criteria.
Muscle contractures are a significant risk factor in children with cerebral palsy. SDR surgery does not eliminate these risks as there is strong evidence that contractures continue to develop however, orthopedic interventions, such as tendon lengthenings may be less throughout the life span as a result of SDR surgery.
Although SDR is an invasive procedure, the side effects are considered to be minimal.
Physiotherapy is important both before and after SDR surgery.
The goals of Pre-operative Physiotherapy are to:
- strengthen weak muscles especially core, glutes and quads
- minimize contractures that may require further orthopaedic surgery
- get family and child used to therapy sessions, challenging the child
Typically, even after surgery, kids continue to use the patterns that they are accustomed to using!! These kids have developed strong neurological pathways that are difficult to break.
The goals of Post-operative Physiotherapy are to:
- improve gait patterns
- promote muscle balance through stretching and strengthening
- enhance static and dynamic balance
- increase dissociation of lower extremities
- reinforce new neurological pathways
Treatment will vary based on progression, motivation, age and pre-op status. Kids need to be challenged in order to make change! Strength and functional exercise needs to be done in alignment and throughout range. Repetition is key!
How often does my child need Physiotherapy after SDR Surgery?
Depending on the surgeon performing the surgery, recommendations vary from 3-5 times per week post-op for the first 6 months, followed by 2-3 times per week for 6-18 months.
Is SDR appropriate for my child?
In Canada, Holland Bloorview Children’s Treatment Centre offers an SDR clinic in conjunction with Sick Kids Hospital. A child needs to be referred by their local Children’s Treatment Centre physician to the Holland Bloorview SDR clinic where the team will assess to determine if client is candidate for SDR. Please check out the link below for more details.
There are many centres in the US that are performing SDR including St. Louis Children’s Hospital and the Gillette Children’s Specialty Healthcare, all of which have different eligibility criteria.
CALL US!! Butterfly’s team of experienced Physiotherapists will help your child spread their wings and be the best that they can be!