About Selective Dorsal Rhizotomy (SDR)

What is Spastic cerebral palsy (CP)?

Spastic cerebral palsy (CP) is the most common type of CP. Spastic means the affected muscles are stiffer and tighter than normal, making movement difficult. Bilateral CP involves both sides of the body.

Selective Dorsal Rhizotomy (SDR) 

Selective Dorsal Rhizotomy (SDR) is one of the treatment options for a child with bilateral spastic CP. 

Other treatments are: 

  • Therapies including physiotherapy, occupational therapy, speech pathology, orthotics
  • Anti-spasticity medicines eg. baclofen 
  • Botulinum toxin-A (Botox庐, Dysport庐) injections to relax specific muscles 
  • Intrathecal baclofen pump (ITB) surgery to relax many muscles 
  • Orthopaedic surgery to treat muscle shortening and joint contractures.

Graphic images representing 5 GMFCS levels

GMFCS (Gross Motor Function Classification System) illustrations are reproduced with the permission of The Royal Children鈥檚 Hospital Melbourne.

  • SDR is mostly suitable for children who walk by themselves, with or without a walking frame ( 2 & 3).
  • Treatment goals are an important part in deciding if SDR is the best treatment choice. 
  • Goals for children, GMFCS level 4, can include care and comfort goals, as well as functional goals. 
  • SDR is not typically used as a treatment for children of GMFCS levels 1 & 5 in Australia.

Other important points: 

  • It is best done when the child is young, around 4-8 years old. 
  • It is an operation on the lower spinal cord. 
  • It lessens spasticity in the legs, not other types of muscle stiffness (eg dystonia). 
  • Nerve fibres that cause spasticity are selected and cut to relax the muscles. The cut nerves do not grow back, so the results are long lasting.

Where is SDR done?

  • In Australia SDR is done at certain specialist hospitals in Sydney, Brisbane, Melbourne and Adelaide. 
  • In Australia, the surgery and inpatient stay are fully funded. 
  • In overseas centres, mostly USA and UK, cost relies on your own funding.