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How does SDR help lessen spasticity?

Muscle tone is controlled by a reflex of nerves found in the spinal cord. This reflex involves a sensory nerve bringing information from a muscle back to the spinal cord, and a motor nerve going back to the muscle and causing it to move. 

Injury to the brain in children with CP stops this reflex from working well, resulting in spasticity. In SDR, sensory nerves causing the spasticity are cut so that spasticity is lessened.

What happens during SDR?

There are 2 ways of doing SDR surgery: single-level and multilevel. Both follow the same process and require general anaesthetic. The type of surgery offered for your child will depend on the hospital and the surgeon.

• The surgeon does an incision, which is a surgical cut, on your child’s lower back. This makes a window in the spinal canal so the surgeon can see the nerve rootlets. In the single-level surgery the incision is smaller.
• The surgeon identifies the nerves that manage movement (motor nerves). The surgeon keeps the motor nerves away from the nerves which manage feeling (sensory nerves). The surgeon only cuts the sensory nerve rootlets to lessen the spasticity.
• The surgeon tests each bundle of sensory nerves with an electric impulse to see if the electrical activity in the muscle/s is normal or not.
• The surgeon cuts the bundles that show a response that is not normal when tested.
• The surgery can take several hours from start to finish.

Illustrations reproduced with the permission of Warsi et al (JNS Pediatrics, 2020). Copyright Nebras Warsi.