UCSF's approach to SDR
At UCSF Benioff Children's Hospitals, your child is cared for by one of the most experienced SDR teams on the West Coast. Our Peacock Cerebral Palsy & Movement Disorders Center – named after a pioneer of SDR – is the largest spasticity treatment program in Northern California. For more than 20 years, our team has performed SDR with excellent long-term outcomes. We use a minimally invasive SDR technique designed to support faster recovery.
We consider rehabilitation and physical therapy a key part of the treatment. UCSF's Inpatient Rehabilitation Program was designed to be child-friendly and has a staff of pediatric specialists who are experienced in working with children who have undergone SDR.
Our team includes specialists in pediatric neurology, neurosurgery, orthopedics, rehabilitation medicine and physical therapy. These experts work closely together before, during and after surgery to provide coordinated, compassionate care.
Who is eligible for SDR?
SDR is recommended for children with spasticity.
If spasticity is the main reason your child has difficulty walking, SDR may help them walk more easily – or even, independently. But SDR can also benefit children who aren't able to walk without support. Following SDR, they have less pain and spasticity and are better able to sit, stand and use assistive devices.
Other benefits reported by parents include: better function in the upper extremities, reduced caregiving needs, and improved mood, alertness and cognition as well as quality of life for the entire family. Parents are typically satisfied with the results after surgery.
Evaluation and planning
Before surgery, your child will go through a thorough evaluation to make sure SDR is the best treatment option.
This process includes:
- Evaluation by a pediatric rehabilitation specialist (physiatrist), who may explore other treatments first
- Multidisciplinary review through our Hypertonia Program, where a team of experts compares SDR with other options
- Surgical consultation, where you meet the neurosurgeon to discuss the procedure and what to expect
The SDR procedure
We use a minimally invasive technique that was developed by UCSF neurosurgeons. The neurosurgeon makes a small incision in the lower back and lifts one spinal bone to create a small opening. This is the most minimally invasive approach available. It allows the surgeon to see the tiny nerve branches that control movement and sensation in the legs. Using gentle electrical stimulation, the surgeon tests each nerve to identify which ones are causing the most muscle tightness. Only those specific nerves are cut, while healthy nerves are left intact.
Your child will be fully asleep under general anesthesia for the entire procedure. This approach is less invasive than traditional surgery and allows for an easier, less painful recovery as well as optimal spine health.
Hospital recovery
After surgery, most children stay in the hospital for 3 to 5 days.
As with any surgery, there are some risks, such as:
- Infection
- Nerve injury
- Wound healing issues
- Reactions to anesthesia
These complications are uncommon. Some children may feel temporary tingling or discomfort in their legs, which usually improves over time. The most common post-surgical complication relates to wound healing, which can be treated with oral antibiotics or topical ointments.
Rehabilitation and physical therapy
For the best results, SDR is followed by inpatient rehabilitation and physical therapy. At UCSF Benioff Children's Hospitals, most children receive 3 to 6 weeks of intensive daily physical therapy through our inpatient pediatric rehabilitation program – the only one in Northern California certified by California Children's Services.
This is a signature feature of our program, and, we believe, a major factor contributing to the outstanding results we see over time. The intensive inpatient therapy after surgery helps the brain learn how to use the newly mobile extremities. This sets the foundation for long-term improvement over the years.
After completing the inpatient program, children usually continue outpatient physical therapy for several months, ideally 3 to 5 times per week.
For an in-depth, technical look at how our experts use SDR to manage spasticity in patients with cerebral palsy, watch this video.
