What is selective dorsal rhizotomy (SDR)?
Selective dorsal rhizotomy (SDR) is a surgical procedure that helps reduce muscle tightness in children with spasticity, a prominent feature of cerebral palsy. Spasticity happens when certain nerves send too many excitatory signals to the muscles, causing them to be stiff, tight and hard to control.
During SDR, the surgeon carefully cuts specific nerves in the spine that are causing muscle tightness, which helps the muscles relax and move more easily. This leads to improved function like walking, reduces pain and improves musculoskeletal health. At UCSF Benioff Children’s Hospitals, we use a pioneering, minimally invasive technique that involves making only a small incision in the lower back and avoids removing any spinal bone during the procedure. This approach, developed by UCSF neurosurgeons, is less invasive than traditional surgery and allows for an easier, less painful recovery as well as optimal spine health.
What are the benefits of SDR?
SDR can help reduce pain and improve movement and mobility. Children find it easier to walk, sit, stand and use assistive devices after surgery. While SDR doesn't help every child walk independently, it can improve movement, reduce pain and make everyday activities easier – all of which will support your child’s muscular skeletal health throughout their life.
SDR is not a cure for cerebral palsy. But, when combined with physical therapy, it can greatly improve function, comfort, mobility and overall quality of life.
What is UCSF's approach to SDR?
UCSF has one of the most experienced SDR programs on the West Coast. Our Cerebral Palsy & Movement Disorders Center, named after one of the treatment’s pioneers, is the largest and most comprehensive spasticity program, with the most experienced team in SDR, in Northern California. For over two decades, our center has performed SDR with excellent long-term results. We also have an integrated Inpatient Rehabilitation Program, which was designed to be child-friendly with a staff of pediatric specialists who are experienced in working with children with cerebral palsy after 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 benefits from SDR?
SDR is recommended for children with spasticity. If spasticity is the main factor affecting your child’s ambulation, the surgery can help them to walk better or 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.
More about the procedure
The neurosurgeon makes a small incision in the lower back and creates a small opening in the spine by temporarily lifting only one spinal bone. This 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 see how the leg muscles respond. This allows the surgeon to identify which nerves 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.
Recovery and rehabilitation comes with minimal risks
Children typically stay in the hospital for 3 to 5 days following surgery.
As with any surgical procedure, SDR has potential risks, such as infection, nerve injury, wound healing issues and reactions to anesthesia. But these complications are rare. Some children may have temporary tingling or discomfort in their legs, which usually resolves over time. The most common complication after surgery relates to wound healing, which can be treated with oral antibiotics or topical ointments.
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.
