SDR
Selective Dorsal Rhizotomy
Selective Dorsal Rhizotomy service at The Portland helps children with
cerebral palsy to walk
The Portland Hospital for Women and Children in London provides Selective
Dorsal Rhizotomy for children with cerebral palsy. This is the only fully
private service of its kind in Europe.
Selective Dorsal Rhotzotomy (SDR) is a surgical procedure offered to children
with spastic diplegia to improve their ability to balance, walk and participate
in normal daily activities and sport. Children with spastic diplegia as
a result of cerebral palsy can find it difficult to walk due to spasticity
in their lower limbs.
SDR involves sectioning (cutting) of some of the sensory nerve fibres
that come from the muscles and enter the spinal cord.
Surgery involves a 1 to 2 inch incision along the centre of the lumbar
spine. The spinous process and a portion of the lamina are removed at
a single level to expose the lower end of the spinal cord and spinal nerves.
The sensory nerve roots are identified and exposed. Each root is then
divided into 3-5 rootlets. Each rootlet is tested with EMG, which records
electrical patterns in muscles. Rootlets are ranked from 1 (mild) to 4
(severe) for spasticity. The severely abnormal rootlets are cut. This
technique is repeated for rootlets between spinal nerves L1 and S1/S2.
The advantages of this type of surgery are:
• Reduced risk of spinal deformities in later years
• Shorter-term, less intense back pain
• Early commencement of intensive physiotherapy
• Shorter operating time and therefore reduced risks associated with general
anaesthetic
The SDR service at The Portland Hospital is led by Mr Kristian Aquilina,
Paediatric Neurosurgeon (previously at Frenchay Hospital, Bristol and
currently at Great Ormond Street Hospital for Children, London). The specialist
multidisciplinary team also consists of a consultant paediatrician specialising
in neurodisability, a neurophysiologist, specialist physiotherapists and
(where appropriate) a paediatric orthopaedic surgeon. Mr Aquilina worked
with Dr TS Park at the Center for Cerebral Palsy in St Louis.
Children are rigorously assessed pre-operatively to ensure that SDR is
the best treatment option to maximise their potential.
The selection criteria are:
• Children usually between the ages of 3 and 12 years with a diagnosis
of spastic diplegia and significant diffuse spasticity in the lower limbs
that involves most of the muscle groups
• There should be no significant injury to the areas of the brain involved
in posture or coordination - this is confirmed by an MRI scan
• Children need to demonstrate adequate muscle strength, be able to comply
with intensive physiotherapy post-operatively and have a definite plan
for post-operative physiotherapy in place
Surgery takes 3 to 4 hours. Post-operatively children spend one night
in the hospital’s 10-bedded paediatric intensive care unit for close observation
and are on bed rest for the first 3 days.
Intensive physiotherapy commences on day 3. The reduction in spasticity
is often immediate and the focus of treatment sessions is to improve trunk
and lower limb strength, improve balance and re-educate walking patterns.
Children are discharged home on day 6 but continue a twice daily physiotherapy
programme for the next 2 weeks. At this point they can return to their
usual routine but research has shown that physiotherapy must continue
on a regular basis for a period of 1-2 years to optimise the effects of
the surgery and ensure that changes to movement patterns are lasting.
The Portland Hospital is the only private hospital in the UK dedicated
to the healthcare of women and children. It offers a range of specialties
and full diagnostic support. The hospital cares for children with complex
needs and those requiring a variety of surgical and medical interventions.
The Acute Neurorehabilitation Unit provides intensive rehabilitation programmes
for children to optimise recovery and help them reach their potential
in life.
