understanding Selective Dorsal Rhizotomy

Selective Dorsal Rhizotomy (SDR) is a surgery. It helps lessen muscle stiffness, also known as spasticity, in patients with conditions like cerebral palsy. Spasticity is caused when the brain, spinal cord, nerves and muscles don't talk to each other quite right. SDR aims to improve movement, function and quality of life. It works by cutting select nerve rootlets in the spinal cord that are sending abnormal signals to the muscles. SDR is often used when other treatments, like physical therapy or medicine, have not worked well enough.

what signs and symptoms may indicate a need for Selective Dorsal Rhizotomy?

Signs and symptoms that might indicate the need for SDR include:

Muscle stiffness
Difficulty walking
Balance issues
Muscle weakness
Pain

how is the need for Selective Dorsal Rhizotomy diagnosed?

To decide if SDR is needed, we will do the following steps:

Comprehensive evaluation: A physical and neurological exam by a team of different specialists.
Medical history: Detailed review of your child’s medical history, including previous treatments and therapies.
Imaging studies: MRI or CT scans of the brain and spine to assess the extent of neurological damage.
Functional assessment: Evaluation of your child’s motor function, spasticity levels and impact on daily activities.
Trial injections: Sometimes, Botox or nerve blocks are used short-term to reduce spasticity. This lets us see if doing so improves your child's function and comfort before we do surgery.
Consult and discussion: In-depth discussion between your family and your child’s care team about the potential benefits, risks and outcomes of SDR.

how does Dayton Children’s approach Selective Dorsal Rhizotomy surgery?

We will make a small cut in your child's back. Then we'll open one level of the bone in the spine so we can access the nerve roots. We use state-of-the-art monitoring equipment to test the nerves and decide which ones need to be cut. Using this test helps us make sure your child gets the most benefit. It also helps tell us which nerves we should leave because they are important for things like bowel and bladder control. In general, we aim to cut about 50% of the nerves for a useful reduction in spasticity.

why this approach?

With this process, we see:

The best results
Fewer complications
Less pain
Your child can start rehab much faster

what are the benefits of Selective Dorsal Rhizotomy surgery?

Selective Dorsal Rhizotomy surgery can help children with spasticity by:

Improving mobility: By reducing muscle stiffness, SDR can make it easier for children to move, walk and do physical activities. It can also help your child’s balance and coordination.
Making them more comfortable: Improving muscle tightness also improves pain and discomfort. This helps children feel better in their daily lives.
Better posture: Better posture can allow your child to sit, stand and walk more easily. This can also help your child be more independent, doing things like, dressing, bathing and playing more on their own.
Fewer medicines or treatments: After SDR, some children need fewer medicines or treatments to care for their spasticity. But, the benefits of SDR can vary child to child. A thorough evaluation by your child's care team is needed to decide if this is a good option for your child.