preparing for Selective Dorsal Rhizotomy surgery

• Exercise: Please continue any current therapy. Activities that focus on muscle strengthening, especially of the upper body, can help your child after surgery. 

• Nutrition: For six weeks before surgery, we recommend foods high in iron, calcium, Vitamin C, Vitamin D and protein. 

• Bowel management: Your child will have trouble with constipation after surgery because of anesthesia, pain medicine and limited movement. It is important to develop and start a bowel treatment plan before the SDR surgery. 

• Outpatient therapy: Your family should prepare for many outpatient therapy visits after discharge. Reach out to your local therapy facility to plan for follow-ups or discuss with your current therapy team. If your child is school-age, be sure the school is aware of the upcoming surgery and the need for school-based therapy services. 

• Your child’s surgery time will be confirmed the day before surgery. If you haven’t heard from us by 4:00 pm the day before surgery, call 937-641-4269. 

  • If you cannot make the scheduled surgery, call 937-641-3461, right away to let our office coordinator know. We will reschedule the surgery. 

  • We will do our best to keep your child’s surgery at the scheduled time. Sometimes a need arises, and we will need to change your time. For example, another patient may cancel, and we may move your time up. Or cases may need to be moved ahead of you to meet the requirements of our operating room. We will let you know as soon as possible if we need to change your time. 

• Eating/drinking instructions before surgery 

  • It is very important to follow these instructions. If they aren’t followed, we may have to delay or cancel your child’s surgery. Even a small amount of food or drink in your child’s stomach during surgery can cause very serious problems. 

  • No solid foods, candy, chocolate, chewing gum or any form of tobacco products 8 hours before arrival time. Examples include: 

    • Crackers 

    • Bread 

    • Meat 

    • Milk products, including yogurt 

    • Fruits 

    • Vegetables 

    • Applesauce 

  • Clear liquids are permitted until 6 hours before arrival time. Examples include: 

    • Water 

    • Apple juice 

    • White grape juice 

    • Sprite 

    • Pedialyte 

    • Gatorade 

    • Avoid any red-colored liquids 

  • The following beverages are not clear liquids and should not be given after midnight the day before your child’s surgery: 

    • Orange juice 

    • Banana juice 

    • Pineapple juice 

    • Grapefruit juice 

    • Purple grape juice 

    • Mountain Dew 

    • Broth 

    • Milk 

  • Your child should bathe for 2 days prior to the surgery using the special cleansing soap provided. Encourage your child to have a bowel movement before arriving for surgery. 

  • Bring the names and amounts of any medications your child is taking. 

getting to the surgery center

Please arrive one hour before your surgery time. Your surgeon and anesthesiologist will meet with you, and we will complete any needed lab work or IVs. 

• Main campus: Park in the free parking garage and come in the main entrance. Your first stop will be the welcome center in the main lobby. They will guide you to the surgery center on the second floor. 

checking in and meeting your care team

• When you check in at the registration desk, you and your child will get an ID bracelet. This is for your child’s safety, so please leave it on and make sure your child leaves it on. 

• Then you and your child will be taken to your room to prepare them for their procedure. 

• You will meet with your child’s care team, including a nurse, the anesthesiologist and surgeon. 

• The surgeon will talk to you about the procedure and answer any questions you have. 

• Please leave your cell phone number so we can call you when your child is waking up. You can also track your child’s progress during surgery by looking at the TV monitors in the waiting area. If you leave the waiting area, please let us know. 

Selective Dorsal Rhizotomy surgery

• The goal of selective dorsal rhizotomy surgery is to relax the spastic muscles in your child’s leg(s). 

• During surgery, your child’s neurosurgeon will carefully separate the nerve roots of the spinal cord to identify those that cause spasticity/stiffness. A small electrical stimulus is applied to each nerve root going to the legs. If the electrical stimulus causes an abnormal leg response, the neurosurgeon may cut the sensory nerve root. 

• By cutting the abnormal nerve roots your child will still have the ability to move, but with less spasticity/stiffness. 

• Surgery typically takes about six hours. 

• After surgery, your child will be admitted to the pediatric intensive care unit (PICU) for at least two days. 

After Selective Dorsal Rhizotomy surgery, your child may have some pain in their back, legs or feet. For most children, this pain gets better each day following surgery. 

easing pain 

We want to manage pain before it gets severe. Taking medicines regularly helps control or prevent pain. 

• Medicines: We give your child different medicines for different reasons. Our pain team will help decide on the best medicine. 

  1. Gabapentin 

  2. Acetaminophen and NSAIDs 

  3. Opioids (Narcotics) 

  4. Baclofen 

  5. Valium 

Pain medicines can cause a range of side effects, including sleepiness, nausea or vomiting, constipation, urinary retention, itching or rash. If your child starts experiencing any of these symptoms, please notify their care team. 

During your child’s stay in the PICU, they will be closely monitored by their care team. 

• Staying in bed: Your child will stay in bed for the first three days after surgery. It is important to lie flat and straight during this time. 

• Log rolling: Your child should change positions every two hours to help relieve pressure or pain in different joints. Your child’s nursing team will use a technique called “log rolling”. After a few days, your child’s nursing team will teach you how to log roll your child safely. 

• Knee braces and foot braces: Your child will wear both braces (called orthotics) to help keep the legs and feet straight and prevent muscle spasms or tightness from developing. 

• Using the bathroom: Right after surgery, while lying flat in bed, your child will have a urinary catheter in place to keep the bladder empty.  

• Eating and drinking when tolerated: Your child may not eat or drink much for a few days after surgery. They may be nauseous and vomiting from the anesthesia or sleepy from the pain medicine. We will begin giving your child small amounts of clear liquids and move to solid foods as your child tolerates. 

• IV fluids: We will keep an IV in your child until they are drinking and taking medicines by mouth. 

• Entertaining your child: It is important to have movies, books or simple games to help keep your child entertained and distracted while they are flat and still. Please let us know if you need help keeping your child entertained. 

• The inpatient rehabilitation program at Dayton Children’s offers patients comprehensive care and therapies to help them recover from Selective Dorsal Rhizotomy surgery. 

• The length of time spent in inpatient rehabilitation will vary depending on your child’s progress and your family’s situation. 

  • Length of stay is typically longer for children who are walking with or without an assistive device before surgery. 

  • All members of the SDR and inpatient rehabilitation teams will keep you updated on your child’s progress. 

  • Your child’s care team will meet with your regularly to review your child’s medical plan of care. 

• Inpatient rehabilitation therapy schedule 

  • Once transferred to inpatient rehabilitation, your child will receive three hours or therapy each day between physical therapy and occupational therapy (and speech therapy if changes from baseline occur after surgery). Therapy may be individual or group sessions anytime during the following hours: 

    • Monday through Friday: 8:30 am to 3:00 pm 

    • Saturday: 8:00 am to noon 

    • Sunday: No scheduled therapy 

• Following discharge from inpatient rehabilitation, your child will attend outpatient physical therapy at least three times per week. 

After Selective Dorsal Rhizotomy surgery, it is important to limit the movement in your child’s legs, hips, chest and abdomen. 

weeks 1 - 6

• Legs 

  • Your child should not lift their legs higher than 30 degrees. 

  • Lifting one or both legs higher than 30 degrees places stress on the part of the back where your child had the selective dorsal rhizotomy surgery. 

• Hips 

  • Your child should not flex their hips past 90 degrees. 

  • When sitting up in a chair, your child’s back should be straight, and their knees are bent. Bending forward will place stress on the part of the back where your child had the selective dorsal rhizotomy surgery. This is more relevant during the first two weeks following surgery. 

  • A wheelchair should not be used before your child’s therapist tell you it is okay. This typically happens one week after surgery. 

• Head of bed 

  • Do not raise the head of your child’s bed higher than 30 degrees. 

  • When lying down, your child’s legs should be straight. Raising the head of the bead higher than 30 degrees places stress on the part of the back where your child had the selective dorsal rhizotomy surgery. 

  • Your child’s care team will set the head of the bed to only raise 30 degrees. 

weeks 7 - 12

• Chest and abdomen 

  • No twisting or bending from the waist. 

Your child will need follow-up appointments with the surgeon and Cerebral Palsy clinic team. 

• The surgical team will keep a close eye on the incision for the first couple of weeks after surgery and may schedule another follow-up in the neurosurgery clinic if needed 

• The inpatient rehab team will help you schedule your first follow-up appointment before you go home. 

• Follow-up appointments in clinic usually begin about two to four weeks after discharge. 

• Your child will need to be seen by the Cerebral Palsy clinic team every three months for the first year.