Selective Dorsal Rhizotomy

Key points to remember about selective dorsal rhizotomy

• selective dorsal rhizotomy (SDR) is an operation to cut sensory nerves in the spinal cord
• it reduces spasticity (stiffness) in the legs of tamariki/children with cerebral palsy
• SDR is currently not offered in Aotearoa New Zealand
• if you are thinking about SDR, talk to your local team and other Aotearoa New Zealand experts
• talk to them about whether SDR is the best option for your tamariki/child

What is selective dorsal rhizotomy?

Selective dorsal rhizotomy (SDR) is a permanent neurosurgical operation which reduces spasticity (stiffness) in the legs of tamariki/children with cerebral palsy (CP).

What does selective dorsal rhizotomy involve?

SDR is an operation to cut sensory nerves in the spinal cord. This reduces the spasticity (stiffness) in the legs.

It's important to remember that SDR surgery cannot be reversed or repeated. Cut nerves cannot grow back.

A hospital stay

The operation takes several hours and requires a hospital stay.

Intensive exercise programme

After the operation, children need an intensive exercise programme to get strong and moving again. This takes many months.

Who is suitable for selective dorsal rhizotomy?

Suitable

Tamariki/children who have:

• spasticity related to cerebral palsy (such as diplegia)

Not suitable

Tamariki/children who have:

• dystonia
• weakness
• contractures
• previous major orthopaedic surgeries

Best for

SDR is best for tamariki/children who are:

• aged 4 years and above
• have good strength
• can move their knee and foot separately

Tamariki/children who are GMFCS II to III show the best results.

See what the GMFCS levels mean (PDF, 230KB)

Find out more about cerebral palsy

What are the benefits of selective dorsal rhizotomy?

The benefits depend on function before surgery. Benefits include the following:

• permanent reduction in spascity (stiffness)
• improved movement ability and function
• improved balance (including sitting balance)
• better endurance
• there may be improved sleep
• less pain and muscle spasms
• it may be easier to use a standing frame, special seating and orthotics

Are there any risks to selective dorsal rhizotomy?

Possible complications

Complications after SDR are uncommon but can include:

• infection
• leak of cerebrospinal fluid
• fluid collection below the skin
• severe leg weakness
• loss of bladder control

Possible long-term complications

• sensory changes in the leg
• spinal curviture (scoliosis)
• more difficulty walking ot balancing

Is selective dorsal rhizotomy available in Aotearoa New Zealand?

SDR is currently not offered in Aotearoa New Zealand.

Most families who have accessed SDR have paid for an operation overseas

Most families/whānau have accessed SDR by paying for themselves for an operation in the USA or England.

Once back in Aotearoa New Zealand, your local therapy team may not be able to provide all the therapy your tamariki/child needs or that has been recommended. 

Without regular therapy, your child may not do as well after the operation.

The therapy that is needed

• intensive
• for up to 2 years after the operation

Therapy includes:

• strengthening exercises
• coordination, balance and movement exercises

Children/tamariki need to be able to follow instructions and participate.

What are the important considerations for selective dorsal rhizotomy?

Remember, SDR cannot be reversed.

If you and your family/whānau are thinking about SDR for your child, talk to your local team and other Aotearoa New Zealand experts. Talk about whether SDR is the best option for your tamariki/child.