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Tests and Treatments

Selective Dorsal Rhizotomy (SDR) Surgery

 

Selective dorsal rhizotomy (SDR) surgery is a procedure that treats muscle spasticity caused by abnormal communication among the brain, spinal cord, nerves and muscles. It corrects muscle spasticity by cutting the nerve rootlets in the spinal cord that are sending abnormal signals to the muscles.

SDR surgery is a treatment for cerebral palsy

Selective Dorsal Rhisotomy surgery benefits children who are affected by spasticity. Children aged 4 to 7 are the best candidates for SDR surgery. Based on long-term outcomes research done at Gillette Children's, SDR surgery has been shown to:

  • Eliminate or reduce spasticity.
  • Improve walking patterns.
  • Preserve walking speed

Research also showed small trends:

  • Positive impact on stiffness
  • Positive impact on knee extension

Your care team will talk with you in detail about the outcomes you can expect for your child. 

Selective Dorsal Rhizotomy Doctors

The team of experts includes a neurosurgeon, a pediatric rehabilitation medicine physician and a physical therapist.

 

Who Benefits From Selective Dorsal Rhizotomy Surgery or SDR Surgery?

Selective Dorsal Rhizotomy surgery is irreversible, so it’s critical to carefully select patients who will benefit most from the surgery. When evaluating candidates for SDR surgery, a team of experts including a neurosurgeon, a pediatric rehabilitation medicine physician and a physical therapist will consider:

  • Cerebral palsy type: The best candidates for SDR surgery typically have spastic diplegic cerebral palsy that affects the legs more than the arms.
  • Gross motor function: If your child is at levels I, II or III on the Gross Motor Function Classification System – Expanded & Revised (GMFCS–E&R)—meaning they can walk and are expected to continue walking—they might be a good candidate.
  • Gait analysis data: Gait analysis can indicate whether abnormal movement patterns stem from spasticity or another movement disorder. It also quantifies how much energy is used when walking by measuring oxygen consumption. Candidates for SDR surgery often require 200 to 600 percent more energy to walk than others do.
  • Age: If your child is age 4 to 7, they are typically candidates for SDR surgery, but older children can benefit from the procedure as well.
  • Cognitive abilities: Because SDR surgery requires extensive rehabilitation, the best candidates are cognitively able to follow directions and participate in therapy.

If your child is a candidate for SDR surgery, they will undergo a spasticity evaluation, which includes a physical examination and gait and motion analysis.

At Gillette Children’s, your child’s growth, challenges and expected outcomes will be assessed by specialists who are trained to work with kids. Once your child is identified as a good candidate for surgery, we’ll work with your family to plan a time for surgery and rehabilitation that will work with your schedule.

As a regional leader in pediatric neurosurgery, Gillette is one of the top providers of SDR surgery in the U.S. Patients from across the world come to Gillette for SDR surgery.

 

Video - Selective Dorsal Rhizotomy Surgery | Treatment for Cerebral Palsy

Gillette Children's offers many spasticity treatment options for children with cerebral palsy. In children who have cerebral palsy, spasticity takes the form of muscle tightness that can inhibit normal movement. Treatment options at Gillette Children's range from botulinum toxin and phenol injections to intrathecal baclofen pumps to selective dorsal rhizotomy surgery—depending on the child's age and level of involvement. Treatments for spasticity focus foremost on improving the quality of life for the patient with cerebral palsy.

We first learned about Abby's diagnosis when she was about a year and a half old. I think I was overwhelmed. I think there was some denial involved. It was very hard to admit that this perfect little baby maybe wasn't exactly what I thought it was going to be.
 
Abby, when she was little I think she must have been 3 or 4 when we first saw her and I first had a chance to see her. She had a lot of spasticity. She unfortunately also had a lot of weakness.
 
Spasticity or tone in the context of cerebral palsy, takes the form of tightness in the muscles.
 
Spasticity has a variety different treatment options and it depends on the age of the child, the level of spasticity and the general diagnosis. But, we have things that range from simple range of motion exercises, braces or splints, orthopedic surgery, botulinum toxin injections, Dafina blocks, Rosatom ease intrathecal baclofen pumps,-- it runs a whole gamut of different types of treatments that we are able to provide here at Gillette. The treatments that Abby has had done here have impacted every aspect of her life. It has just been a positive influence on her and us as well.

We can't always get rid of spasticity completely, but we do have treatments that can improve spasticity or the tightness or abnormal tightness of those muscles. If we can help them do more for themselves and be easier to take care of and more comfortable and those are the kinds of things we look at trying to provide. For the goal of each of the two surgeries, the rhizotomy and baclofen pump placement is to reduce tone to improve the patient's function, make them more comfortable, make them easier to care for and prevent future orthopedic deformities. Selective dorsal rhizotomy surgery involves dissecting out sensory rootlets within the spinal canal, cutting the abnormal ones and thereby decreasing abnormal signals to the motor system and decreasing tone at each level. We dissect out anywhere from five to twenty rootlets and typically here at Gillette we end up cutting twenty to forty percent of the rootlets.

They've done a few different things to improve my mobility and so I won't be in a wheelchair when I'm 20. But, there's still more to be done. Physical therapists are making everything fun in physical therapy. Sometimes it isn't fun, -- it's a long process.

There's some long tough hauls there and some things that they have to go through to get better. After that type of a surgery an intrical baclofen pump is an implanted device that delivers drug via pump placed in the abdomen. A nice thing about a baclofen pump is that the results are all reversible. So, if the amount of tone reduction is too much, the amount of drug delivered can be reduced and if for whatever reason the pump doesn't work, it can be removed.

What we want for Abby is to continue functioning, improving, living life to the fullest-- all things that Gillette has helped her achieve. Abby knows that she has cerebral palsy but she lives her life with the motto that there's nothing she can't do.
 
The doctors at Gillette make me feel like I can do anything I want and they'll help you do it.

 

A Guide for Families | Selective Dorsal Rhizotomy

Gillette Children’s Specialty Healthcare is one of the top providers of selective dorsal rhizotomy (SDR) surgery in the United States. People from throughout the nation and the world come here for the procedure. View A Guide for Families | Selective Dorsal Rhizotomy