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SDR Surgery: What Is It and Who Should Have It?

Selective dorsal rhizotomy is a surgical procedure that has been practiced for over 100 years in some form, although accounts differ as to who first performed the surgery. During this procedure, an incision is made in the lower back, the spinal cord is opened up, and the nerves that cause the spasticity are extracted and cut. The normal nerves are left intact. (This is of course a vastly simplified description of a very complex procedure: you can read more about it here Center for Cerebral Palsy Spasticity and here Selective Dorsal Rhizotomy)

As mentioned in the previous post, Spastic Cerebral Palsy: What Is It?, SDR surgery is not appropriate for everyone, and there are other options for treatment. It is important to note, too, that sometimes orthopedic surgery will be needed in addition to SDR surgery because orthopedic surgery addresses different issues than SDR surgery does. Orthopedic surgery is intended to increase the range of movement of the patient’s joints, and while this can be improved as a side benefit of SDR surgery, that isn’t one of its main purposes. Thus, although things such as physical therapy and splints can help improve joint movement after SDR surgery, it is possible that the patient will still need the help of an orthopedic surgeon. In other words, as wonderful as SDR surgery is, it is not a cure-all.

A consultation with the patient’s team of physicians is the only way to know for certain if he or she is a good candidate for SDR surgery, but there are a few general guidelines to go by.
• Age: The patient is ideally between the ages of 2 and 6, although some hospitals will perform the procedure through the age of 40.
• Type of cerebral palsy: The patient must have spastic diplegia, spastic hemiplegia, or spastic quadriplegia. Patients whose spasticity is mostly in their legs generally have the best results.
• Mobility history: The patient must be able to get around to some degree unassisted, even if this means only that he or she can crawl without an aid.
• Temperament: The patient must exhibit signs of being able and willing to follow the procedure up with intensive physical therapy and the motivation to continue therapy long term in order to truly benefit from the surgery.
There are additional requirements at different hospitals, but these are the basics. There is a shorter list of reasons someone would not be able to have SDR surgery, including having had meningitis or head trauma, having severe scoliosis, or having dystonic cerebral palsy. After SDR Surgery: What Can You Expect?