SDR
What is it: Surgery to reduce spasticity by cutting specific spinal nerves.AKA: Selective Dorsal Rhizotomy- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
3 Resources
Referenced in this guide
40 Research papers
Referenced in this guide
3 Expert views
Contributed in this guide
38 Patient views
Contributed in this guide
Figure out what SDR means for you
Page contents
Basics: What you need to know
Selective Dorsal Rhizotomy (SDR) is a specialized surgery that aims to reduce spasticity—unwanted tightness in muscles—commonly linked with Cerebral Palsy. By carefully cutting certain nerve fibers in the spine, doctors hope to lessen the signals that produce excessive muscle contraction. This approach can help individuals experience greater freedom of movement and better control of their daily activities. While it has shown encouraging outcomes for many, it is crucial to understand the potential risks, including surgical complications and the possibility that some people might not respond as well as others.
History and development
- Early Foundation: Early 20th-century neurologist Dr. Otfrid Foerster performed some of the first rhizotomy procedures, exploring ways to relieve muscle rigidity.
- Major Contribution: In the late 1980s, Dr. T.S. Park at St. Louis Children’s Hospital refined SDR, making it more effective and safer for children with spastic cerebral palsy.
- Refined Techniques: Advancements in microscope use and nerve testing have steadily improved the precision of the procedure, improving results and minimizing complications.
- Global Adoption: Hospitals worldwide now use SDR as an option, especially for children whose spasticity does not respond well to less-invasive treatments.
What is known
- Reduced Spasticity: SDR directly targets overactive nerve signals, helping to loosen tight leg muscles and improve walking ability.
- Long-Term Gains: Many children experience sustained benefits with better mobility, balance, and sometimes increased independence.
- Physical Therapy Needs: Extensive post-surgery physical therapy is essential to teach muscles how to move with reduced spasticity, ensuring the best possible outcomes.
- Secondary Benefits: Some families report fewer muscle spasms at night and a possible reduction in pain or discomfort during daily tasks.
What is not known
- Exact Candidate Criteria: While MRI scans and nerve responses guide selection, there is no absolute standard indicating who will benefit the most.
- Full Lifespan Impact: Research on outcomes over decades is limited, so it is still unclear how benefits hold up as patients grow older.
- Influence on Other Symptoms: Some cerebral palsy features, like coordination problems or speech difficulties, may not improve through SDR, and the degree of indirect improvements is uncertain.
- Rare Risk Profile: Instances of nerve damage or worsened spasticity are rare, but it remains unknown how often subtle negative effects might appear later.
- Focused Nerve Cutting: Surgeons identify and cut the nerve fibers sending too many signals to tight muscles.
- Spinal Precision: A small opening in the lower spine allows direct access to these nerves.
- Electrical Testing: Teams use monitors to confirm which nerves over-activate muscles, guiding targeted cuts.
- Reduced Tightness: With fewer spasm signals, muscles relax and become easier to move.
- Nerve Damage: Rare but possible, leading to numbness or additional muscle weakness.
- Spine Issues: Potential risk of back pain or spinal instability if healing is slow.
- Infection Risk: Any major operation exposes patients to the possibility of infection.
- Worsened Spasticity: In rare cases, muscle tightness can shift or intensify instead of improving.
- Age Factor: Some argue that younger children benefit more, doubting its effectiveness in older patients.
- Physical Therapy Load: Critics say the intense therapy and rehab might be too demanding for some families.
- Possible Over-Promise: Some feel individual results can be unpredictable, so high expectations can lead to disappointment.
- Cost Concerns: The surgery and extended rehab can be expensive, and insurance coverage varies.
Patient views
Experiences
- Patients appreciate reduced spasticity and improved mobility.
- Many report increased independence and quality of life.
- Some experience better sleep and reduced pain post-surgery.
- SDR is seen as life-changing by many patients.
Challenges
- Some experience permanent loss of sensation or numbness.
- The procedure is expensive and requires extensive rehab.
- Not all patients see expected improvements in gait.
- Concerns about long-term complications and side effects.
Tips
- Emphasize the importance of post-surgery physical therapy.
- Research and choose experienced surgeons for better outcomes.
- Set realistic expectations for recovery and improvements.
- Consider the financial and emotional commitment required.
To calculate the reported effectiveness for a patient view, the model first analyses whether it can be ascertained that the person writing the review has had direct experience of the treatment for themselves or a loved one. If so, it then uses sentiment analysis to rate their view from 1-5 on how effective this treatment was for them, with 1 being the least effective, and 5 the most effective.
Patient view
My son’s body was immediately less tense. He went from only being able to walk with a walker to walking independently in all environments within one year. Prior to surgery he could take some haphazard independent steps on his very high tiptoes. He could put heals to the ground when standing still with support but as some as he went to move, the spasticity would kick in. This was no longer an issue after surgery. The below video was taken 1 year after surgery. He also began making short sentences for the first time while lying down at the hospital. It was as though he had more breath to speak. Prior to this he could only say a handful of single unclear words. He has in the 3 years since SDR become fully verbal. His overall happiness has greatly improved.
January 2024 • Turnto Consumer Review
Patient view
SDR reduced Hannahs spasticity so much so that she is able to sit cross legged, she can undress herself, and climb into the bath. She was unable to move her limbs esp. her legs so easily before. We have managed to come off Baclofen as well, she sleeps better also.
I think it was a game changer for her.
June 2024 • Turnto Consumer Review
Expert views
What they liked
- Experts appreciate SDR's ability to reduce leg spasticity.
- SDR is effective for children with bilateral spastic cerebral palsy.
- Experts note improved functional mobility post-SDR.
- SDR is praised for long-term spasticity reduction.
What they didn't like
- SDR is irreversible, making it a permanent decision.
- Weakness can become a primary issue post-SDR.
- Experts note SDR's limited effect on dystonia.
- Recovery requires intensive, long-term rehabilitation.
What are they unsure about
- Experts are unsure about SDR's long-term impact on motor function.
- Uncertainty exists about SDR's effect on activity and participation.
- Experts question SDR's suitability for mixed motor types.
- Long-term outcomes of SDR are still being studied.
3 expert views
Expert view
Selective Dorsal Rhizotomy (SDR) is a surgical procedure that can help children with cerebral palsy by reducing spasticity in their lower limbs. This surgery is particularly effective for children with bilateral spastic cerebral palsy who want to improve their mobility or walking. In Australia, there is a careful selection process to determine which children are suitable for SDR, focusing on those with spasticity as their main motor issue. Evidence shows that children with this specific condition benefit the most from the surgery, while those with mixed motor types may not see the same results.
September 2024 • The Selective Dorsal Rhizotomy and bridging the gap: co-designing a decision aid for informed decision making.
Expert view
Selective Dorsal Rhizotomy (SDR) is a significant surgery for individuals with spastic diplegia, a common type of cerebral palsy. The surgery involves making an incision in the spine, which can be serious due to the spinal cord's importance, but recovery can be relatively quick. After the surgery, patients typically need to rest flat for 72 hours to allow healing, which can be boring but is necessary to prevent complications. Gradually, patients can start moving again, and many report improvements in their ability to walk and perform daily activities. For example, one patient noted that three years post-surgery, they could walk independently at home and had improved flexibility, allowing them to sit cross-legged for the first time as an adult. However, some patients may experience changes in sensation, such as feeling cold in their feet.
December 2024 • Gillette Children’s Healthcare Series
What and who it targets
Ambulatory with limitations
Potential to boost walking efficiency
Children with diplegia
Better outcomes from targeted spasticity reduction
Stable trunk control
Ensures effective rehabilitation post-surgery
Ages three to ten
Optimal neuroplasticity and motor development potential
Relevant research
How much evidence on this?
- SDR has been studied for over 30 years.
- Numerous studies and reviews support SDR's effectiveness.
- Over 50 research papers and clinical trials available.
- Consistent findings across multiple large-scale studies.
Research focusing on
- SDR reduces spasticity and improves motor function.
- Post-SDR, many patients report improved quality of life.
- Common side effects include temporary numbness.
- Researchers are exploring SDR's long-term effects.
What needs more research?
- Long-term impact on muscle strength remains unclear.
- Optimal age for SDR is still debated.
- Effects on non-ambulatory patients need more study.
- Long-term spinal deformity risks are uncertain.
- ⬤ Minimal research: Very little scientific study exists, with no or very few peer-reviewed studies. Insufficient data for conclusions.
- ⬤⬤ Limited research: Few studies exist, mostly small trials or case reports. Findings are preliminary and lack strong validation.
- ⬤⬤⬤ Moderately researched: Multiple studies, including mid-sized trials, exist. Some findings are replicated, but more research is needed.
- ⬤⬤⬤⬤ Well-researched: Supported by substantial evidence, including at least one large trial or meta-analysis.
- ⬤⬤⬤⬤⬤ Extensively studied: Numerous large studies and meta-analyses exist. Findings are widely accepted with strong scientific consensus.
Research
This paper investigated the outcomes of two different surgical techniques used in selective dorsal rhizotomy (SDR) for children with spastic cerebral palsy. The researchers looked at children who had undergone SDR between 1997 and 2016, comparing the results of single-level laminectomy (SLL) and multiple-level laminotomy (MLL) in terms of various physical and functional improvements one year after surgery.
The study found that both surgical methods led to significant improvements in spasticity, joint movement, walking patterns, and overall physical activity. However, the SLL technique showed a greater improvement in ankle movement during walking compared to MLL, with an average increase of 7.59 degrees versus just 0.29 degrees for MLL. The rates of scoliosis, a curvature of the spine, were similar for both techniques, indicating that neither method significantly increased this risk.
For families dealing with cerebral palsy, this research suggests that SDR can lead to meaningful improvements in mobility and daily activities for their children. The choice between SLL and MLL may depend on specific goals, as SLL appears to offer better results for ankle movement without increasing the risk of scoliosis.
This paper is reliable as it is a retrospective cohort study published in the reputable journal Neurosurgery. The long time frame of the study and the number of patients involved (60 children) provide a solid basis for the findings, making it relevant for understanding the effectiveness of SDR techniques.
July 2022 • Neurosurgery
Research
This paper investigates the effectiveness of selective dorsal rhizotomy (SDR) combined with physiotherapy (SDR+PT) compared to physiotherapy alone (PT-only) in children with spastic diplegia. The study analyzed data from three randomized clinical trials, focusing on outcomes related to spasticity and motor function over a period of 9 to 12 months after treatment.
January 2002 • Developmental medicine and child neurology
Accessibility
- ⬤ Extremely Difficult to Access: Rare, experimental, or highly specialized. Requires multiple referrals, long wait times, travel, and strict follow-up.
- ⬤⬤ Difficult to Access: Limited to select centers with moderate barriers. Requires referral, potential travel, and wait times of weeks to months.
- ⬤⬤⬤ Moderately Accessible: Available in larger hospitals or clinics. Requires a basic referral, with moderate wait times and some coordination.
- ⬤⬤⬤⬤ Easy to Access: Widely available in most clinics. Minimal referral, short wait times, and simple preparation or follow-up.
- ⬤⬤⬤⬤⬤ Trivial to Access: Easily found in pharmacies or clinics. No referral needed, minimal wait, and straightforward access.
- ⬤ Up to $100
- ⬤⬤ Up to $500
- ⬤⬤⬤ Up to $2000
- ⬤⬤⬤⬤ Up to $10,000
- ⬤⬤⬤⬤⬤ More than $10,000
Method to access
- Typically performed in specialized clinics and hospitals.
- Requires referral from a specialist.
- Involves pre-surgical evaluations and post-operative rehabilitation.
Cost
- Costs for SDR surgery range from approximately $25,000 to $50,000.
- In the UK, costs are around £20,000 to £30,000.
- Additional expenses may include travel, accommodation, and rehabilitation.
Insurance cover
- Often covered by insurance in the United States, but coverage varies by plan and state.
- In the UK, it may be covered by the NHS under specific conditions.
- Coverage in other regions varies widely, often requiring detailed policy review.
Locations
- Boston Children's Hospital, USA: Known for advanced treatments in cerebral palsy.
- Mayo Clinic, USA: Offers comprehensive care for cerebral palsy.
- St. Louis Children's Hospital, USA: World leader in SDR surgery.
- Nationwide Children's Hospital, USA: Offers specialized SDR programs.
- Other specialized pediatric hospitals globally may offer SDR.
Related clinical trials
Frequently asked questions
Key resources
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