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Selective Dorsal Rhizotomy (SDR) Surgery: A Treatment for Muscle Spasticity
What is Selective Dorsal Rhizotomy (SDR) Surgery?
Selective Dorsal Rhizotomy is a neurosurgery that permanently reduces spasticity (muscle tightness) in people with conditions such as cerebral palsy. In the lower spinal cord, the surgery cuts certain sensory nerve fibres, thereby making the legs stiff and have an irregular muscle tone.
Brain injury can interrupt the normal connectivity of signals between the brain and muscles. This is called spasticity. It makes the muscles contract continuously and can make moving difficult and painful and lead to joint deformities, among other outcomes, over the years. SDR surgery helps restore the right balance of muscle tone by cutting only the nerve rootlets that cause damage. It does not influence other functions.
How Does SDR Surgery Work?
A neurosurgeon does a minor cut in the lower back when performing SDR surgery to reach the spinal cord. To do so, the surgeon uses specialised tools and electrophysiological monitoring to identify and isolate the sensory nerve roots from the motor nerve roots. Next, each sensory nerve rootlet is examined to identify which ones are sending out abnormal signals that cause spasticity.
The abnormal nerve rootlets are cut out, and the normal ones preserved. That method is particularly sensitive to the type of nerve connections involved and is used to ensure that only the trouble-causing nerves are cut off, resulting in improved muscle function and fewer side effects. It generally takes four to five hours for the surgery to complete.
Who is a Candidate for SDR Surgery?
SDR surgery is mainly suggested for children with spastic cerebral palsy, especially those with spastic diplegia (which mostly affects the legs) or spastic quadriplegia (which affects all four limbs). The best candidates usually:
- The process works best for children between the ages of 3 and 10, but it can also work for older children and some adults.
- They should have spasticity as their primary movement disorder, rather than dystonia or athetosis.
- Show good strength and motor control at the base level.
- Be able to think clearly enough to take part in intensive rehab.
- Get full post-surgery therapy services.
Before suggesting SDR surgery, a team of experts from different fields carefully looks at the patient, including their physical condition, walking style, MRI scans, and other tests to see if the surgery will help them.
The SDR Surgical Procedure
The SDR procedure consists of a number of carefully planned steps:
- The patient is given general anaesthesia so they don’t feel any pain during the surgery.
- The neurosurgeon cuts a small hole in the middle of the lower back.
- To show the nerve fibres underneath, muscles, bones, and the covering of the spinal cord (dura) are cut away to make a small “window” in the spine.
- The surgeon finds the motor nerves and separates them from the sensory nerves. This keeps the motor nerves safe during the surgery.
- Electrodes are put on sensory nerve roots, and electromyography (EMG) is used to stimulate the nerves and find out which ones are causing spasticity.
- The surgeon cuts off a part of the abnormal sensory nerves. The nerves and amount that are cut off are different for each patient.
- After the nerve cutting is done, the incision is closed up in layers.
The patient is closely watched in a recovery room after surgery, which is usually in the intensive care unit (ICU). The whole process takes about 4 to 5 hours, and after the surgery, you will need to stay in the hospital for about 5 days.
Success Rates and Effectiveness of SDR Surgery
Clinical data from top hospitals demonstrates that SDR surgery is very effective at lowering spasticity. Studies from Great Ormond Street Hospital (GOSH) show that 97% of children had a big drop in muscle tone after SDR surgery. For most muscle groups, the average Modified Ashworth Scale (MAS) score went from between 2 and 4 before surgery to 0 two years after surgery.
For children with GMFCS levels II and III (a way to rate motor function in cerebral palsy), gross motor function always gets better. After two years, GMFM-66 scores (a standardised test) went up by an average of 6.60 points for level II children and 5.44 points for level III children.
Quality of life evaluations reveal significant improvements, particularly in physical functioning, pain relief, and family health. Parents say that after their children have successful SDR and rehab, they are more comfortable, mobile, and independent.
Cost Analysis of SDR Surgery
The price of SDR surgery can be completely unique depending on where it is done, what hospital it is done at, and whether national healthcare or private insurance pays for it.
| Country/Region | Estimated Cost Range | Coverage Notes |
| UK (NHS) | Fully covered for eligible patients | Available at 5 specialist centers for qualifying cases |
| UK (Private) | £23,000 – £35,000 | Includes surgery and initial rehabilitation |
| USA | $40,000 – $70,000 | Varies by insurance coverage |
NHS Coverage in the UK
In the UK, the NHS offers SDR surgery at five specialised centres for children who meet certain clinical criteria. Some of these centres are: Great Ormond Street Hospital in London, Alder Hey Children’s Hospital in Liverpool, Bristol Royal Hospital for Children, Leeds Teaching Hospital, and Nottingham University Hospital.
Private treatment is an option for patients who don’t meet NHS standards but might still benefit from the procedure. This includes children with GMFCS level IV, for whom NHS services don’t currently pay for the surgery, but it may be right for some children.
After surgery, you will need to consider the extra costs of rehabilitation, which is very intensive and lasts for several months. If healthcare systems don’t cover this fully, it can cost a lot more.
SDR for Adults vs. Children
SDR in Children
- Perfect age range: 3 to 10 years.
- Better neuroplasticity makes it easier to adapt.
- Intervening earlier stops secondary problems from happening.
- Usually shows better functional results.
- Rehabilitation progress is usually quicker.
SDR in Adults
- Not as common, but can be beneficial in some situations.
- It could potentially mitigate the appearance of ageing caused by spasticity.
- It takes a longer time to adjust to changes in muscle tone.
- Increased likelihood of numbness and sensory alterations.
- Needs a stronger commitment to rehabilitation.
SDR is generally performed on children, though adults with spastic cerebral palsy or other causes of spasticity can also benefit from the procedure in some cases. When making a decision whether to have adult SDR, you have many factors to consider, including your overall health, the severity of your spasticity, your functional goals, and your willingness to go through rehabilitation.
Studies have shown that those who receive SDR are able to improve such abilities as ambulation, sitting, standing, and equilibrium, as well as to improve endurance and activity levels.
However, the rehabilitation process may be more challenging for adults who have lived with spasticity for many years and developed compensatory movement patterns.
What to Expect Before and After SDR Surgery
After successful SDR surgery and rehabilitation, people usually see improvements in their posture and ability to move around.
Before Surgery
- Muscle stiffness and tightness that are easy to see
- Scissoring gait patterns while walking
- Joints that don’t move very much
- Problems with balance and coordination
- Pain or discomfort when moving
- Challenges with daily tasks and taking care of oneself
After Surgery and Rehabilitation
- A big drop in muscle tightness
- There has been an improvement in walking and gait patterns
- More movement in the joints
- Better balance and a lower chance of falling
- Less pain from spasticity
- More freedom in everyday tasks
The video above shows how much progress can be made after SDR surgery and a lot of hard work in rehab. When the right kind of therapy follows the procedure, most patients see significant improvements in their mobility and quality of life. However, the results are different for each person.
Timeline for recovery and the process of rehabilitation
It takes a lot of work to recover from SDR surgery, and you need to be committed to intensive rehabilitation. During the recovery process, you can expect the following:
Right after the surgery (Days 1–5)
- Stay in the hospital for about 5 days
- The first 24 to 48 hours should be spent lying flat to protect the surgery site
- Managing and keeping an eye on pain
- Gentle physical therapy starts 2–3 days after surgery
First Week to Sixth Week of Recovery
- Daily physical therapy sessions that focus on range of motion
- Muscles previously hidden by spasticity gradually strengthen
- Getting used to moving with a new muscular tone
- Temporary bracing may be used for support
Months 2–6: Intermediate Recovery
- Continued intensive physical and occupational therapy (3–5 times a week)
- Pay attention to movements and activities that are useful
- Training your gait and doing balance exercises
- Making the muscles in your core and legs stronger
Recovery over a long period of time (6 months or more)
- Therapy that continues at a lower frequency
- Strength and function keep getting better
- Improving how you walk and your motor skills
- Usually, the best results happen 1 to 2 years after surgery
StandSure Helps With SDR Rehabilitation
Physiotherapists helped design the StandSure board, which gives important standing support during the recovery period after SDR surgery. This specialised equipment helps patients get their bodies back in the right position, balance, and strength during this important time of recovery.
How StandSure Helps with SDR Recovery
For the best results after SDR surgery, rehabilitation must be done correctly. The StandSure board was made with the help of experienced physiotherapists and provides specialised support during this important healing time.
StandSure’s main benefits for SDR patients
- Offers stable support for exercises that require standing
- Helps with excellent posture and alignment
- Helps with weight-bearing activities that are beneficial for bone health
- Allows balance training to move forward slowly
- Helps build strength in the legs and core
- You can use it at home between therapy sessions
How StandSure Helps Physiotherapists
- Building up your ability to stand over time
- Exercises that help you control your weight
- Activities for dynamic balance
- Tasks for functional reaching and manipulation
- Exercises that make you stronger over time
- Getting ready to stand on your own
Support Your Child’s SDR Recovery Journey
The StandSure board is a great tool for therapy at home between professional sessions. It helps you get the most out of SDR surgery by letting you practice standing and balancing on a regular basis.
Pros and Cons of SDR Surgery
Advantages of SDR Surgery
- Long-lasting decrease in spasticity
- Better ability to move around and walk
- More movement in the joints
- Less pain from tight muscles
- Stopping bones and joints from getting misshapen
- More independence in daily tasks
- Better quality of life
- Less need for repeat treatments like Botox
Things to think about and risks
- Risks of surgery (infection, bleeding, and anaesthesia)
- Possibility of cerebrospinal fluid leakage
- RUncommon risk of sensory alterations or numbness
- Minimal chance of changes in how the bladder and bowels work
- Needs a lot of dedication to rehabilitation
- The initial weakness may be temporarily heightened
- Not appropriate for every form of cerebral palsy
- If not covered by healthcare, the cost is high
Before going ahead with SDR surgery, a multidisciplinary team of specialists should carefully consider the individual case and decide if the possible benefits are worth the risks for that patient.
Top SDR Centres in the UK
There are a number of specialist centres in the UK that do SDR surgery. Each one has a team of experienced professionals from different fields who work together to give patients with cerebral palsy the best care possible.
Great Ormond Street Hospital
London
- Set up SDR service in 2013
- One of the five centres is run by the NHS
- Full monitoring of outcomes
- Team with a lot of experience in different fields
Bristol Royal Hospital for Children
Bristol
- The Centre for Special Neurosurgery
- A clinic just for SDR assessments
- Full rehabilitation program
- Strong background in research
Leeds Teaching Hospital
Leeds
- The SDR centre that the NHS pays for
- Team of experienced paediatric neurosurgeons
- Services for rehabilitation that work together
- The collaborative care method
When choosing a centre for SDR surgery, think about things like how experienced the team is with the procedure, how they choose patients, how thorough their rehabilitation program is, and how well they have done it in the past. Most centres hold informational sessions or consultations to help families make wise choices.
Common Questions About SDR Surgery
How often does SDR surgery work?
Research indicates that more than 95% of patients exhibit substantial alleviation of spasticity subsequent to SDR surgery. Functional improvements vary based on the individual’s condition before surgery, with most children showing improvements in mobility, comfort, and quality of life when the procedure is combined with appropriate rehabilitation.
At what age is it most beneficial for SDR surgery?
SDR can be performed on people of any age, although most physicians deem it best for children between the ages of 3 and 10. This is typically the age range with the best combination of neuroplasticity (the brain’s ability to change) and intensive rehabilitation. But in some instances older children, teenagers, and even certain adults can take advantage of the therapy process as well.
How long does it take to heal after SDR surgery?
Most people stay in the hospital for five days at first. Intensive rehabilitation lasts for 3 to 6 months after surgery, which includes therapy sessions multiple times a week. Most patients keep getting better for one to two years after surgery as they get stronger and learn new ways to move. It usually takes two years after surgery for all of the benefits of SDR to show up.
Will my child need to use things like the StandSure board while they are recovering?
During SDR rehabilitation, people often use specialised equipment, like the StandSure board, to help with proper alignment, balance training, and strength building. These tools give you the stability you need to safely practise new movement patterns while also building the strength and coordination that spasticity used to limit. Your physiotherapist can suggest certain pieces of equipment that would help your child’s specific rehabilitation needs.
Does the NHS in the UK pay for SDR surgery?
Yes, the NHS offers SDR surgery at five specialist centres for children who meet certain medical requirements, usually those with spastic-diplegic cerebral palsy in GMFCS levels II and III. Children with GMFCS level IV may be able to have the procedure, but NHS services don’t pay for it right now, so the family would have to pay for it themselves.
What does the scar from SDR surgery look like?
A modern SDR surgery usually leaves a single vertical scar on the lower back that is about 4 to 6 cm long. Clothes usually hide the scar well, and it gradually fades over time. Surgeons use delicate closure techniques to minimise scarring; most patients say the cosmetic results are not as bad as the functional benefits of performing the procedure.
Final Thoughts: Choosing SDR Surgery Wisely
For spasticity (and in particular for children with cerebral palsy), Selective Dorsal Rhizotomy (SDR) surgery has many promising benefits. With the proper rehabilitation, the procedure may permanently loosen tight muscles, help patients move around a bit easier, lessen pain, and improve their overall quality of life. Thinking about SDR surgery also requires skilled specialists to evaluate your eligibility, correctly perform the surgery itself, and support you in recovery. The process takes a serious dedication to intensive therapy, but the reality is that many patients will benefit from the long-term effects that will change the way they live.
The StandSure board and other specialised equipment can help patients get used to their new muscular tone and movement patterns by helping them develop proper alignment, balance, and strength.
Help Your SDR Recovery Journey
Developed by a Physiotherapist the StandSure board with over 10 years research plays a crucial role in the rehabilitation process following SDR surgery.
