I am a parent/carer.....What do I need to know about SDR surgery?

Selective Dorsal Rhizotomy - SDR
NHS GGC
The surgery is carried out if it will help your child with their tight leg muscles.
Your will know and will have seen the pain and how hard it can be for your child to move their legs.
The aim is to release the tightness and make movement easier for your child.

What happens during the SDR operation?

The treatment is carried out while your child is under asleep (with anaesthesia) and takes around 4 hours.
A cut in the skin is made in the spine around about waist level.  The muscles covering the spinal column are moved out of the way. A small part of bone is removed to gain access to the nerves in the spinal canal. It is kept to be put back in place after the treatment (this is called a laminoplasty).
There is a thin membrane which covers the spinal cord which is opened to allow access to the sensory nerve roots. 
Sensory roots cause the spasticity seen in some children with cerebral palsy.  Each of the sensory nerve roots is then split into a smaller rootlets. Each rootlet is stimulated. This is to show the ones that contribute most to the movement of your child's lower limbs. These rootlets are then cut.
The process is done again for all the other nerve roots on both legs. The aim is to cut the right number of sensory rootlets to lessen muscle tightness.
At the end of the surgery the membrane which covers the spinal cord is closed up again. The removed section of bone is put back into place and secured. The spine muscles are also put back in place. The skin is closed with stitches which will dissolve over time.

Where will the operation take place?

The surgery will take place at the Royal Hospital for Children, Glasgow.

What are the risks of SDR surgery?

This surgery can not be reversed and does carry some risks. The surgeon will explain these risks in full.
Complications don't occur very often and are rare but you would need to be aware of them.
They can include:
  • Infection
  • Leakage of cerebro- spinal fluid from the cut in the skin
  • Pus or flued below the skin where it was opened
  • Severe leg weakness
  • Weakness in holding in urine
  • General surgery risks
  • Curved spine (known as scoliosis) 

What happens on admission to hospital?

You will be asked to come into the ward to stay on the day before the treatment.
You and your child will be settled into the ward. A pre-operative check will take place to make sure your child is fit for the surgery. 
Further tests will take place with the SDR physiotherapist to see how much movement your child has. This will allow checks after the treatment to see if they are better at moving.  As part of this process a plan for on-going care will take place.
A check will take place with orthotics to make sure your child has not grown out of their current splints.  If they need new splints this will take place during your stay. They will be sorted out before your stay is complete.

What happens before the operation?

Your child's surgeon will visit you to explain about the operation in more detail. They will discuss any worries you might have with you. They will also ask you to give your permission for the operation by signing a consent form.
The nurses and doctors will complete the paper work and checks. A physiotherapist will also see you to do some final tests.
Your child will not be above to eat or drink at all for a few hours before the anaesthetic.  This is called 'fasting' or 'nil by mouth'.  This process makes it safer for your child and makes being sick less likely. This can cause problems during the treatment and cause a risk from sick going into the lungs. This can happen at the time of the treatment or after if food is given too soon before the surgery.
You will be able to stay with your child until they are asleep and go into the operating theatre.  You will be there with them when they wake up.

What should I bring into hospital during the Operation Stay?

When coming in for SDR please bring:
  • Your child's wheelchair (if your child already uses one).
  • AFOs and suitable footwear.
  • Long warm socks.
  • Shorts & T-shirt.
  • Pyjamas or nightgown, dressing gown and slippers.
Other items you may wish to bring with you are:
  • a cuddly toy, doll or teddy.
  • a comfy blanket and/or pillow.
  • story books or books to colour in.
  • reading books or comics
  • movies on DVD
  • tablet and/or mobile phone (you can connect to patient Wi-Fi on the ward).

What happens after the operation?

After the surgery your child will be on bedrest for a planned 24 to 48 hours.  They will likely experience pain at the site of surgery and this will be managed with medication.
While your child remains in bed they will likely have a urinary catheter in place for a short period of time. This is to drain off their urine into a bag (called a catheter). Some children complain of mild headache at this stage.  
It is normal for children's legs to feel different in the first week.  Some children describe the first few days like 'walking on clouds'.  Their legs may also be slightly weaker at this stage.
Physiotherapy will start gradually depending on the child's needs.
You should expect your child to be in hospital for up to 3 weeks prior to transfer back to your local community team.

Will my child need new orthotics?

As part of the assessment before surgery you will be assessed by a member of the orthotic team. 

Appropriate orthotics will be provided for after surgery, if this is required.

What happens when we get home?

Once you are home your child may tire more easily.  A gradual return to school may be helpful.  You and your child will continue physiotherapy rehab for up to 2 years depending on your child's needs.

There will be a review around 3 months after surgery to check the wound check up. 

Then physiotherapy or gait lab assessments will be carried out at 6 months, 1 year, 2 year, 5 year after surgery.

Ongoing physiotherapy and orthotic care will be carried out by your child's local orthotic team.