Selection Criteria

Selective Dorsal Rhizotomy - SDR
NHS GGC

We accept referrals for both ambulant and non-ambulant children with cerebral palsy. The aims for surgery for those children with GMFCS 2 -3 is to improve gait and for children with GMFCS 4/5 the aim is to improve care and comfort. Children with GMFCS level 1 are not considered for surgery.

If, after careful consideration, SDR is not recommended for a child the Multi-disiplinary Team (MDT) will give guidance to the child's referring team and to the family/carers on what alternative interventions may be appropriate to improve function and quality of life.

The selection criteria for the SDR service have been established based on consideration from the MDT team and using the best evidence. A database has been established for purposes of learning and further development of the service.

Children with GMFCS 2-3 level

Inclusion Criteria

  • Diagnosis of Cerebral Palsy
  • Age Range 4-10 
  • Established as a 2-3 level on the GMFC Scale
  • Demonstrable lower limb spasticity
  • Predominant white matter injury (Peri Ventricular Leukomalacia) on MRI brain scan
  • Adequate lower limb extension power >3 or MRC Oxford scale
  • Adequate selective control of lower limbs
  • Good control of spinal posture and balance 
  • Able to understand and comply with rehabilitation with good cognitive ability
  • Well motivated and emotionally robust with evidence of compliance with physio/orthoses
  • Good family/social support and a commitment to participation in rehabilitation following surgery

Exclusion Criteria

  • predominant motor pattern of dystonia or involuntary movements
  • significant basal ganglia changes on MRI brain scan
  • significant contractures (may require orthopaedic assessment and intervention)
  • Hip migration index > 30%
  • Scoliosis
  • Significant upper limb disfunction that impairs the ability to use a walking aid
  • Other sever chronic medical conditions (would need to be considered on a case by case basis)

Children with GMFCS 4-5 level

Inclusion Criteria

  • Diagnosis of Cerebral Palsy
  • Age over 4 years
  • Established as a 4-5 level on the GMFC Scale
  • Demonstrable lower limb spasticity.
  • Predominant white matter injury (Peri Ventricular Leukomalacia) on MRI brain scan.
  • Requirement for adjuvant tone treatment
  • significant difficulties with positioning, personal care, supported standing and pain.

Exclusion Criteria

  • predominant motor pattern of dystonia or involuntary movements
  • significant basal ganglia changes on MRI brain scan.
  • significant contractures (may require orthopaedic assessment and intervention)
  • Hip migration index >30%
  • Previous spinal fusion can be a contraindication.
  • Other severe chronic medical conditions (would need to be considered on a case by case basis)

Radiology Required Input

Investigations/imaging of areas of the following skeletal structures are normally required to ensure that the patient is suitable for surgery:-

  • Hip Xray                - to ensure there is no hip dysplasia (<40% Reimers index).
  • Spinal Xray/MRI   - to clarify there is no scoliosis.
  • Cranial MRI           - to confirm there are no basal ganglia changes.