Does your child have Cerebral Palsy? Let's learn about this SDR surgery (Selective Dorsal Rhizotomy)

As a parent, how sad do you feel when you see your child suffering from Cerebral Palsy, having difficulty walking, running, jumping, and performing daily tasks? It is especially difficult to watch the child suffer from the extreme stiffness in the legs, that is, the stiffness in the muscles (spasticity), isn't it? Today we are talking about a special surgery that can help such children.

What is Selective Dorsal Rhizotomy (SDR)?

Simply put, Selective Dorsal Rhizotomy (SDR) is a surgical procedure performed to permanently reduce muscle stiffness (spasticity) in children with Cerebral Palsy.

This involves selectively cutting and removing some of the sensory nerve fibers in the lower spine that are causing the stiffness in the child's legs. But don't worry, this surgery will not paralyze the child's legs. It will also not affect the movement of the legs.

But one thing to keep in mind: To get the best results from this surgery, you need to undergo intensive physical therapy and rehabilitation programs after the surgery. Also, this surgery is not suitable for all children with cerebral palsy.

What conditions are treated with SDR surgery?

Doctors use this SDR surgery to treat muscle stiffness (spasticity) in children with cerebral palsy.

Cerebral palsy ( CP ) is a condition that affects a child's ability to control their muscles. It is caused by damage to the parts of the brain that control movement and coordination. Many children with CP have a condition called spasticity . This means that when a child tries to move, or sometimes even just stand still, some of the muscles suddenly contract and become stiff. This can make things like walking difficult, cause pain, and interfere with daily activities.

SDR surgery is mainly performed on children with Spastic Diplegic Cerebral Palsy, which affects only two legs, and Spastic Quadriplegic Cerebral Palsy, which severely affects all four limbs.

How does this surgery work?

Imagine, the normal tightness of the muscles in our body is controlled by a process in the nervous system in the spinal cord. In this, a sensory nerve brings information from the muscle to the spinal cord, and then a motor nerve goes back to that muscle and causes it to contract.

Normally, this process is controlled by messages from our brain. That means we can control our muscles as we want. However, in cerebral palsy, the brain's ability to control this is reduced. As a result, some muscles are constantly contracted and stiff.

SDR surgery can eliminate this excessive stiffness (spasticity). The surgeon selects and cuts only the abnormal sensory nerve rootlets that are causing this stiffness. This is why it is possible to reduce the stiffness without affecting other functions. During the surgery, all of these nerves are tested to find out exactly which nerves are working well and which nerves are the problem.

When this stiffness is gone, the underlying muscles can begin to function normally. Then, the child's movement, such as walking, will improve. Also, if this stiffness persists, the possibility of muscle scarring and joint and bone deformities (contractures) can be prevented with this surgery.

How to prepare a child for SDR surgery?

Since SDR surgery is not suitable for every child, your child will undergo a special screening process to see if it will benefit them. For this, several specialist doctors will examine the child.

All of these people examine the child and work together as a team to decide whether SDR surgery is right for the child. In addition, several other tests may be performed:

• To plan post-surgery treatment, physical and occupational therapists videotape the child's movements and activities.
• An MRI of the brain to make sure there are no other neurological conditions.
• Meet with a neurosurgeon to explain the risks of the surgery and the recovery process.
• Meet with an anesthesiologist to make sure anesthesia is safe for the child.

What happens during the surgery?

These are the steps that typically occur during SDR surgery.

1. Anesthesia: The anesthesiologist gives the child anesthesia. This makes the child sleepy and pain-free during the surgery.

2. Incision: The neurosurgeon makes a small incision in the middle of the child's lower back.

3. Nerve exposure: Through that incision, a small "window" is made between the bones of the spine and the membrane (dura) that covers the spinal cord, and the nerve fibers underneath are exposed.

4. Nerve separation: Next, the motor nerves and sensory nerves are separated. The motor nerves are protected to prevent damage.

5. Nerve testing: Using electrodes, a technique called electromyography (EMG) is used to stimulate sensory nerves. This can help pinpoint which abnormal nerves are causing spasticity and which are normal nerves.

6. Nerve cutting: Then, a certain percentage of the abnormal sensory nerves found are cut away. The amount of nerves cut varies from child to child.

7. Suturing the incision: After the nerve cutting is complete, the incision is sutured back closed layer by layer.

8. Recovery room: After surgery, the child is kept under observation in the Intensive Care Unit (ICU).

This surgery usually takes about four or five hours.

What happens after the surgery? And what are the benefits?

After the surgery, the child will need to stay in the hospital for about five days. During the first 24-48 hours, the child will need to remain in bed. Physical therapy will begin within a few days.

Benefits for children with CP that only affects the legs (Spastic Diplegic CP):

• Improved walking and mobility.
• Increased stamina.
• Reduced falls and improved balance.
• Good sitting and standing posture.
• Reduction of pain caused by spasticity.

Benefits for children with Spastic Quadriplegic CP:

• Ability to sit more comfortably for longer periods of time.
• Being able to use a potty seat.
• Ability to operate a wheelchair independently.

Also, because the muscles are less stiff, it becomes easier for caregivers to change the baby's diaper and feed him.

What are the risks of this surgery?

Like any surgery, SDRs have minor risks.

Short-term complications:

• Infection
• Bleeding
• Cerebrospinal fluid (CSF) leak

Permanent complications (very rare):

• Hypersensitivity to touch (hyperesthesia), sometimes accompanied by pain.
• Loss of urinary control (urinary incontinence).
• Loss of bowel control (bowel incontinence).
• Weakness or loss of previous ability to walk.

Don't worry, your child's medical team will explain all these risks to you thoroughly before the surgery.

Recovery time and the importance of physical therapy

Physical therapy and occupational therapy are extremely important after surgery. This rehabilitation program is essential to achieve the results of the surgery.

The physical therapist will do exercises to strengthen, stretch, and improve the child's muscles. The occupational therapist will help the child become more independent at home and at school.

Before your child leaves the hospital, the therapists will give you a clear explanation of the exercises and treatments you need to do at home. You will need to do these treatments several days a week for 3-6 months.

If you notice any signs of a complication after your child's surgery, such as a wound infection or loss of urinary control, call your doctor immediately.

SDR Surgery, Cerebral Palsy, Spasticity, Muscle Stiffness, Physical Therapy, Neurosurgery, Child Health