Does your child have cerebral palsy? Here is what you need to know about SDR surgery

If your young child has cerebral palsy, you might notice their arms and legs feel very stiff and tight. Doctors call this tightness spasticity. This tightness can make it hard for your child to walk, run, or do everyday tasks. Today, we will look at a special surgery that can offer lasting relief. It is called Selective Dorsal Rhizotomy, or SDR for short.

Cerebral palsy affects how a child controls their body movements. Damage to the parts of the brain that handle movement and coordination causes this condition. Many children with cerebral palsy struggle with muscle tightness. When your child tries to move, certain muscles suddenly pull tight. This causes discomfort, pain, and makes walking very difficult.

What Is SDR Surgery in Simple Terms?

Selective Dorsal Rhizotomy, or SDR, is a surgical procedure designed to permanently reduce muscle tightness in children with cerebral palsy. While it is a complex operation, the concept is straightforward. Surgeons target and cut specific sensory nerve fibers in the lower part of the spinal cord that cause leg muscles to stay tight.

The most important thing to know is that this surgery does not cause paralysis in your child's limbs. It also does not directly block normal movement. Instead, the goal is simply to release the muscles that are locked in painful, rigid spasms.

Keep in mind that to get the best possible results, your child must take part in intense physical therapy after the surgery. Also, remember that this surgery is not suitable for every child with cerebral palsy.

Who Is This Surgery For? Is It Right Every Child?

Doctors primarily perform SDR surgery to treat muscle stiffness caused by cerebral palsy. As you know, cerebral palsy is a condition that affects a child's ability to control body movements. It happens due to an injury in the parts of the brain that manage coordination.

SDR surgery specifically targets two main groups:

• Spastic diplegic cerebral palsy: This is when muscle tightness mainly affects both legs.
• Severe spastic quadriplegic cerebral palsy: This is when muscle tightness severely affects all four limbs.

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How Does This Surgery Reduce Muscle Stiffness?

To understand how this works, let us look at how our nervous system functions. The normal tone in our body muscles is managed by signals traveling through the spinal cord. Think of our nerves like a telephone network in the body.

First, sensory nerves bring information from the muscles back to the spinal cord. Second, motor nerves send messages from the spinal cord back out to tell the muscles when to contract.

Normally, our brain does a great job managing this message exchange. However, when a child has cerebral palsy, the brain's ability to control these nerves is reduced. Some sensory nerves become overactive and constantly send wrong signals telling the muscles to stay tight.

During SDR surgery, the surgeon selects and cuts only the overactive sensory nerve rootlets. They use a special test called electromyography, or EMG, to find the exact nerves sending faulty signals. This lets them lower muscle tightness without harming other important functions.

Once the muscle tightness goes away, the underlying muscles can start working normally again. This helps improve your child's ability to move and stay active. It also helps prevent bone and joint deformities that often happen when muscles stay tight for years.

How Do You Prepare for the Surgery?

Because SDR surgery is not right for every child, an expert medical team evaluates your child carefully. This team usually includes several specialists.

This team works together to make the final decision about whether SDR surgery will benefit your child. Also, you may need several other tests before the surgery:

• Physical and occupational therapists perform deep evaluations to record your child's movement abilities. They often record videos to plan post-surgery treatments.
• A brain MRI scan to confirm there are no other hidden neurological disorders.
• A visit with a pediatric neurologist to check for other nerve-related issues.
• Another visit with the neurosurgeon to discuss surgical risks and recovery times.
• A consultation with an anesthesiologist to make sure anesthesia is safe for your child.

Step-by-Step Guide to the Surgery

SDR surgery generally follows a clear step-by-step process in the operating room:

1. Anesthesia: First, the anesthesiologist gives your child full general anesthesia. This ensures your child sleeps deeply through the entire operation and feels zero pain.

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

3. Nerve Exposure: Through this small cut, the surgeon gently navigates past muscles and bone to open the outer covering of the spinal cord, exposing the nerve fibers underneath.

4. Nerve Separation: Next, the surgeon carefully separates the motor nerves from the sensory nerves, making sure to protect the motor nerves from any harm.

5. Finding Faulty Nerves: The team places tiny electrodes on the sensory nerve roots and runs an electromyography test. This test delivers gentle electrical signals so the team can identify which nerves send incorrect signals causing muscle spasms.

6. Cutting Nerves: The surgeon carefully cuts a specific percentage of the abnormal sensory nerves. The exact nerves and amount cut depend entirely on your child's unique needs.

7. Closing the Cut: Once the nerve work finishes, the surgeon closes the back incision layer by layer with stitches.

8. Recovery: After surgery, nurses move your child to the pediatric intensive care unit or a specialized recovery room for close monitoring.

This surgical procedure usually takes about four to five hours from start to finish.

What Happens After Surgery?

After the surgery, your child will need to stay in the hospital for about five days. During the first 24 to 48 hours, your child must rest flat in bed. Physical therapy sessions start just a few days after the operation while your child is still recovering.

What Are the Benefits of This Surgery?

The results of SDR surgery vary depending on your child's specific condition. Success relies heavily on the hard work your child puts into physical therapy after the procedure.

Does This Surgery Have Risks?

Yes, just like any major surgery, SDR carries certain risks. However, permanent complications happen very rarely.

Your child's medical team will discuss every single one of these risks with you in detail before the operation.

Recovery Time and the Importance of Physical Therapy

This is the most crucial and mandatory part of SDR surgery success. The surgery is only the first step of the journey. To see real results, rehabilitation treatments are absolutely necessary.

Physical therapy and occupational therapy begin just a few days after surgery. For three to six months following the operation, your child will attend therapy sessions on most days of the week.

• Physical Therapist: They guide your child through exercises to strengthen muscles, stretch limbs, and make movement easier. At first, the therapist does the work, but as your child recovers, they actively join in.
• Occupational Therapist: They help your child practice daily tasks like dressing and playing so they can become more independent.

The main goals of these exercises include:

• Increasing overall body strength.
• Improving balance and posture while sitting and standing.
• Preparing the legs for independent standing.
• Making transitions smoother, such as moving from a seated position to standing.

A Note from Dr. Priya Sammani