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01923 388 453
07535 715 011
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(SDR) SELECTIVE DORSAL RHIZOTOMY - PRE AND POST OPERATION

There is no actual cure for cerebral palsy but there are a wide range of treatments that are aimed at relieving many of the symptoms. Selective dorsal rhizotomy (SDR) is a complex and time consuming neurological surgical procedure that aims to relieve severe muscle spasticity in the legs, it is aimed mainly at children but adults have also been known to have the procedure too. It is usually only recommended if the periventricular leukomalacia which is also known as the white matter of the brain is damaged and all other forms of treatments have failed.

What is selective dorsal rhizotomy?

SDR is a surgical procedure of the lumbar spine which is in the lower back. The procedure consists of revealing the conus medullaris which is the end of the spinal cord. This is done to gain access to the nerve roots that innervate the muscles of the lower limbs. Electrical stimulation is used in order to identify the nerve roots which are causing the spasticity; these nerves are then partially cut. This is a complex procedure which is done under general anaesthetic and can take many hours.

Pre selective dorsal rhizotomy

It is essential that the child is undergoing physiotherapy sessions prior to the surgery in order to strengthen the areas that will be affected by the post operatively so that a faster recovery is made. The muscles prior to surgery will be in a state of spasticity and spasm so will not work to their full potential. Certain muscles will be more affected than others which can cause weakness and muscular imbalances. Physiotherapy before SDR aims to decrease the spasticity whilst strengthening the areas which have become weak, for instance if the muscles that turn the hips inwards are in a state of stiffness then these will be short and tight which will make the muscles that turn the hips outwards elongated and weak. Our physiotherapists aim to increase an all-round level of strength and flexibility.

Our Physiotherapists will aim to:-

  • Strengthen weak muscles
  • Stretch tight muscles
  • Retrain the muscle imbalances
  • Maintain and increase power
  • Educate and give the best exercise programme prior to surgery

Post selective dorsal rhizotomy

The outcome of SDR is based upon how many nerves were divided within the surgery. The outcome is also dependant on joint deformities, muscles contractures and the level of impairment before the surgery took place. This is why pre-operative physiotherapy treatment sessions play an essential role in the rehabilitation of SDR.

Post operatively the child will undoubtedly have some degree of muscle weakness and may not be able to perform certain movements which they were able to perform before the surgery. Intense physiotherapy sessions are recommended so that previous movements can be gain in the shortest amount of time possible.

This may take time but our specialised physiotherapists understand the processes and cycle and aim to improve the child abilities so that levels of functional movements can be gained.

What our physiotherapists aim to:-

  • Promote independent walking
  • Improved gait patterns
  • Improve sit to stand movements
  • Balance independently
  • Improve upper limb motor control
  • Make improvements so can keep up with their peers.

Strength training and conditioning

Post selective dorsal rhizotomy does not cause weakness of the muscles permanently but rather in the weeks following the surgery. It is worth remembering that CP presents with muscle weakness to a degree and when the spasticity is eliminated or reduced it is then that the underlying muscular weakness is apparent and not caused by the surgery.

Individuals with CP typically present with some form of deformities in the lower limb such as hamstring contractures, hip subluxations and feet deformities. All of which can be improved by SDR.

A strengthening programme aims to improve the condition and strength of the muscles that may have become weak due to the combination of the operation and the CP. Studies have shown that a strengthening programme after surgery not only increases lower extremity range of movement but also increase strength too which if maintained can contribute to a near normal gait pattern as possible.

As everybody presents differently post-surgery it is important to be fully assessed by the physiotherapist so that the strengthening programme can be commenced at the appropriate stage.

If you would like more information, please do not hesitate to contact us on: 01923 388 453, or send an email to info@rehabwalk.co.uk