Selective dorsal rhizotomy (SDR)

What is selective dorsal rhizotomy?

Selective dorsal rhizotomy (SDR) is a surgical procedure that aims to reduce tight and stiff muscle tone (spasticity) in the lower legs. It works by dividing some of the sensory nerve roots within the lumbar region of the spine (lower back).

This may help to:

• Reduce spasticity and painful spasms, which may lead to improvement in:
  • personal care
  • easier dressing
  • better sleep
  • higher energy levels
• Improve mobility for those who are already up and walking.

The reasons, risks, benefits and alternatives of surgery are individual for each child, and so we will talk about these with you before surgery.

What happens before the surgery?

Your child will be invited to a pre-operative clinic where they will meet members of the team. The team will include nurses, physiotherapists and doctors. We will go through your child’s history, and complete any preparation work needed. This might include:

• blood samples
• body washes
• a review of medications
• taking consent for surgery (if not already done)

We will advise you on how long your child cannot eat for and admission details.

We will also give you an opportunity to ask any questions you may have relating to surgery.

What happens the day of the surgery?

Your child will be not allowed to eat before their surgery, but they can have sips of water. The ward staff can help you with this. The operation will be carried out under a general anaesthetic. 1 parent or carer can attend in the anaesthetic room until your child is asleep.

Once in theatre, the neurosurgeon will make a cut into the lower back. To find the nerves to be operated on, special electrical monitoring equipment will be used to guide the neurosurgeon on the selection of the nerves that are most affected.

The wound will then be closed with stitches and covered with a dressing. Your child will be brought to the post anaesthetic care unit (PACU), where you will be able to see your child. They will have intravenous fluids (IV), pain relief, and a catheter to help them wee.

What happens after surgery?

Some children need a high dependency unit (HDU) bed after the operation. This depends on each different child’s difficulties and will talked about with you before the operation.

After the operation, your child will need to stay on flat bed rest for up to 3 days. They can begin to eat and drink again as soon as they feel up to it. The nurses will help you with this.

The nurses will need to do regular observations, which may disturb your child’s sleep initially. These observations are very important, and it lets us monitor your child’s movement and sensation in their legs. It also measures their pain, temperature and blood pressure. This then allows us to provide the best care to help to keep them comfortable.

Will my child be in pain?

On the ward, your child will receive regular pain relief to help with any pain and discomfort they may experience. Straight after the operation, they will have regular painkiller medication through their IV drip. This will gradually change to medicine that can be swallowed when your child can manage this. Your nurse will help, and will make sure your child is regularly checked and medications adjusted as needed.

What happens next?

Once your child is eating and drinking safely and managing to take their medicines, we will start to remove the intravenous fluids.

We will then start to gently move your child with the help and advice of physiotherapists and surgeons.

Your child will need to gradually increase the time they spend sitting in their wheelchair if they use one. For some children who were walking before the operation, then the physiotherapy will have a long term focus on strengthening and balance work.

Physiotherapy will be different for each child. It may include advice for local community service to review all equipment and splints.

How long will my child be in hospital?

Your child’s stay in hospital will vary depending on the reason and aim of the surgery. It will typically be between 1 and 3 weeks. We will talk with you about when your child can be able to go home and together we will make a joint decision between you, your child and the team (neurosurgeon, physiotherapist, occupational therapist and nurse).

What happens once my child is discharged?

When your child is ready to go home, the nurses will organise your medications, outpatients appointments and talk about wound care with you. This includes any stitches that may need to be removed if not already done.

The nurses will make sure that you are happy to go home, and will give contact information, for if you need to speak to the ward. The ward is contactable 24 hours a day, and we are always happy to help and give you advice over the phone if needed.

Follow-up

A follow-up appointment will be made and posted to you within a couple of weeks to attend the review clinic, and again at 6 weeks with the neurosurgeons.

After this, your child will be continually followed-up within your normal clinic appointments as well as physiotherapy. The hospital physiotherapist will contact your local community therapist to let them know you will be going home and discuss the plans for therapy once they are home.

Your child will also have follow up appointments with the neurology team to talk about spasticity medication and how this will be reduced.

What are the visiting times?

Visiting is open 24 hours for parents and carers. Whilst we do allow other visitors, we encourage people to be responsible and respectful of quiet time. The nurses may ask other visitors to leave at these times.

It is possible to have 1 parent stay overnight at the bedside with your child. There are bathroom facilities as well as a parent’s room to make hot drinks. We also have a residential area called Treetops which has accommodation for parents. Please ask your nurse on arrival to the ward, and they will add you to the waiting list if you would like to use this facility.

What other things should I consider?

Things to keep children occupied

Bring books, tablets, DVD players and toys that your child can use when they are lying flat.

Wheelchairs and walking aids

If your child already has a wheelchair or uses a walking aid please bring them with you to hospital.

If your child has any splints for their legs and feet please bring them also. If they do not use splints, they may need them after the operation. This will be assessed and organised at the time.

Special diets

If your child is on any special diet, formula or milk please highlight this at pre-admission clinic so it can be ordered and ready for their admission.