Selective Dorsal Rhizotomy


Selective Dorsal Rhizotomy service at The Portland helps children with cerebral palsy to walk
The Portland Hospital for Women and Children in London provides Selective Dorsal Rhizotomy for children with cerebral palsy. This is the only fully private service of its kind in Europe.
Selective Dorsal Rhotzotomy (SDR) is a surgical procedure offered to children with spastic diplegia to improve their ability to balance, walk and participate in normal daily activities and sport. Children with spastic diplegia as a result of cerebral palsy can find it difficult to walk due to spasticity in their lower limbs.
SDR involves sectioning (cutting) of some of the sensory nerve fibres that come from the muscles and enter the spinal cord.
Surgery involves a 1 to 2 inch incision along the centre of the lumbar spine. The spinous process and a portion of the lamina are removed at a single level to expose the lower end of the spinal cord and spinal nerves. The sensory nerve roots are identified and exposed. Each root is then divided into 3-5 rootlets. Each rootlet is tested with EMG, which records electrical patterns in muscles. Rootlets are ranked from 1 (mild) to 4 (severe) for spasticity. The severely abnormal rootlets are cut. This technique is repeated for rootlets between spinal nerves L1 and S1/S2.
The advantages of this type of surgery are:
• Reduced risk of spinal deformities in later years
• Shorter-term, less intense back pain
• Early commencement of intensive physiotherapy
• Shorter operating time and therefore reduced risks associated with general anaesthetic

The SDR service at The Portland Hospital is led by Mr Kristian Aquilina, Paediatric Neurosurgeon (previously at Frenchay Hospital, Bristol and currently at Great Ormond Street Hospital for Children, London). The specialist multidisciplinary team also consists of a consultant paediatrician specialising in neurodisability, a neurophysiologist, specialist physiotherapists and (where appropriate) a paediatric orthopaedic surgeon. Mr Aquilina worked with Dr TS Park at the Center for Cerebral Palsy in St Louis.
Children are rigorously assessed pre-operatively to ensure that SDR is the best treatment option to maximise their potential.

The selection criteria are:
• Children usually between the ages of 3 and 12 years with a diagnosis of spastic diplegia and significant diffuse spasticity in the lower limbs that involves most of the muscle groups
• There should be no significant injury to the areas of the brain involved in posture or coordination - this is confirmed by an MRI scan
• Children need to demonstrate adequate muscle strength, be able to comply with intensive physiotherapy post-operatively and have a definite plan for post-operative physiotherapy in place
Surgery takes 3 to 4 hours. Post-operatively children spend one night in the hospital’s 10-bedded paediatric intensive care unit for close observation and are on bed rest for the first 3 days.
Intensive physiotherapy commences on day 3. The reduction in spasticity is often immediate and the focus of treatment sessions is to improve trunk and lower limb strength, improve balance and re-educate walking patterns. Children are discharged home on day 6 but continue a twice daily physiotherapy programme for the next 2 weeks. At this point they can return to their usual routine but research has shown that physiotherapy must continue on a regular basis for a period of 1-2 years to optimise the effects of the surgery and ensure that changes to movement patterns are lasting.

The Portland Hospital is the only private hospital in the UK dedicated to the healthcare of women and children. It offers a range of specialties and full diagnostic support. The hospital cares for children with complex needs and those requiring a variety of surgical and medical interventions. The Acute Neurorehabilitation Unit provides intensive rehabilitation programmes for children to optimise recovery and help them reach their potential in life.



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