Selective Dorsal Rhizotomy (SDR):

 

Welcome to our SDR page...

This page contains the basic information about Selective Dorsal Rhizotomy in Leeds, together with information sheets for patients & families, physiotherapists and medical professionals.

SDR has been performed with great success in Leeds since October 2012. We have performed >70 operations so far.

In 2014-16, the Leeds team was delighted to be commissioned as an official SDR provider for the NHS Commissioning through Evaluation programme. This ended in March 2016.

The team in Leeds continue to accept new patient referrals. These are seen in a multidisciplinary spasticity assessment clinic. We assess patients for the full range of applicable spasticity treatments, so we are happy to accept referrals for NHS review.

If the clinic review suggests that SDR is a suitable treatment to offer, it is important to note that this surgery is not currently available as an NHS-funded treatment. In Leeds we offer a “self-funding” programme to UK NHS patients. These patients receive the SDR surgery and 3-weeks of post-operative physiotherapy at cost. We do not charge additional private-patient fees for this group of UK families. For families outside the UK, full private patient fees are payable. Details of cost are available on application. Obviously another option would be to wait for the results of the Commissioning through evaluation programme and see if NHS England chooses to fund the SDR surgery in the future. However, we do not know at present when a decision will be made.

The Spasticity Team in Leeds

  • Mr John Goodden – Consultant Paediatric Neurosurgeon
  • Dr Raj Lodh – Consultant in Paediatric Neurorehabilitation
  • Kate McCune – Specialist Paediatric Physiotherapist
  • Katie Davis – Specialist Paediatric Physiotherapist
  • Mr Brian Scott – Consultant Paediatric Orthopaedic Surgeon
  • Ms Laura Deriu – Consultant Paediatric Orthopaedic Surgeon

Pre-Referral Guidance

Children over the age of two years with spastic diplegic cerebral palsy may be potential candidates for the selective dorsal rhizotomy (SDR) procedure. Care must be taken to ensure candidates will potentially benefit from the procedure due to its irreversible nature.  Please see Referral Assessment section below.

Referral Process

Referrals for consideration of the SDR procedure are accepted from Consultant Paediatricians, Consultant Paediatric Neurologists, Consultant Orthopaedic Surgeons, and GPs.  These referrals are discussed in the MDT Spasticity meeting before patients are listed for an outpatient appointment.  If further information is required this will be requested before the referral is finally accepted.

An initial patient assessment will be undertaken in an MDT clinic by a paediatric neurosurgery consultant, paediatric neurorehabilitation consultant and paediatric physiotherapist.  If SDR is deemed to be the most appropriate treatment, funding and costs can then be discussed. 

Please ensure your physiotherapist is aware and in agreement with the referral as long-term rehabilitation is essential.They will also need to completean assessment document and send it to us (see downloadable forms below).

Referral Criteria

  1. Cerebral Palsy with spasticity mainly affecting the legs (aka Spastic Diplegic Cerebral Palsy)
  2. Age 2 years and upwards
  3. MRI shows typical cerebral palsy changes with no evidence of damage to key areas of brain controlling posture and coordination (cerebellum)
  4. GMFCS levels II-III.
  5. Definite dynamic spasticity in lower limbs affecting function and mobility
  6. No dystonia
  7. No evidence of genetic or progressive neurological illness
  8. Mild to moderate lower limb weakness with the ability to maintain antigravity postures. The stronger the better pre op.
  9. No significant scoliosis or hip dislocation

Please note these are referral criteria and not criteria that define definite suitability for SDR surgery.  Suitability for SDR surgery will be judged when the child is reviewed in the multidisciplinary spasticity clinic.

The Assessment & Clinic

We see children in a “multi-disciplinary spasticity clinic”.  This means that you are seen by several different specialists during the same period of time.  Three separate appointments are given, one after the other, so that detailed reviews can be undertaken by the Physiotherapy Team, the Consultant Paediatric Neurologist and the Consultant Paediatric Neurosurgeon. Where necessary, appointments are also made to see a specialist Orthopaedic Surgeon, but this appointment may be at a later date.

Due to the amount that we need to go through, the series of appointments can last up to 2 hours in total.

The clinic is set-up to review patients for either SDR or intrathecal baclofen - ie a wide range of cerebral palsy patients.

We recommend you bring a pair of shorts for your child to wear during the Clinic Assessment.  Please also ensure that you bring your child’s splints, walking aids and wheelchair with you to Clinic as they will be required during the assessment.

Your child will be assessed by all the team members for a thorough assessment.  During that clinic appointment a recommendation will be made about what the most suitable treatment would be.  This decision / recommendation will be given towards the end of the final consultation, allowing time to discuss the reasons for our decision. 

The assessment may also find a need for orthopaedic surgery operations to be done after the SDR operation – for example, tendon lengthening surgery.  If this is felt to be necessary, arrangements will be made for a review by a specialist children’s orthopaedic surgeon before SDR surgery can be planned.

It is also sometimes necessary to recommend a period of muscle strengthening before SDR can be considered.  If this is the case, you will be given a repeat appointment and your physiotherapy team will be contacted to arrange the required physiotherapy.

If the clinic review suggests that SDR is a suitable treatment to offer, it is important to note that this surgery is not currently available as an NHS-funded treatment. In Leeds we offer a “self-funding” programme to UK NHS patients. These patients receive the SDR surgery and 3-weeks of post-operative physiotherapy at cost. We do not charge additional private-patient fees for this group of UK families. For families outside the UK, full private patient fees are payable. Details of cost are available on application. Obviously another option would be to wait for the results of the Commissioning through evaluation programme and see if NHS England chooses to fund the SDR surgery in the future. However, we do not know at present when a decision will be made.

In 2014, Leeds was recognised and Commissioned by NHS England as an official provider of SDR surgery for patients for its trial of SDR. We continue to strive to provide high-quality services which are internally audited. We also monitor & present our SDR outcomes at National and International paediatric neurosurgery conferences.

Videos

Below are links to YouTube videos concerning SDR:

Further Information

For further information please contact:

Downloads:

All information last updated July 2016

Website created and edited by Ian Anderson