Selective Dorsal Rhizotomy
A selective dorsal rhizotomy or SDR is a surgery that can help treat children with spasticity or increased muscle stiffness and spasms. When these conditions are not responding to braces or certain medications a SDR may be considered. During this procedure nerves are tested and identified and then cut to help improve muscle symptoms. This helps to have clearer communication between the spinal cord nerves and the muscles, ultimately decreasing muscle tone and stiffness.
What to expect from your visit:
We are very happy to have a multidisciplinary spasticity clinic. During your visit with us you will meet our Physical Medicine and Rehab team and Neurosurgeons so that your child’s care can be uniquely tailored to them. Each child and case of spasticity is unique; they will be seen and evaluated and plans will be discussed about how we can help improve each child’s spasticity and ultimately their overall quality of life.
What to expect the day of surgery:
If you and your surgeon decide that a Selective Dorsal Rhizotomy will improve spasticity and quality of life this is what to expect. Families will be given a date and time during their clinic appointment. It is standard that children do not have anything to eat past midnight on the day of surgery. We understand this is difficult for our very young patients and take special care to schedule those surgeries as early in the day as possible. It is important you bathe your child and wash their hair either the night before or the morning of surgery to help prevent post operative infections.
In the morning your surgeon will review everything discussed in the office and be sure to answer any questions caregivers or children have. The surgery generally requires 1-3 hours to complete and updates will be provided by our OR staff. Our Physical Medicine team is present at the time of surgery as well to help make sure each surgery is uniquely tailored to each child. There is some additional time required at the beginning of your child’s surgery while the anesthesia team places an IV and helps your child fall asleep.
There will be a small incision at the lower back about 1-2 inches in length. It can be a bit painful after surgery but we have plenty of experience managing post-operative pain and aim to keep kids as comfortable as possible following any procedure. To aid in healing our patients will lay flat for the first 72 hours following the procedure, this reduces strain on the incision, prevents spinal fluid leaks, and supports early healing. Our physical medicine team will be involved during the entire hospitalization and often our patients are transitioned to the inpatient rehab unit 4-5 days after surgery so they can quickly start benefitting from the reduced spasticity following the procedure and work one on one with our physical and occupational therapists.
To care for the incision wash daily with a mild soap and dry gently. The incision will have small clear sutures that will dissolve on there own in approximately 10 days. Patients should avoid submerging the incision completely underwater for 14 days following surgery, so this means taking modified baths and no swimming in pools or lakes.
Caregivers and patients should monitor for any redness or swelling that occurs in the days or weeks following surgery. Rarely a superficial wound infection could occur and is easily treatable if detected early. Please notify the Neurosurgery department at (313)833-4490 of any redness, swelling, or drainage and one of Advance Practice Providers will provide you immediate guidance, and a same day appointment if necessary.
A scheduled “wound check” appointment will be made 10-14 days after surgery with one of our Advanced Practice Providers. This is a good time to talk about returning to school, day care, or other activities. This is another great opportunity to sit and answer any and all questions now that the stress of the hospital is behind you. In addition to the wound check, a scheduled follow up with your surgeon will be provided as well 4-6 weeks after surgery.
Click here to learn more about one of our extraordinary young patients as he recovers from his selective dorsal rhizotomy surgery.