Cerebral palsy arises from a brain injury sustained by a child, often before he or she is born although it may also occur during the newly-born (neo-natal) period. The injury may not be detected for some years and is usually noticeable when the child has delayed developmental milestones relating to matters such as posture, walking, balance, language and learning.
A common cause of cerebral palsy is premature birth and/or oxygen deprivation. Certain parts of the foetal brain may be damaged, particularly the parts which control leg movement and co-ordination. This can lead to stiffness in the muscles and can impair the child’s mobility and learning capacity.
The muscles in both the arms and legs may be compromised, although spastic diplegia, which affects the leg muscles more than the arms, is the most common type of cerebral palsy.
The National Institute for Health and Clinical Excellence (NICE) states in its Guidelines that:
“Lower limb spasticity affects 80% of people with cerebral palsy. This can impair walking and sitting, and can cause discomfort, cramps and spasms”
The NICE Guidelines explain that:
“The aim of selective dorsal rhizotomy is to ease muscle spasticity and improve mobility in people with cerebral palsy. It involves cutting nerves in the lower spine that are responsible for muscle rigidity”.
If the procedure succeeds it may reduce lower limb spasticity, reduce the number of subsequent orthopaedic procedures, improve gross motor function, improve gait and walking and improve the child's level of independence and his or her quality of life.
It is important to realise that SDR is not a cure for cerebral palsy, but if the procedure succeeds it may help a child’s physical state by reducing muscular stiffness and improving a child’s mobility.
SDR is carried out while your child is under a general anaesthetic and the Great Ormond Street Hospital reports that the procedure takes around four to five hours.
Physiotherapy will be needed following surgery to obtain the best results. At first, this takes place in hospital and then at your home, usually with parents helping and participating. The NICE Guidelines point out that there is a chance that further surgery will be required.
Is SDR Suitable For My Child?
It is generally accepted that SDR is most suitable for children with spastic diplegia aged between three and twelve years of age. If your child is older, he or she may still benefit from SDR but may also need orthopaedic surgery.
To determine if your child is suitable for the SDR operation, he or she will need multi-disciplinary medical assessment, including Paediatric and Neurosurgical assessment, an MRI scan of the brain and X-Rays of the hips to confirm the stability of the hips.
SDR is a procedure that cannot be reversed and before it is tried, intensive physiotherapy and other treatments may be trialled, including treatment with injections known as botulinum toxin injections.
What Can Be Expected From The Procedure?
Children whose cerebral palsy is related to premature birth may have a good response to SDR. This is not the case for all causes of cerebral palsy and SDR is not suitable for all types of cerebral palsy.
According to Great Ormond Street Hospital:
“There is now enough evidence to demonstrate that SDR is associated with substantial long-term benefits. These are not only related to reduction in spasticity, but also relate to improved movement and walking as well as improved quality of life for both the children and their families”.
The NICE Guidelines state that:
“The non-randomised comparative study of 142 patients treated by the procedure or ITBP (intrathecal baclofen pump) reported that 94% and 96% of parents respectively were satisfied at 1-year follow-up”
How is SDR funded?
SDR surgery is a hot topic for the UK cerebral palsy community as although the NHS appears to offer the treatment there are problems with funding. However, it is available on the NHS and a number of the procedures have been funded by the NHS.
You should ask your doctor if your child can be referred to a hospital when their procedure can be carried out on the NHS.
Many procedures take place on a self-funded basis. Dr Park at the St Louis Children's Hospital in the US is the leading authority on SDR surgery.
However, UK Hospitals where SDR is available include:
- Robert Jones and Agnes Hunt Hospital in Oswestry
- Leeds General Infirmary
- Nottingham University Hospital
- Alder Hey Hospital, Liverpool
- Frenchay Hospital, Bristol
- Great Ormond Street Hospital, London
- The Portland Hospital For Women and Children
If you suffer from cerebral palsy or your child, a family member or a friend suffers from cerebral palsy then our team of experienced lawyers could provide support in obtaining information about the condition and about treatment by SDR. Click here for more information.
This article is based on the following sources and further information can be obtained from:
Shaun Rylands is a former medical solicitor with years of expertise in cerebral palsy cases.