After Selective Dorsal Rhizotomy (SDR) Surgery
After surgery, your child is taken to the high-dependency unit
for an overnight stay. This facilitates close monitoring and
ensures optimal pain control, usually by a combination of
intravenous and epidural medication. The child is encouraged to lie
on the back, but will be helped to turn from side to side
every 4 to 6 hours. It is normal for children to complain
of headache at this stage.
On return to the neurosurgical ward the intravenous analgesia is
reduced slowly. The bladder catheter is removed 3 days after
surgery. Gentle physiotherapy in the bed is started on day 2.
It is usual for children to have some numbness in their legs,
and often some difficulties passing urine, in the first week. The
legs will be less stiff than before surgery, but may also at this
stage be significantly weaker.
Your child will be encouraged to start sitting out of bed on day
3. Physiotherapy is then gradually increased, paying particular
attention to maintaining good trunk balance and range of movement
in the lower extremities. Muscle strengthening exercises are begun.
In-patient physiotherapy will continue up to three weeks
post-operatively, when most children would be ready for discharge.
The aim of this programme is to continue to develop strength in the
lower limbs, trunk and pelvis, increase range of movement in the
legs, develop isolated lower extremity movements, and to develop
and improve walking. All this takes time, and will be continued
after hospital discharge through the local physiotherapy services.
Parents will have the opportunity to learn how to participate in
the rehabilitation process and will be given a home programme to
follow.
Complications after SDR are rare. These include infection, leak
of cerebrospinal fluid from the wound, development of a fluid
collection below the skin, severe leg weakness and incontinence. In
addition, there are risks associated with general anaesthesia, but
these are very rare.
You will receive a follow up phone call at 3 months
post-operatively to check how everything is going. We will
then invite you in for physiotherapy reviews at 6, 12 and
24 months to monitor progress and update recommendations. A
gait lab evaluation will be repeated at two years. Any issues can
be raised at any stage within the multi-disciplinary meetings for
thorough clinical opinion.
(This information can also be found within the paediatric physiotherapy SDR
webpages.)
