Selective Dorsal Rhizotomy (SDR)

Selective dorsal rhizotomy is a spinal operation that permanently reduces leg spasticity, most often in children with spastic diplegic cerebral palsy. The surgeon identifies the sensory nerve rootlets that carry abnormal signals from the leg muscles into the spinal cord and cuts a proportion of them.

It lowers muscle tone for life, which can make walking smoother, ease care and reduce later orthopaedic surgery. It does not cure cerebral palsy, does not treat weakness, dystonia or fixed contractures, and its benefit depends on many months of intensive physiotherapy afterwards.

What Selective Dorsal Rhizotomy (SDR) involves

Under general anaesthesia without muscle relaxants, the child lies face down. Through a 3 to 5 centimetre incision over the lower back, one or two vertebral arches are opened at the end of the spinal cord and the dura is opened. Under the microscope the sensory (dorsal) roots from L1 or L2 to S1 or S2 are separated from the motor roots. Each dorsal root is divided into several rootlets, and each rootlet is stimulated electrically while muscle responses are recorded. Rootlets producing abnormal, spreading responses are cut, typically 50 to 70 percent of the total, while sacral rootlets for bladder and bowel are protected. The dura is closed watertight.

Who is a good candidate for Selective Dorsal Rhizotomy (SDR)?

Selection is strict and made by a team of neurosurgeon, paediatric neurologist, orthopaedic surgeon and physiotherapists after gait assessment and MRI.

• Children aged roughly 3 to 10 with spastic diplegia, born prematurely, with typical periventricular changes on MRI
• Children who walk alone or with aids (GMFCS levels II and III) and have good underlying strength and trunk control
• Spasticity that is clearly limiting function rather than being used for support
• Families able to commit to daily physiotherapy for a year or more

It is usually not the right choice if:

• Children whose main problem is dystonia, ataxia or mixed tone, which SDR does not improve
• Severe weakness, where spasticity is what allows standing
• Significant fixed contractures or hip dislocation as the main issue, which need orthopaedic management
• Damage to the basal ganglia or cerebellum on MRI, or progressive neurological conditions

Technique options

• Single-level approach at the conus: A small opening at one level with less bone removed. Now the most common technique.
• Multi-level laminoplasty: Roots identified at their exit points along the lumbar spine, with the bone replaced afterwards. Used in some centres for clearer identification.
• Intrathecal baclofen pump: An adjustable, reversible alternative, better for severe generalised spasticity or mixed tone.
• Botulinum toxin and orthopaedic surgery: For focal spasticity or fixed deformity; often still needed in addition to SDR as the child grows.

What happens during your treatment

Surgery takes 3 to 4 hours under general anaesthesia. The child usually lies flat for 1 to 3 days to reduce spinal fluid leak and headache, with a urinary catheter and strong pain relief, sometimes through an epidural. Leg sensitivity, tingling and muscle spasms are common in the first days. Hospital stay is about 5 to 7 days before rehabilitation starts.

Preparing for your trip

Plan for 4 to 8 weeks including early rehabilitation in Istanbul. Your surgeon reviews photographs and your medical history before you book, and you meet in person the day before surgery for examination, marking and consent with a professional interpreter.

• Stop smoking and nicotine at least four weeks before and after surgery; it is the single biggest avoidable cause of wound problems
• Tell the team about every medicine and supplement you take; blood thinners, some herbal products and hormone treatment may need to be paused on your doctor's advice
• Arrange for someone to travel with you or to be reachable, and keep the first days at home free of work and lifting
• Book a changeable return flight; your surgeon confirms when you are fit to fly

Recovery and results

The legs feel markedly weaker at first because spasticity was masking weakness. Inpatient or daily outpatient physiotherapy begins within days and continues intensively for 3 to 6 months, then regularly for 1 to 2 years. Most children regain their pre-operative level by 3 to 6 months and improve beyond it over the following year. Orthoses usually need remaking.

• Back to everyday activity: 3 to 6 months to regain baseline
• When results show: Tone reduced immediately; function improves over 6 to 24 months
• How long they last: Permanent reduction in spasticity

Safety, risks and revision policy

Serious lasting complications are rare in experienced hands, but this is irreversible surgery on spinal nerves.

• Temporary numbness, tingling or hypersensitivity in the legs and feet, occasionally permanent patches of altered sensation
• Temporary bladder or bowel disturbance; permanent incontinence is rare
• Spinal fluid leak, wound infection or meningitis
• Persistent weakness revealing poor underlying strength, with loss of function if selection was wrong
• Back pain, spinal deformity or hip subluxation in the long term, needing monitoring through growth
• Residual or returning tightness from contractures, so orthopaedic surgery may still be needed

Every written proposal arranged through Clinic-Y states what the clinic covers if a correction is needed. Ask for it before you book, not after.

Cost of Selective Dorsal Rhizotomy (SDR) in Türkiye

Clinic-Y does not publish a single price for Selective Dorsal Rhizotomy (SDR), because the honest figure depends on your case. What moves it:

• Surgeon and neuromonitoring team experience and time
• Length of hospital stay and any paediatric intensive care
• Duration of inpatient rehabilitation purchased with the surgery
• Pre-operative gait analysis, MRI and hip X-rays
• New orthoses and equipment after surgery

Send your photographs or reports and you receive written, all-inclusive proposals from suitable teams, side by side. Reviewing your case is free.

Frequently Asked Questions