Selective Dorsal Rhizotomy Referral Pathway

Selective Dorsal Rhizotomy (SDR) is a neurosurgical procedure to reduce spasticity. A small number of children with cerebral palsy are known to benefit from this. As this procedure is permanent careful child selection is important.

CRC provides a specialist multi-disciplinary clinic where SDR is considered.  Referral criteria and pathway is outlined below.  Where this procedure is recommended, it will now take place in CHI at Temple Street, with early rehabilitation provided at CRC.

If you feel that your child may be suitable for SDR it is important to raise this with your local paediatrician and physiotherapist. They will then jointly discuss and consider if your child is a potential candidate for surgery.

General Referral Criteria:

Spastic bilateral (diplegic) cerebral palsy
GMFCS II, III
Age 4-10y
Spasticity should be limiting function
No previous multi-level orthopaedic surgery
Stable hips and spine
MRI – changes of periventricular leukomalacia
Well-motivated child

The referral letter should be completed by the child’s paediatrician and must contain information regarding MRI brain, hip status, response to previous botulinum toxin/spasticity management and goals that have been discussed with the parents and child.

When baseline referral criteria have been met, the SDR assessment process is initiated. This involves two separate assessments:

1. An SDR- specific physiotherapy assessment (form available on request, SDR team physiotherapist can assist/guide local physiotherapist in completion of same if required)
2. Gait Analysis at the CRC (child must be at least 4 years old to enable a meaningful analysis).

Should there be a lack of certainty regarding the appropriateness of any referral the SDR assessment team is happy to discuss with local clinicians regarding specific cases at any point.

---

Contact Person:

Joanne Kehoe

Contact Tel:

+35318542277

Contact Email:

jkehoe@crc.ie

---