Paediatric neurosurgery · UK
Selective Dorsal Rhizotomy - reducing spasticity for life.
A one-time paediatric neurosurgical procedure for children with spastic diplegic cerebral palsy - cutting selected sensory nerve rootlets in the lumbar spine to reduce spasticity permanently. Followed by a full year of intensive physiotherapy.
Why patients choose us
- 01
A paediatric neurosurgeon with SDR volume
A named surgeon operating a high-volume SDR list at a UK children’s neurosurgery centre - not an occasional case.
- 02
The whole MDT before you consent
Neurosurgery, neurology, physiotherapy and orthopaedics assess your child together. If SDR is not the right route, we say so.
- 03
A rehab plan in writing
Twelve months of physiotherapy is where the outcome is made. We set the plan, the sessions and the funding conversation before surgery is booked.
Indicative pricing
What private Selective Dorsal Rhizotomy (SDR) costs in the UK.
Ranges across UK and European centres offering SDR privately. Rehab is the majority of the cost and the majority of the outcome.
In short
SDR + first-year rehab, UK: £55,000–£95,000 all-in.
| Procedure | Indicative range | Typical duration | Stay / turnaround |
|---|---|---|---|
| Multidisciplinary SDR assessment | £1,500–£3,500 | 2–3 hours | One-day visit |
| Instrumented 3D gait analysis | £900–£1,600 | 2 hours | Report in 5–10 days |
| SDR surgery (single-level laminoplasty) | £30,000–£45,000 | 4–6 hours | 7–14 nights |
| Inpatient rehab (2–4 weeks) | £8,000–£18,000 | Daily therapy | 2–4 weeks |
| Outpatient physiotherapy year (private) | £12,000–£30,000 | 3–5 sessions/week | 12 months |
| SDR + first-year rehab, all-in | £55,000–£95,000 | - | 12 months of care |
| Follow-on orthopaedic surgery (if needed) | £8,000–£20,000 | 2–4 hours | 1–3 nights |
Prices vary by hospital, by consultant, and by the complexity of your case. We come back with a firm quote within one working day.
The problem
A one-time procedure that only works with a full year of rehab.
SDR is one of the most rewarding operations in paediatric neurosurgery when done for the right child. It is also one of the easiest to do badly by cutting too many rootlets or not investing in rehab.
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Selection is everything
Not every child with spastic CP benefits. GMFCS level, age, cognition and family commitment all count - we say when SDR is not the right route.
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The surgery is the start
The gains come from 12 months of daily physiotherapy. Skip the rehab and the surgery is wasted; commit to it and the change can be transformational.
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Combine with orthopaedic planning
Fixed contractures do not go away when spasticity does. Orthopaedic surgery - tendon lengthening, femoral derotation - is planned in the same conversation.
The journey
From enquiry to recovery - what happens, in order.
One team from first message through follow-up.
Phase 1 · Before
Assessment, imaging and planning
Phase 2 · On the day
Procedure and recovery
Phase 3 · After
Results, follow-up and review
- 01
Before
You tell us about your child
A short, confidential form. GMFCS level, current treatments, spasticity map, imaging done so far.
- 02
Before
We come back with a route
Within one working day: whether SDR looks right, what the assessment should include, and how the funding could work (private, insurance, NHS).
- 03
Before
Multidisciplinary assessment
Neurosurgeon, neurologist, paediatric physio and orthopaedic surgeon over one or two visits. Gait analysis, MRI brain and spine, hip X-rays.
- 04
Before
Rehab plan and family commitment
The physiotherapist maps the 12-month rehab schedule with your family and prescribes orthotics and equipment. Signed off before consent.
- 05
On the day
Admission and surgery
Same-day admission, GA and 4–6 hours in theatre. EMG-guided rootlet selection at L1–S2. One or two nights on paediatric HDU.
- 06
On the day
Inpatient rehabilitation
2–4 weeks on a paediatric neurorehab ward. Daily physiotherapy, gait retraining and standing frame work.
- 07
After
Twelve months of outpatient rehab
Three to five physiotherapy sessions per week for a year. Six and twelve-month reviews with gait analysis and the surgical team.
Typical end-to-end: 4–8 weeks from assessment to surgery. Full rehab: 12 months of intensive physiotherapy.
When it helps
When Selective Dorsal Rhizotomy (SDR) is the right step.
The situations where SDR is considered, and the flags that mean a different route.
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Spastic diplegic cerebral palsy
GMFCS II or III - walking with difficulty because of leg spasticity, not because of weakness or dystonia.
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Age 3–10 with growth ahead
The sweet spot. Younger brains adapt to new motor patterns; older children still benefit but progress plateaus.
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Spasticity limiting function despite treatment
Botulinum toxin, oral baclofen and intensive physiotherapy have been tried and hit a ceiling.
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Selected GMFCS IV children
Where SDR is aimed at easier care, comfort and positioning rather than independent walking - a different but valid goal.
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Adults with spastic diplegia
A small but growing group. Selection is stricter and outcomes more modest - the years of built-in weakness are hard to reverse.
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Post-stroke spasticity in older children
Occasional indication for hemi-SDR after early stroke - case selection is careful.
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Family able to commit to a year of rehab
Time, transport, cost and daily practice - the honest question we ask before offering surgery.
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Red flag: dystonia rather than spasticity
Dystonic CP responds poorly to SDR - sometimes worsens. Baclofen pump or deep brain stimulation are the routes to consider.
Approach options
Two main approaches, one long-term commitment to rehabilitation.
What each option involves, and when we recommend it.
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Single-level laminoplasty (St Louis approach)
A single L1 laminoplasty exposes the conus and cauda equina rootlets in one field. Standard at most experienced UK centres.
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Multi-level laminectomy
Traditional approach across L2–S1 or L2–S2. Larger dissection, longer recovery - less common now.
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EMG-guided rootlet selection
Every rootlet is stimulated and the muscle response graded. Abnormal rootlets are cut; normal ones spared. Typically 50–70 percent of tested rootlets are transected.
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Intraoperative neuromonitoring
Continuous motor and sensory monitoring alongside EMG - protects bladder, bowel and motor function during the dissection.
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Inpatient rehab (2–4 weeks)
Immediately after discharge: daily physiotherapy on a paediatric neurorehab ward, gait retraining, standing frame work.
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Outpatient rehab (12 months)
Three to five physiotherapy sessions per week for a year. The main driver of outcome - funded privately or through NHS community teams.
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Orthopaedic follow-on surgery
Twelve to twenty-four months after SDR: tendon lengthening, femoral or tibial derotation, foot correction - done once soft-tissue changes have settled.
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Ongoing gait analysis
Baseline, 12 months and 24 months. Objective data on cadence, step length and joint kinematics - not just clinical impression.
Our vetted UK network
A small panel of specialists, we picked them.
Consultants across London and the major UK cities. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every specialist in our network.
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UK paediatric neurosurgery centres accredited for SDR (Bristol, Leeds, Great Ormond Street, Alder Hey model)
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Multidisciplinary selection panel: neurosurgery, neurology, physiotherapy, orthopaedic surgery
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Access to instrumented three-dimensional gait analysis before and after surgery
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Named paediatric physiotherapist to lead the 12-month rehab plan before the family consents
Safety and recovery
What to expect afterwards - honestly.
SDR is a well-established operation in the right hands. The risks worth planning are the first year of rehab, and the honest conversation about what SDR does not fix.
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General anaesthetic in a paediatric theatre
A paediatric anaesthetist, paediatric ICU cover and a full neuromonitoring team. Typical operating time 4–6 hours.
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Sensory change is the main risk
Dysaesthesia (tingling, altered sensation) in the legs is common in the early weeks and usually settles. Persistent sensory change is rare.
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Weakness and function early on
Almost every child looks weaker for the first weeks - the antigravity work spasticity used to do is gone. Strength returns with rehab.
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Bladder and bowel function
Temporary retention or urgency for a few days is common. Persistent change is very rare with modern EMG-guided technique.
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CSF leak, wound infection, meningitis
Under 5 percent combined. A visible bulge, clear fluid leak or fever needs the neurosurgical team same day, not the GP.
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Spinal deformity long-term
A small increased risk of scoliosis with the multi-level approach - one reason many centres prefer single-level laminoplasty in growing children.
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Recovery of hip and knee contractures
SDR reduces spasticity but does not lengthen tight muscles. Fixed contractures need orthopaedic surgery later.
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Not a cure for cerebral palsy
The brain lesion is unchanged. Cognition, communication and upper-limb function are not directly affected by SDR - the win is lower-limb spasticity.
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Red flags after surgery
Fever, spreading redness, headache with clear discharge from the wound, weakness beyond the expected postoperative dip - same-day neurosurgery, not routine.
Reading your report
Your operation note in four parts. Read the last one first.
The note the neurosurgeon sends after SDR keeps to the same shape - surgical detail, EMG data, and the rehab handover that carries you into the next year.
A quiet reminder
Medical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the report before your review, just ask.
- 01 Header
Age, GMFCS level and indication
Who the child is, their pre-operative GMFCS level, and the specific functional goals SDR is targeting.
- 02 Technique
Approach, levels and monitoring
Single-level laminoplasty or multi-level laminectomy, which rootlets were tested, and the neuromonitoring set-up.
- 03 Findings
Rootlets cut and EMG response
The proportion of rootlets cut at each level and the EMG grading that drove the decision - the objective record of the operation.
- 04 Plan
Rehab prescription and orthopaedic outlook
Read this first: the physiotherapy schedule, the orthopaedic conversation for 12–24 months out, and the follow-up gait analysis dates.
Recognised by major UK insurers
Some UK insurers cover SDR case-by-case for children meeting selection criteria. NHS commissioning (NHS England) funds SDR for eligible children aged 3–9 years at designated centres - we can help you understand both routes.
Frequently asked
Everything we get asked about Selective Dorsal Rhizotomy (SDR).
Quick answers on eligibility, rehab, NHS funding and outcomes for children considering SDR.
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Which children are suitable for SDR?
The classical candidate is a child aged 3–10 with spastic diplegic cerebral palsy, GMFCS level II or III, whose spasticity limits function despite botulinum toxin, oral baclofen and intensive physiotherapy. Selected GMFCS IV children benefit for comfort and easier care rather than independent walking. Dystonic and severe mixed presentations respond poorly.
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Is SDR available on the NHS?
Yes. Since 2019 NHS England has commissioned SDR for eligible children aged 3–9 at a small number of specialist centres. Selection is strict and waits vary. Private assessment does not disqualify a child from the NHS route - some families use one to inform the other.
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How permanent is SDR?
The spasticity reduction is permanent - the cut sensory rootlets do not regenerate meaningfully. What changes over time is how a growing child uses the new baseline. That is why the first year of rehab and the orthopaedic follow-on are so important.
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What is the recovery like?
Two to four weeks of inpatient rehabilitation, then a full year of outpatient physiotherapy at 3–5 sessions per week. Children often look weaker for the first month before gains appear from month three onwards. Most families describe the change as gradual rather than dramatic.
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How much does private SDR cost in the UK?
Surgery alone runs £30,000–£45,000. Including the first year of intensive private physiotherapy, orthotics and follow-up gait analysis, most families plan for £55,000–£95,000 total. Some UK insurers cover the surgical component for children meeting criteria.
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What if there are already fixed contractures?
SDR does not lengthen tight tendons or restore range that has been lost. Orthopaedic surgery - hamstring or Achilles lengthening, femoral derotation - is planned 12–24 months after SDR once soft tissues have adapted to the new tone.
Related treatments
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Cerebral palsy hub
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Physiotherapy for muscular aches and pains
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Craniotomy of meningioma
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Diaphragm pacing for spinal cord injury
Complex neuromuscular care example.
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All tests & procedures
Every treatment we arrange.
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