Foundation for Botond’s Steps | Surgery and Rehabilitation
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Surgery and Rehabilitation

SDR surgery (Selective Dorsal Rhizotomy)

SDR involves sectioning (cutting) of some of the sensory nerve fibers that come from the muscles and enter the spinal cord.


Two groups of nerve roots leave the spinal cord and lie in the spinal canal. The ventral spinal roots send information to the muscle; the dorsal spinal roots transmit sensation from the muscle to the spinal cord.


At the time of the operation, the neurosurgeon divides each of the dorsal roots into 3-5 rootlets and stimulates each rootlet electrically. By examining electromyographic (EMG) responses from muscles in the lower extremities, the surgical team identifies the rootlets that cause spasticity. The abnormal rootlets are selectively cut, leaving the normal rootlets intact. This reduces messages from the muscle, resulting in a better balance of activities of nerve cells in the spinal cord, and thus reduces spasticity.

SDR műtét

Physical therapy

During hospitalization

Many movements, including gentle stretching, rolling, and mat activities begin on the third postoperative day. Patients operated in St. Louis Hospital are obliged to take part in a 3 weeks long program, which includes 1 hour therapy in the hospital and 1 hour therapy at home every day. Persistent muscle and tendon contractures after SDR are treated with orthopedic surgery as a last resort. Right after orthopedic surgery therapy continues for another 2 weeks. After casting is removed patients are ready to head home. At discharge, a report, a prescription for physical therapy, and a postoperative protocol will be given to the patient to hand-carry to the primary physical therapist.


Home program

Programs vary for each patient, but all include positioning, range of motion to gain muscle length, strengthening, and developing reciprocal movement. A hospital therapist will give all specific activities and methods. It is expected that Botond will perform a daily home exercise program in addition to receiving regular physical therapy. Two years long strict prescribed daily physical therapy is essential after SDR,that should be completed with swimming, horse riding, walking, stretching, balance development.