Cerebral Palsy
Surgery
Surgery for people with cerebral palsy (CP) usually involves either:
- Loosening tight muscles and releasing fixed joints, most often performed on the hips, knees, and ankles. In rare cases, this surgery may be used for people with stiffness of their elbows, wrists, hands, and fingers.
- Cutting nerves on the limbs most affected by movements and tightness (spasticity). This procedure reduces spasms and allows more flexibility and control of the affected limbs and joints.
A doctor evaluates the person's symptoms, age, and general state of health when considering whether to recommend surgery.
A thorough checkup is needed to help the doctor determine which muscles and nerves are affected and what type of surgery would best treat the condition. A gait analysis is part of the examination if the person is able to walk.
For young children, surgery may be postponed if doing so will likely prevent the need for additional surgery in the future.
Other surgeries related to cerebral palsy
Surgery for various orthopedic problems: Surgery for other problems is sometimes needed for children with CP. These surgeries vary depending upon the specific problems involved. For example, some children may need surgery to correct uneven leg length, dislocation of the hip, curves in the spine (scoliosis), or an eye problem.
Medication-related surgery: A small pump is surgically implanted under the skin in the abdomen for some people with CP. This pump is used to deliver medications, such as baclofen (Lioresal), directly into the fluid surrounding the spinal cord. For more information, see antispasmodics.
Surgery Choices
The main surgery choices for people affected by cerebral palsy (CP) are:
- Orthopedic surgery (for muscles, tendons, and joints). This type of procedure is done to lengthen a tendon to increase a limb's range of motion by cutting through a muscle or tendon (release) and sometimes reattaching it in a different area.1
- Selective posterior rhizotomy (cutting nerves of affected limbs). This procedure is usually considered only for children with severe muscle tightness in the legs.
What To Think About
Health professionals do not agree about the best age for people with cerebral palsy (CP) to have surgery.
- Some surgeons believe that children less than 2 years old with CP benefit most from orthopedic surgeries because it allows them to grow and develop more like other children.
- Some health professionals believe that all surgery should wait until a child is older than age 2, and some prefer to wait until sometime between ages 6 and 8 years. They believe that more problems can be corrected during the same surgery if orthopedic surgery is postponed until the child is older.
Surgery is not used nearly as often for the arms as for the legs. Surgery on arm deformities carries more risks related to sensory damage; also, surgery has a more limited impact on functional abilities than on the legs.8
Sometimes medications or physiotherapy are used to postpone or eliminate the need for surgery. Physiotherapy is also needed for most children after surgery. The type of therapy and special equipment needed after surgery (such as braces, casts, and splints) depend on the child's specific needs. In general, post-surgical physiotherapy usually starts as soon as possible and may continue for as long as 6 months.
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| Author: | Douglas Dana Sabra L. Katz-Wise Ralph Poore | Last Updated: March 6, 2007 |
| Medical Review: | Anne C. Poinier, MD - Internal Medicine Michael J. Sexton, MD - Pediatrics Thomas Emmett Francoeur, MDCM, CSPQ, FRCPC - Pediatrics Louis Pellegrino, MD - Developmental Pediatrics | |
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