and cerebral palsy
Why Surgery May Be Needed for Children with Cerebral Palsy
Depending on the severity of a child’s cerebral palsy, surgical interventions may be needed to help improve the child’s quality of life and/or health. CP affects muscle growth and in some cases a discrepancy may occur between muscle growth and bone growth. This may lead to deformities of bones and joints, a loss of function, pain, and make care more difficult. In these cases, orthopedic surgery (OS) has a critical role to play. Orthopedic surgeons are typically involved in the treatment of spasticity, contractures, joint dislocations, bone deformities and in the overall improvement of musculoskeletal function and ambulation.
For some children, orthopedic surgery may be recommended to correct a problem such as hip dysplasia or scoliosis or when spasticity and stiffness are severe enough to make walking and moving difficult or painful. Children who can not take adequate amounts of nutrition orally may need surgery for a feeding tube or to prevent reflux.
Requirements for Orthopedic Surgery in Cerebral Palsy
The team of medical and rehabilitation professionals who are going to treat a person with CP must have:
- Knowledge of normal anatomy and physiology, particularly regarding ambulation,
- A good understanding of the functional pathology present in CP,
- Realistic goals/objectives for treatment that are shared commonly by the patient, family, and others concerned with the child’s welfare.
- Knowledge and ability to carry out any of the treatments that are required, and
- A facility with the resources to carry out the necessary evaluations/treatments.
Tendon Release and Muscle Lengthening
Surgeons can lengthen muscles and tendons that are proportionately too short, which can improve mobility and lessen pain. Orthopedic surgeries may be staggered at times appropriate to a child’s age and level of motor development.
Anti-reflux surgery generally includes a fundoplication, balances lower esophageal sphincter pressure by wrapping the upper stomach around the esophagus in the abdomen. Many different LARS techniques are available.
Herrington Rod Surgery
Involves spinal fusion to correct or greatly improve scoliosis deformities in children with CP. Scoliosis is a condition in which a person’s spine is curved. The condition can be classified as congenital (caused by anomalies present at birth), idiopathic (arising after birth and caused by unknown factors) or neuromuscular, where it is a secondary symptom of another condition such as cerebral palsy or spina bifida.
Tenotomy is an outpatient surgical procedure for the hip, in which the doctor loosens a tendon in the hip joint that has become too tight due to incorrect positioning. This procedure is performed before other surgeries, such as open reduction, that place the ball-shaped top of the thigh bone into the socket.
Open Reduction Hip Surgery
In open reduction, the surgeon makes a small incision in the groin and removes excess tissue to make more room in the hip socket. The surgeon then places the ball of the hip joint back into the socket.
Hip arthroscopy is a minimally invasive procedure that is often performed to repair torn cartilage—a common complication of untreated developmental hip dysplasia in adults. Hip arthroscopy allows the doctor to obtain a detailed view of the hip joint while repairing the cartilage.
Osteotomy is a type of surgery that may be used to deepen the hip socket and realign the thigh bone. The approach used depends on your age and type of problem caused by developmental hip dysplasia.
Selective Dorsal Rhizotomy (SDR)
SDR is a surgical procedure recommended for cases of severe spasticity when all of the more conservative treatments – physical therapy, oral medications, and intrathecal baclofen — have failed to reduce spasticity or chronic pain. A surgeon locates and selectively severs overactivated nerves at the base of the spinal column. SDR is most commonly used to relax muscles and decrease chronic pain in one or both of the lower or upper limbs. Potential side effects include sensory loss, numbness, or uncomfortable sensations in limb areas once supplied by the severed nerve.