Common Cerebral Palsy Surgery Options
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 and 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.
The Benefits of Surgery for Cerebral Palsy Patients
The most effective way to manage cerebral palsy in children is to incorporate a comprehensive therapy plan. And for a child with cerebral palsy, surgery is just one of the many options that can help improve independent mobility and support healthy growth.
Some doctors or specialists may recommend other forms of therapy, such as physical therapy and medication, before recommending surgery. However, surgery is meant to address the unique needs of individual patients. When a child is experiencing chronic pain or discomfort, surgical intervention may offer the most immediate and long-lasting relief. The goals of surgery are to make a child’s cerebral palsy more manageable and prevent future complications, which also creates the best chance of living as independently as possible.
Surgical intervention for children with cerebral palsy can correct alignment and improve motor abilities. Orthopedic surgery on the legs, feet, ankles, arms, and wrists can lead to better posture and control, and some gastric procedures are recommended for alleviating co-existing conditions tied to cerebral palsy.
For some patients, non-surgical forms of treatment may create improvement on their own. For others, cerebral palsy surgery can:
- Relieve stiff muscles
- Reduce muscle spasticity
- Correct spinal curvatures (scoliosis)
- Prevent spinal deformities
- Reduce tremors
- Correct foot deformities
- Improve posture, balance, and coordination
- Relieve pain and joint problems
- Correct fixed joints and tendons
- Free permanently tightened muscles (contractures)
- Prevent hip dislocation
- Treat co-occurring conditions, such as gastroesophageal reflux disease
Considerations to Address Before Choosing Surgery
When it comes to a treatment plan for children with cerebral palsy, there is no singular relied-upon approach. Because children experience differing levels of severity, surgery may be the best alternative for one patient but not another. That’s why, for parents who are considering surgical intervention, it is critical to understand not only the benefits but the risks, as well.
Surgery is recommended for children with CP only when the benefits of a particular procedure exceed any potential risks. For example, children who are able to walk independently may experience better results from surgery than those who need assistance with walking. In this case, parents of non-ambulatory children may want to avoid going the surgical route if the chance of improving mobility isn’t high enough.
It is also important to remember that surgery performed under general anesthesia poses inherent risks. Complications are rare, but the risk of bleeding, infection and the need for additional surgeries should be considered. Above all, parents should consult with pediatricians and consider various forms of intervention before deciding on surgery.
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.
What Types of Surgery are Available for Cerebral Palsy Cases?
- 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.
- Fundoplication: 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 laparoscopic anti-reflux surgery (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: 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: 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: 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 child’s 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.
When Is Surgery Appropriate?
Because each cerebral palsy case is unique, parents and pediatricians work together to weigh the possible benefits against the potential risks of surgery. The most important factors in the decision include a child’s physical limitations, level of pain or discomfort, personal goals, and age.
The appropriate age at which a child is able to endure surgery depends on the individual, although children with cerebral palsy are most often treated between the ages of 3 and 10. However, physicians have different opinions on the best time in a child’s life to suggest surgery, so consult your pediatrician to determine what is best for your child.
If you’re contemplating whether surgery is the appropriate measure for your child, consider these important questions:
- How will my child benefit from the procedure?
- Are there unique risks associated with a particular type of surgery?
- Do the benefits outweigh the potential risks?
- What is the success rate for the recommended surgery?
- Is my child the correct age for this surgery?
- What can be expected during rehabilitation?
- Are there other options?
If you suspect your child’s cerebral palsy was caused by medical negligence, contact the Cerebral Palsy Family Lawyers at Janet, Janet & Suggs. Our years of experience, combined with our legal and medical expertise, enables us to uncover the truth and work to recover the compensation families are entitled to. Contact us today to let us help you and your family seek the justice you deserve.
Giles H. Manley, M.D., J.D., F.A.C.O.G. | CPFN Medical Advisor
Board-Certified OBGYN | Medical Malpractice Attorney
Dr. Manley has delivered over 2,000 babies and uses his wealth of medical knowledge to uncover medical errors that were missed by others (keep in mind most CP cases involve errors committed at or around the time of birth). READ FULL BIO