Cerebral Palsy: Surgery

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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 to 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 exam 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, or curves in the spine (scoliosis).

Medicine-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 medicines, 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). It's done to increase range of motion. For example, the surgeon may lengthen a tendon, cut through muscles or tendons, or attach a tendon to a different part of the bone.¹ Surgery to treat spinal curves or to prevent or treat hip dislocation is also done.

Selective dorsal 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

Doctors 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 doctors 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.⁷

Sometimes medicines or physical therapy are used to postpone or get rid of the need for surgery. Physical therapy 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 physical therapy usually starts as soon as possible and may continue for as long as 6 months.

Last updated:	October 14, 2008
Author:	Debby Golonka, MPH
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Louis Pellegrino, MD - Developmental Pediatrics
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC