Surgery for Cerebral Palsy in Children

Our surgeons use the results of ongoing physical assessments conducted during the cerebral palsy spasticity clinic to evaluate whether surgery can benefit a child’s physical and psychosocial development.

Neuromuscular specialists at Hassenfeld Children’s Hospital at NYU Langone may recommend surgery for children with severe muscle spasticity that doesn’t respond to rehabilitation therapy or medication. Our doctors recommend a surgical procedure only when it offers the greatest opportunity to improve a child’s muscle control, mobility, and quality of life.

Because cerebral palsy frequently affects multiple muscle groups and joints, doctors may recommend “multilevel” surgery to address several areas of the body on the same day. This approach avoids the need for several surgeries on separate dates.

Surgery can seem intimidating for children and families. Our doctors provide information about each procedure and how it may help your child. Social workers and psychologists are available to join these discussions to ensure that you have all of the information needed before making a decision.

If surgery is performed, our pain management specialists are available 24 hours a day to ensure that your child recovers comfortably. These physicians can answer any questions you have and continue to work with families after the child has been discharged from the hospital. This ensures that postoperative pain is managed appropriately during every stage of recovery.

Orthopedic Surgery for Cerebral Palsy

Doctors may recommend orthopedic surgery to lengthen tendons or correct the alignment of bones to improve a child’s ability to sit, stand, and walk. There are a variety of possible surgical procedures to accomplish this. Doctors determine the best procedure or combination of procedures depending on the child’s age, level of motor function, and severity of symptoms.

Typically, surgery is performed on children age two and older.

Tendon Surgery

Tendons are the strong, flexible tissues that connect muscles to bones. Children with cerebral palsy often have spasticity, which may lead to contractures, or a shortening of tendons and muscles. Over time, these tissues become stiff and may restrict a child’s movement. Occasionally, doctors recommend surgery to maintain or improve muscle function.

The most common type of surgery in children who can walk involves lengthening tight tendons and re-aligning bones in the feet, legs, hamstrings, or hips. In children with spasticity and quadriplegia—which affects the upper and lower body on both sides—the most common surgery performed is to correct a problem in the hips.

Tendon surgery in the groin and hamstrings, a band of muscle that connects the buttock to the knee joint, can increase flexibility in the hips, helping a child stand up straighter and sit and walk more easily. The procedure is also commonly performed in the calf or heel to increase range of motion in the leg and foot, making it easier to stand and walk.

Physicians may perform tendon surgery using general or local anesthesia, depending on the age of the child and the tendons involved.

Our cerebral palsy specialists recommend annual follow-up visits at the cerebral palsy clinic, so doctors can monitor your child’s development after surgery. These regular appointments also allow doctors to evaluate any new or recurring spasticity. This enables them to intervene before it becomes more serious.

Osteotomy

Osteotomy is a procedure to reshape bones and correct their alignment, improving joint mobility and reducing pain. For example, the hip joint is a ball-and-socket joint, which means the top of the thighbone, called the femur, is supposed to fit snugly into the socket-shaped pelvic bone.

Frequently, this does not occur in children with cerebral palsy. Muscle spasticity can lead to partial or total hip dislocation, in which the femur dislodges from the pelvic socket. This poor alignment can cause disfigurement and pain.

Surgeons perform osteotomy to reshape and reposition the bones of the joint, ensuring the ball-and-socket components fit together and that the hip moves smoothly. If necessary, surgeons may release tight tendons surrounding the hip during the same procedure to improve functional outcome.

Surgeons may also recommend osteotomy to reposition bones in other parts of the body, including the lower leg. Osteotomy is performed using general anesthesia.

Spinal Surgery

Children with cerebral palsy may develop scoliosis, in which the spine develops unusual curves that may affect a child’s ability to sit or stand properly.

If scoliosis is affecting your child’s ability to walk, or if it’s causing persistent back or neck pain, surgeons may recommend a procedure called spinal fusion. This can straighten and stabilize the spine and decrease pressure on pinched nerves.

Doctors use general anesthesia to perform this surgery. In a spinal fusion, surgeons permanently bind two or more back bones, called vertebrae, into one solid bone. Often, surgeons use metal plates, screws, and rods to keep the spine stabilized and prevent vertebrae from getting too close to nerves.

They may also use a small piece of bone, called a bone graft, to help the vertebrae fuse together. The bone graft is usually taken from the child’s lower spine.

Recovery from Orthopedic Surgery

Recovery from orthopedic surgery often requires a splint, cast, or crutches for several weeks while the bones and tendons heal. After spinal fusion, the doctor may recommend a back brace to provide additional support for the spine.

If a surgeon performs multiple procedures at once, your child may need to wear casts or braces in different parts of the body at the same time. This limits mobility during healing, and your child may temporarily need a wheelchair. Social workers with experience helping families of children with cerebral palsy are available to help care for your child during recovery.

Our doctors, nurses, and pain management specialists ensure that your child is comfortable during recovery. If appropriate, physical medicine doctors visit your child in the recovery room and assess the level of function in muscles and joints, preparing your child for the start of physical therapy.

Some children are admitted for intensive inpatient rehabilitation to strengthen the body. This can help the child to function better after returning home.

Neurosurgery for Cerebral Palsy

Selective dorsal rhizotomy is a neurosurgical procedure to sever one or more sensory nerves that are causing muscle spasticity in the legs and feet. This procedure can relieve muscle tightness, allowing a child to move more easily.

Selective dorsal rhizotomy is performed using general anesthesia. The surgeon reaches the spinal cord by removing a small piece of the vertebra covering the spinal canal. The surgeon then carefully identifies the affected nerves using sophisticated technology that recognizes which nerves are producing abnormal responses.

After these nerves are correctly located and separated from larger nerve bundles, surgeons use special tools to cut the nerves where they leave the spinal cord. This is repeated for all affected nerve groups. The removed piece of spine bone is replaced and secured with sutures.

Recovery from Neurosurgery

After surgery, your child is provided with pain medication to ease discomfort while the spine heals. He or she may need to remain in the hospital for two or three days, so doctors can monitor initial recovery.

As soon as your child can stand and walk on his or her own, physical and occupational therapists begin gentle stretching exercises to improve flexibility and muscle tone in the hips, thighs, and legs.

After your child is discharged from the hospital, doctors recommend intensive physical therapy for six to eight weeks. At that time, doctors assess your child’s progress and determine the next steps.

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