Cerebral Palsy and Surgery

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Surgery is an important treatment option for children with cerebral palsy, especially those with spasticity and stiffness that impede mobility. Most doctors recommend cerebral palsy patients try lower-risk options before surgery, such as medications and various types of physical therapy. Surgery is invasive and requires recovery time, but it has the potential to improve mobility and reduce pain.

How Is Surgery Used to Treat Cerebral Palsy?

Surgery is just one of many treatment options for cerebral palsy. Doctors usually recommend more conservative treatments first, including physical therapy and medications. A child may qualify for surgery when these fail to provide enough benefits.

Several types of surgeries for cerebral palsy. Depending on the type used, surgery for cerebral palsy can potentially provide several benefits: 

• Improved mobility
• Pain relief
• Reduced stiffness
• Corrected deformities of the foot or spine
• Improved posture
• Improved coordination and balance
• Realigned joints and bones
• Reduced hip relocations

Surgery may also be used to treat cerebral palsy’s associated or co-occurring conditions.

Surgery for Ambulatory vs. Non-Ambulatory Children

Children experience cerebral palsy in different ways and to varying degrees. Some children can walk or are ambulatory, while others cannot walk at all or are non-ambulatory. Sometimes, ambulatory children may have trouble balancing and coordinating movements or struggle to move their muscles and joints correctly.

Walking for these children may also be painful. The goal of surgery for an ambulatory child is to help him walk better and more independently, without pain.

For a child who cannot walk, either at all or without an assistive device, surgery helps to make life more comfortable and may even prevent complications. Surgery can help a child feel better and experience less pain while sitting or lying down. If the child can walk with an assistive device, like a walker, surgery may help her gain more independence.

Is Surgery Right for My Child?

Surgery is not an option for every child, and it is important to try medications and therapies before resorting to surgery.

General anesthesia can put a child at risk for breathing difficulties, infections, bleeding, or even having a condition worsen. Parents and doctors must discuss potential surgical options and decide if the benefits outweigh the risks and if the procedure makes sense for the child’s health and well-being.

Orthopedic Surgery for Cerebral Palsy

The most common type of surgery that children with cerebral palsy undergo is orthopedic surgery. This refers to procedures that address the musculoskeletal system.

Children with cerebral palsy can attribute most of their symptoms and challenges to problems with muscles, joints, and bones. Orthopedic surgeons can offer procedures that have the potential to relax spastic muscles, repair joints, correct deformed bones, and relieve pain.

Several common types of orthopedic surgical procedures are used to treat children with CP:

• Osteotomy. This type of surgery is used to make improvements to joints. A surgeon can realign bones to help a child with movement and posture.[1] The effect is often greater mobility and independence and less pain from joints moving incorrectly.
• Muscle lengthening. Tightness in muscles makes movements difficult and painful for children with CP. Surgery can lengthen and release muscles so that they are less stiff and a child can move better.
• Tendon lengthening. The same can be said for tendons, the connective tissue that attaches muscles to bones. When tendons are too tight, it restricts movement and causes pain.
• Tendon or muscle cutting. It may sound damaging, but cutting muscles or tendons can relieve tightness and pain while also improving movements and reducing spasticity. A cut tendon can also be replaced by donor tissue.
• Arthrodesis. This is an aggressive type of surgery used to treat severe cases of spasticity and reduced mobility. It involves permanently fusing bones together. This can help reduce spasms and can also make walking easier.
• Scoliosis repair. Some children have or develop a spinal curvature that may worsen over time (especially when not ambulatory). Surgeons can repair this to assist with posture and movement and prevent respiratory problems.

Selective Dorsal Rhizotomy

Another surgical option for children suffering from symptoms of CP is selective dorsal rhizotomy. Like arthrodesis, this is an aggressive option and is not recommended for most patients. It has the potential to reduce spasticity and relieve pain permanently, but it is also risky.[2]

The surgery involves cutting nerves that are causing spastic muscle movements. The surgeon must determine which nerves are involved and cut their connection to the spinal cord.

The risks are apparent, including mistakes during the procedure. The network of nerves that link muscles and the spinal column is complex, and a surgeon could mistakenly cut the wrong nerves.

Cutting the right nerves can give a child better movement, greater comfort, and significant pain relief. It can also result in loss of movement in specific muscles and numbness. This type of surgery is typically only used for children with severe spasms or muscle tightness.

Other Surgeries for Cerebral Palsy

Most CP surgeries address the condition’s central symptoms: muscle spasms, muscle tightness, mobility, and pain. However, many children with CP also have co-occurring conditions and complications that can also be treated with surgery.

For example, hearing loss is not uncommon in this population, and the insertion of a cochlear implant is a recommended surgery to restore hearing.

For children with CP who struggle to eat because of difficulty swallowing or chewing, surgery can be used to make improvements. A feeding tube may be inserted in severe CP cases that affect nutrition and weight gain. Surgery can also correct acid reflux, which is often a problem because of poor muscle control.

Some children with CP need a small pump surgically implanted in the abdomen to deliver the medication to the spine that reduces muscle spasms and pain.

Recovering from Cerebral Palsy Surgery

Surgical procedures are not a magical fix. A child having surgery for CP will need physical therapy and lots of recovery time. Depending on the type of surgery, therapy may go on for weeks or months.

A child may need to relearn how to use specific muscles or how to walk. This takes time, but in many cases, significant benefits are seen that last for many years.

Can Adults with Cerebral Palsy Benefit from Surgery?

Surgery is more often done in children, but studies provide some evidence that surgery can benefit adults with cerebral palsy, too. One study followed 20 adult cerebral palsy patients undergoing multilevel surgery.

The researchers found that most of the patients had both short-term and long-term improvements in gait. Some patients did not see significant improvements or deteriorated over time.[3]

Some hospitals that treat children also offer selective dorsal rhizotomy for qualifying adult patients with spastic cerebral palsy.[4]

Surgery is a big step, but it can also be the difference between pain and relief, a lack of independence, and complete mobility. Any parent considering surgery must weigh the benefits and risks after attempts at non-surgical interventions fail and work with the child’s medical team to determine the best surgical options.