Surgery is one of many possible interventions for children living with cerebral palsy, although it’s usually not the first choice for treatment. Doctors prefer that patients try lower-risk options first, such as medications and various types of physical therapy. If these don’t help or do not help enough, then surgery may become a viable option for treatment.
For a child with cerebral palsy, surgery can help with a number of issues. It can reduce spasms and muscle stiffness, relieve pain, improve posture and balance, correct damaged joints and much more. Surgery may also be used to correct or improve co-existing conditions like hearing or vision loss. Surgery always has some associated risks, but when the potential benefits outweigh the risks, it is a good option for treatment.
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 children that are ambulatory 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 that 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.
Making Decisions about Surgery
Surgery is not an option for every child, and it is important to try medications and therapies before resorting to surgery. The reason for this is that surgery can be risky and can lead to serious complications. General anesthesia can put a child at risk for breathing difficulties, infections, bleeding or even of having a condition worsen. Parents and doctors must discuss potential surgical options and come to a decision that balances the risks and benefits, and that makes sense for the child’s health and well-being.
The most common type of surgery that children with cerebral palsy undergo is called 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.
There are several common types of orthopedic surgical procedures 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. 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 actually 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, and that may worsen over time (especially when they are not ambulatory.) This can be repaired surgically to assist with posture and movement, as well as 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. The surgery involves cutting nerves that are causing spastic muscle movements. The surgeon must determine which nerves are involved and then 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 correct nerves can provide a child with better movement, greater comfort, and significant pain relief, but it can also result in loss of movement in specific muscles as well as numbness. This type of surgery is typically only used for children with severe spasms or muscle tightness.
Other Surgeries for Cerebral Palsy
Most surgeries for CP address the central symptoms of the condition: 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. In cases of severe CP that affects nutrition and weight gain, a feeding tube may be inserted. 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.
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 certain muscles or how to walk. This takes time, but in many cases, great benefits are seen that last for many years.
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.