Surgery is one of several treatment options for children living with cerebral palsy, although it’s usually not a 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 make walking easier or more comfortable, 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-occurring conditions like hearing or vision loss. Surgery is always risky, 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. Although ambulatory children can walk, they often have difficulty doing so. They may have problems balancing and coordinating movements, may step on their own toes, or struggle to move their 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 this kind of 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. Going under general anesthesia for major surgery puts a child at risk of having dangerous breathing difficulties, infections, or even of having a condition worsened afterwards. Parents and doctors must discuss surgery and come to a decision that makes sense for the child.
The main type of surgery that children with cerebral palsy receive is called orthopedic surgery. It refers to surgery that addresses the musculoskeletal system. Children with cerebral palsy can attribute most of their symptoms and challenges to issues with muscles, joints, and bones. This kind of surgery has the potential to relax spastic muscles, repair joints, correct deformed bones, and relieve pain. There are several common types of orthopedic surgery used to treat children with CP.
- Osteotomy. This type of surgery is used to make improvements to joints. A surgeon can realign joints to give a child better posture or movement. 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 actually lengthen muscles so that the tightness is relieved and a child can move better.
- Tendon lengthening. The same can be said for tendons, 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, but can also make walking easier.
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 the connection to the spinal cord.
The risks are obvious, including mistakes during surgery. The network of nerves that link muscles and the spinal column is complex and it is not difficult for a surgeon to mistakenly cut the wrong nerves. Cutting the right nerves can provide a child with better movement, greater comfort, and significant pain relief, but it can also result in loss of movement in certain 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 a feeding tube may be inserted. Surgery can also correct acid reflux, which is often a problem because of poor muscle control in the stomach and throat. 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.
Surgery is 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 may need to learn how to walk. This takes time, but in many cases a child is better off after this lengthy process than before the surgery.
Surgery is a big step, but it can also be the difference between pain and relief, mobility and a lack of independence. Any parent considering surgery must weigh the benefits and risks, try safer treatments first, and work with their child’s medical team to come up with the best decision about surgery.