Cerebral Palsy Surgery

Cerebral palsy results from a traumatic brain injury or malformation during a child’s birth process, which later greatly impedes the young patient’s developmental process and frequently causes a range of muscular issues in patients suffering from the neurological disorder.

Treatment depends on the individual needs of the patients and the severity of their problems. In many cases, a combination of medical therapies and drugs serve to make the disorder manageable and significantly improve the patient’s quality of life without the necessity of surgery, and in no case will surgery entirely resolve the patient’s condition.  However, severe or extreme symptoms may necessitate surgery to correct adequately the issue and provide sufficient relief for the patient.

Common Orthopedic and Other Surgeries Seeking to Improve Quality of Life for Cerebral Palsy Patients:

  • Individual cerebral palsy patients experience painful tightening of the muscles in their limbs and extremities, which negatively impacts fine motor function and general movement. Muscle lengthening surgery relieves muscular tension and provides patients with a greater range of motion.
  • Short or malformed tendons cause contractures, limiting mobility and the patient’s ability to walk and run. Surgical procedures can lengthen muscles in critical areas to allow the patient to gain increased mobility and improved walking capability.
  • Some cerebral palsy cases benefit more from tenotomies or myotomies, where the tendon or muscle is cut to relieve excessive tightness and stiffness in the patient’s body. The procedure is more extreme, but effective when coupled with diligent physical therapy during the recovery process.
  • During tendon transfers, the tendon is attached to designated positions on the patient’s bone to foster better joint alignment and motor control. The procedure most commonly seeks to improve wrist flexing and extension though doctors may apply the method to other stiff joint groups.
  • Osteotomies surgically realign joints in pursuit of improved posture and greater mobility. Surgeons reposition bones to create healthy alignments in cerebral palsy patients with hip dislocations or issues.
  • Arthrodesis procedures are common in patients with severe spasticity that cannot be corrected with casts, splints, and other medical aids. The process forces the fusion of major bones to increase mobility. For example, fusing ankle and foot bones improve a patient’s walking ability with stronger support and greater stability.
  • Approximately 15 percent of children with cerebral palsy suffer from hearing impairment. Factors causing cerebral palsy, like oxygen deprivation during birth, may also lead to congenital hearing impairment, which can be surgically addressed with cochlear implants, a hearing aid implant. In particular, the surgery is highly beneficial for patients with advanced or severe hearing impairments, but eligibility for the procedure depends on the cause of the patient’s hearing loss.
  • Many cerebral palsy patients experience difficulty eating and swallowing due to low muscle tone and greater risk for aspiration and severe acid reflux. Gastrostomy procedures implant feeding tubes in patients to ease the eating process and aid in maintaining nutritional health for those with serious symptoms.
  • Hydrocephalus surgeries deal with a rare condition where cerebrospinal fluid builds up in the cranial cavity, causing a noticeable change in the patient’s head size. The procedure drains the fluid from the skull, but doctors rarely encounter cases requiring this procedure. Though the condition is fatal when unattended, few cerebral palsy patients face this complication.

Selective Dorsal Rhizotomies and Their Prevalence in Cerebral Palsy Patients

When all conservative treatments of muscles spasticity fail, patients and doctors may pursue selective dorsal rhizotomy surgeries to reduce pain and contractures. Typically, patients with leg spasticity benefit more from the procedure relative to quadriplegic or hemiplegic cerebral palsy patients. During the surgery, medical professionals cut nerves from the spinal column to alleviate the stiffness and pain associated with severe spasticity, while navigating complex nerve networks. Following a successful procedure, cerebral palsy patients experience improved balance, walking, and a marked reduction in involuntary movements and muscle spasms.

 

References:

http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1437171/

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