Orthopedic Surgery Overview
Various orthopedic procedures improve mobility among patients with cerebral palsy. Lengthening muscles and tendons eases spasticity and helps patients achieve better overall quality of life.
Osteotomy and arthrodesis can also provide cerebral palsy relief, realigning bones and correcting deformities. As part of a comprehensive CP treatment plan, effective orthopedic surgery contributes to higher functioning, greater independence and ease of care.
Orthopedic Surgery Explained
Cerebral palsy patients typically face mobility challenges, particularly those diagnosed with spastic cerebral palsy – the most common type of CP. Depending upon the severity of the disorder and the primary muscle groups involved, CP can present severe limitations.
Orthopedic surgery has a dramatic impact, in some cases, significantly improving patients’ ability to move and walk – with or without mobility aids.
In addition to immediate improvements, surgery supports normal long-term development and reduces the number of complications and deformities associated with cerebral palsy. When painful contracture is present, cerebral palsy surgery increases comfort and range of motion, preventing further complications and helping patients overcome movement challenges. Dislocation and other joint problems are also corrected by orthopedic procedures.
Abnormal muscle tone makes it hard for many cerebral palsy patients to comfortably move and walk. Lengthening procedures help correct muscle stiffness and spasticity caused by CP. In combination with other forms of therapy, muscle and tendon lengthening improve patients’ muscle control and range of motion – promoting better balance, coordination, and mobility.
- Muscle Lengthening – Spasticity and contracture limit range of motion, interfering with ambulation and fine motor control. When carried-out on the hands and fingers, surgical muscle lengthening procedures help cerebral palsy patients grasp and manipulate small items. Lengthening in the lower extremities assists walking and reduces future complications arising from muscle tightness.
- Tendon Lengthening – Tendon lengthening surgery is used to treat cerebral palsy conditions like toe walking. To ease tendon tightness and strain, surgeons split affected tendons, before reorienting them to add length. In order to promote healing, joints are immobilized for at least four weeks following surgery.
Lengthening procedures promote independent movement and reduce complications, such as dislocation and deformity. Benefits may be temporary, however, requiring additional surgeries over time.
Tendon Transfer Procedure
Cerebral palsy may cause tendons to pull too hard in one direction, leading to joint problems and range of motion limitations. Tendon surgery helps realign body structures, correcting movement problems and improving patients’ functional abilities. Two types of tendon surgery are used to improve outcomes for cerebral palsy patients:
- Tendon Transfer – When tendons strain and pull too hard, it can lead to deformity and joint complications. This surgical procedure splits an affected tendon, enabling surgeons to reattach it and balance the pull. Successful tendon transfer in the upper extremities may improve patients’ ability to grasp and pinch small items. Tendon transfer also improves range of motion and grip strength.
- Tenotomy/Myotomy – Tenotomy, or tendon release, severs tendons to improve range of motion among cerebral palsy patients. The procedure eases the strain of contracture, allowing muscles and joints to move more freely. Similarly, myotomy is a surgical procedure during which muscles are cut to ease tightness and protect joints from dislocation.
Additional Orthopedic Surgeries
Muscle and tendon surgery carry widespread benefits for cerebral palsy patients. Among other gains, the orthopedic procedures can:
- Decrease spasticity
- Increase strength
- Optimize motor function
- Promote better posture
- Enhance balance and coordination
Additional orthopedic surgeries address bone irregularities and other CP complications:
- Osteotomy – Painful and limiting bone irregularities are sometimes corrected by osteotomy. The procedure effectively realigns bones and joints, leading to greater comfort and mobility. Commonly conducted on problematic hip joints, osteotomy helps prevent dislocation and other cerebral palsy complications.
- Arthrodesis – Cerebral palsy spasticity can lead to flexion in wrists and other joints. In some cases, permanently fusing bones enhances stability and function. During arthrodesis, a surgeon alters adjacent bones, fusing them into a single, immovable structure. Though the joint remains fixed following surgery, the procedure reduces pain and may improve patients’ ability to walk.
Orthopedic surgery corrects various conditions associated with cerebral palsy. In general, procedures are recommended to enhance quality of life, but each type of surgery has unique benefits. Surgical intervention can:
- Promote independence
- Manage pain
- Optimize abilities
- Minimize complications
Surgical outlooks are case-specific, addressing the individual needs of each cerebral palsy patient. Ambulation is of particular concern, guiding surgical recommendations for children with CP.
- Ambulatory – Ambulatory patients benefit from orthopedic procedures, which improve their ability to walk. Poor stride, scissoring and walking in a crouched position are common symptoms among children with CP. Orthopedic surgery addresses these and other conditions.
- Non-ambulatory – Surgical goals for non-ambulatory patients centers on reducing complications and preventing conditions like scoliosis, hip subluxation (dislocation) and contractures. Orthopedic procedures are also recommended to enhance patient comfort and ease of care.
Recovery times and rehabilitation requirements vary, depending upon which procedures are utilized. Modern, minimally invasive surgical techniques promote fast recovery, and may be performed on an outpatient basis.
Sources Used in This Article
- The Journal of Bone & Join Surgery – Tendon Transfer Surgery in Upper-Extremity Cerebral Palsy Is More Effective Than Botulinum Toxin Injections or Regular, Ongoing Therapy
- WedMD – Orthopedic Surgery for Cerebral Palsy
- Herzliya Medical Center – Orthopedic Surgery for Cerebral Palsy
- MyChildWithoutLimits.org – What are the Surgical Options?