Cerebral Palsy - Surgical Treatment for Children

Treating Cerebral Palsy through surgery opens up extensive recovery options and improves the problems associated with it like mobility, growth, stiffness, and posture. It requires physical therapy and medications before and after the surgery to gain the maximum benefits of the treatment. The numerous surgery options help to improve various complexities related to movements, pain, and alignment in ankles, feet, legs, arms, wrists, and hips and the areas where the surgeries are performed as either muscles, tendons, bones, or nerves.

The treatment of cerebral palsy through surgical methods involves the maximum chance for a child to recover from the ailment and live life freely. Still, it does consist of the risk of getting the opposite results, which is a rare case scenario. So before going for the surgery, ensure to take proper knowledge with the concerned specialist. Here is the brief description of each surgical treatment that reduces the pain and problems that are usually caused by cerebral palsy.

Types of Surgery

Today numerous procedures can rectify many issues and even the secondary conditions of cerebral palsy. In this case, orthopedic surgery for cerebral palsy is the first and successful option opted by surgeons to improve the mobility, posture, and gait in children. At the same time, other operations have shown the results to correct co-occurring conditions such as hearing, feeding, vision, and external issues.

Orthopedic Surgery

Orthopedic Surgery is recommended when the child exhibits traits of rotational abnormalities, limited movement, complains of pain in activities like wearing shoes, and joint dislocation. The surgery results in preventing future complications in children’s growth. Several orthopedic procedures are medically present that may help in improving the conditions related to cerebral palsy.

• Muscle lengthening – In the process of surgical muscle lengthening, the child will get relief from the tightness present in the fingers and hands. It improves the ability to move and walk without any obstacles. Also, the lengthening the arm muscles results in strengthening, and the child will be able to hold and grasp objects without any pain.

• Tendon lengthening – The surgery is performed to improve the muscles' stiffness or tightness associated with cerebral palsy and heal the painful movements. The results of the surgery are mostly affirmative and help the child to walk and sit uprightly.

• Tendon transfer – In Cerebral palsy, the tendons become too hard, reducing the chances of flexibility and turns it into the deformity. During the process of tendon transfer, the surgeon has to cut and replace the part of a tendon to ensure that the involved muscles are now correctly aligned. After the surgery, the child can overcome the walking and sitting issues while experiencing lesser pain.

• Tenotomy/Myotomy – The results of tenotomy and myotomy are similar to other surgeries; a child will see the improvement in the muscle functions and easily hold items with hands and feet. These methods are more applied to the cases that lack the control of upper limbs, braces, and cast are the following treatment methods to give better support and alignment. Tenotomy is a primary method of cutting of the tendon while myotomy revolves around the cutting of muscle. Either way is opted according to the condition of the child.

• Osteotomy – Osteotomy is conducted to realign joints and treat bone deformities. In this surgery, doctors will cut and reshape/reposition bones at certain angles to the healthy alignments, which is done in the most affected areas like knees and ankles and commonly reduces or corrects the hip complications.

• Arthrodesis – In the severe case of muscle stiffening, arthrodesis is opted by ortho-surgeons that removes the damaged cartilage before shaping affected bones and permanently fuses the joint in a correct position. Arthrodesis is used when splints and cast can’t help in recovery. The outcomes of the method gives the positive result in walking and movements done by a child.

Ambulatory and Non-Ambulatory Children

Every child experiences cerebral palsy differently. In a case where a child can walk is known as Ambulatory, and on the other hand, those who are not capable enough to walk are Non-Ambulatory children.

Ambulatory children may suffer from maintaining balance and coordinating movements and face terrible pain in the actions of muscles and joints. The surgery result positively affects muscle and joint mobility and helps them walk confidently without any struggle.

For Non-Ambulatory children, the process of surgery is more required to secure them with future complications. In this case, a child cannot manage to walk with or without the support, and after the surgery, he /she may see comfort in sitting, lying down, walking with less pain. If a child is suggested to take the support of walkers or crutches in the future, provide it as it may help regain confidence and improve recovery speed.

About Selective Dorsal Rhizotomy

Selective Dorsal Rhizotomy is a permanent surgical method that helps reduce pain and spasticity due to cerebral palsy. When the rest of the other surgical and non-surgical methods failed to treat the severity of the ailments, SDR is advised by doctors. Children who suffer from muscle tightens in the legs will have better chances to recover than in other locations.

The SDR surgery involves cutting sensory nerve fibers in the spinal column associated with the muscle's stiffness. The procedure is complicated as it requires to surpass the dense network of nerves to reach through the tensed nerves, causing the main problems in the movement. The best results of the surgery come in relaxing upper and lower limbs, improving the movements like sitting, standing, walking, balancing, lifestyle activities, and voluntary motor control.

To recover after the selective dorsal rhizotomy needs a little more care than orthopedic surgeries such as physical therapy and constant monitoring and brings back the muscle control and movements.

Surgical Solutions for Co-Occurring Conditions

The above mentioned cerebral palsy related surgeries are the treatments dealing with the general symptoms and conditions such as muscle stiffness or tightness, mobility issues, pain in movements, and muscle spasms. Moreover, in numerous cerebral palsy cases, the chances of co-occurring conditions also occur, increasing the complications that need different kinds of surgeries to overcome the specific problems.

• Cochlear Implants

Cochlear Implants are recommended for restoring the hearing ability in the children. Every cochlear implant consists of two pieces. The first one is kept behind the ear, and the other one is surgically implanted near to the previous part. The surgery will take two or three hours, including several weeks of recovery and the required therapy afterward.

• Gastrostomy

Children having cerebral palsy suffer from muscle control, which also leads to issues related to feeding and eating. Even it makes it impossible to swallow and chew the food comfortably. Severely affected with acid reflux and aspiration, a condition where drink or food enters the lungs, a child has to undergo lots of trouble due to low muscle tone.

In this surgery, a feeding tube is surgically implanted that makes the digestive path normal and makes the feeding less challenging for both parents and children. This resolves the complications of severe cerebral palsy cases also some few consultations of speech therapists helps a child in practicing swallowing and chewing.

• Hydrocephalus

Only a few children with cerebral palsy have hydrocephalus, which needs surgical methods to treat the ailment. When an excess amount of cerebrospinal fluid builds up in the skull, it causes severe swelling and pressure leads to the abnormal size of the head. In the process of surgery, doctors implant drainage valves to get rid of excess fluid.

Conclusion

When it comes to treating skull related issues, the surgery always has some risks, so its better to understand the possible benefits and risks of the surgery before taking the primary step for your child. Your doctor will suggest the right time and treatment method according to the child's condition and age.