Cerebral Palsy Surgeries- All you need to know

Cerebral palsy, a neurodegenerative disorder, impairs the ability of a person to move, balance, and maintain correct posture. It occurs when the developing and immature brain is damaged, most commonly before birth. Any bodily function involving the brain is called cerebral, while palsy pertains to any weakness or difficulty using muscles. It is a condition in which the brain develops abnormally or becomes damaged, resulting in muscle control problems.

Individuals with cerebral palsy may exhibit signs and symptoms during the early stages of life, such as infancy and preschool. These signs and symptoms may include difficulty in swallowing, as well as an imbalance of eye muscles, which results in the eyes not being able to focus on a single object.

Cerebral palsy has no cure, but there are a variety of treatments that can help improve the child’s day-to-day activities. If medication or physical therapy doesn’t help with severe symptoms of cerebral palsy, an individual may want to consider surgery. Surgery can drastically reduce the pain that the child experiences, especially if the child has severe problems with spasticity or curvature of the spine.

How surgery can help in Cerebral Palsy?

Cerebral palsy can be managed in a variety of ways, but surgery is one of the most effective options for improving mobility, posture, and promoting healthy growth. Generally, Paediatrics Ortho doctors in Bangalore advise patients to begin treatment with lower-risk options, such as medication and physical therapy, before considering surgery. Although surgery is invasive and requires time to recover, it can provide a range of benefits, including improved mobility and reduced pain. Ultimately, the goal of all treatment for cerebral palsy is to provide children with the best opportunity to live independently.

The primary purposes of surgery are to:

• Eliminate muscle stiffness
• Enhance balance and coordination
• Correct spinal curvatures
• Improve posture
• Reduce tremors
• Correct foot deformities
• Prevent spinal deformities
• Relieve pain
• Ensure the proper alignment of joints and tendons
• Free permanently strained muscles
• Prevent hip dislocation
• Treat co-occurring conditions

Considerations before deciding on surgery

It is important to note that surgery is not a viable option for all children, and it is recommended to try medications and therapies before considering surgery. There is no single treatment plan that is suitable for every child with cerebral palsy; a surgical intervention that works in one situation may not be effective in another. Furthermore, the potential advantages must outweigh the potential risks.

General anaesthesia can expose a child to the risk of respiratory distress, infection, haemorrhage, or even worsening of the condition. Parents and physicians must discuss potential surgical alternatives and reach a decision that balances the risks and benefits, prioritising the child’s health and wellbeing. Parents who are considering surgery to improve their child’s health should be aware of the associated risks and benefits.

Ambulatory and Non – Ambulatory Children

Cerebral palsy affects children in various ways and to varying degrees. Some children may be able to walk independently, while others may not be able to walk at all and require assistance. Children who can walk might experience difficulties with balance and movement control, as well as challenges in coordinating their muscles and joints. Additionally, walking could be painful for these children.

The objective of surgery for a child who can walk is to enhance their ability to walk independently and without pain. For a child who is unable to walk, either completely or with assistance, surgery can improve their quality of life and potentially reduce the risk of complications. Even for children who can walk with assistive devices, like walkers, surgery might offer benefits in terms of increasing their independence.

Types of Surgery

Cerebral palsy can be treated in many ways. There are numerous procedures available to address various problems and secondary conditions. Most orthopaedic surgeries are used to correct issues related to movement, posture, and gait. Additionally, other surgeries can be employed to address co-existing conditions like feeding or hearing problems.

Orthopaedic Surgery

Orthopaedic surgery is the term used to describe procedures that focus on the muscular and skeletal systems. This type of surgery is typically recommended when prior treatments and medications have not been successful. Most of the symptoms and difficulties faced by children with Cerebral Palsy can be attributed to problems with the muscles, joints, and bones. Orthopaedic procedures are effective in treating spastic movements, which are often jerky or exaggerated. These procedures can help repair broken joints, correct bone deformities, and reduce pain. Additionally, orthopaedic surgery may also mitigate the risk of future complications, including hip contractures and dislocation.

Orthopaedic procedures can be divided into 6 main categories:

1. Muscle Lengthening – Surgery is performed to lengthen the muscles, which reduces the tightness of the hand and fingers. Lengthening the arm muscles can help children grasp objects more easily and enhance fine motor skills.
2. Osteotomy – This surgical technique is employed to improve joints. An orthopaedic surgeon can reshape the bones to enhance a child’s mobility and posture.
3. Tendon transfer – Transferring a tendon usually involves cutting and replacement. The purpose of tendon transfer is to ensure the muscles in the body are in the correct position.
4. Tendon Lengthening – Tendon lengthening can help reduce painful contractures, which are a permanent tightening of tendons or muscles in the body. Tendon lengthening is often used to assist a child in walking and sitting up straight.
5. Arthrodesis – Arthrodesis is a surgical procedure used to permanently fuse bones together, reducing spasticity and mobility in severe cases of bone spasticity. This can help reduce the intensity of spasms and facilitate walking.
6. Tenotomy/myotomy – Tenotomy involves the surgical removal of a tendon, while myotomy involves the removal of a muscle. Both procedures are used to enhance muscle function, improve upper limb control, and enhance hand and foot grip.

Selective Dorsal Rhizotomy (SDR)

Another way to treat CP in kids is through Selective Dorsal Rhizotomy (SDR). This is an aggressive procedure, so it’s not recommended for the majority of children. While SDR can help improve spasticity symptoms and provide long-term pain relief, it is also a risky procedure.

SDR is a surgical procedure that involves cutting the nerves in the spinal column that cause muscle stiffness in the body. This procedure involves carefully navigating the intricate network of nerves in the body to identify the nerves that are causing movement problems. By targeting the correct nerves, a child may experience improved mobility, increased comfort, and considerable relief from pain. The post-operative recovery of Selective Dorsal Rhizotomy requires intense physical therapy to re-establish muscle coordination and movement.

Other Surgeries

Every child with cerebral palsy exhibits distinct characteristics, and the majority of those with CP experience secondary conditions, such as hearing loss and acid reflux. These secondary conditions can stem from the limited movement associated with cerebral palsy, but they are also amenable to treatment through surgery.

For example, hearing loss is a prevalent issue, and the insertion of a cochlear implant to restore hearing is often recommended. Children with cerebral palsy who struggle with eating due to difficulties in swallowing or chewing can benefit from surgical procedures aimed at improving their eating habits. Surgical interventions, such as the implantation of a feeding tube, can effectively mitigate these complications. Additionally, certain children with CP may require the surgical placement of a small pump into the abdomen for the administration of medication to the spinal cord, which in turn reduces muscle contractions and alleviates pain.

When is the right time for surgery?

Medical professionals have varying views on the optimal time to recommend surgery for a child with cerebral palsy. Some doctors believe that surgery is best for a child when they are young, while others think that surgery should be postponed until the child is older, and that physical therapy and medication should be tried first. Cerebral palsy is typically treated from the ages of 3 to 10 years old, although the exact age varies from person to person. An expert can help determine the right treatment for your child. Visit Top Pediatric Orthopaedic Hospital in Bangalore to discuss your child’s unique medical needs and the best timing for you with your care provider.