Cerebral Palsy and Orthopaedic Surgery
Orthopaedic surgery can prevent spinal deformities and contractures but requires particular expertise and appropriate rehabilitation following surgery.
When contractures cause severe movement problems, surgery to lengthen muscles and tendons may be recommended. Gait analysis is used to identify problem muscles, eliminate compensation factors associated with walking, and check surgical results. Cameras and computers record and analyze the patient's walk, and electromyography records muscle activity.
Surgically lengthening a muscle makes it weaker and may require months of recovery. Whenever possible, therefore, doctors try to fix affected muscles with a single surgery. If more than one procedure is required, operations usually are scheduled as close together as possible.
Cerebral Palsy and Neurosurgery
Dorsal root rhizotomy treats spasticity in the legs by selectively severing nerves that overstimulate leg muscles. The procedure is controversial, but it can benefit some CP patients, particularly those with spastic diplegia.
Stereotactic neurosurgery may improve rigidity, choreoathetosis, and tremor. The area of the brain treated controls the part of the body meant to be improved. A head CT scan is performed to produce images of the brain. Coordinates of the location to be treated are moved to a stereotactic frame. The frame is used like a map to guide an electrode to the target area in the brain. An electrical impulse is sent through the electrode and into the brain tissue to change the brain cells.
Stereotaxic thalamotomy can reduce some hemiparetic tremors. This procedure involves cutting parts of the thalamus, the brain's center for relaying messages from the muscles and sensory organs. There is significant risk with this procedure.
Chronic cerebellar stimulation is an experimental technique that uses electrodes surgically implanted on the surface of the cerebellumthe part of the brain that coordinates movementto decrease spasticity and improve motor function by stimulating certain nerves. Some studies claim the procedure improves spasticity, while others report less satisfactory results.