Cerebral palsy surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Surgery is not the first-line treatment option for patients with cerebral palsy. Surgery is usually reserved for patients with severe disease causing functional abnormalities. Surgical interventions include selective dorsal rhizotomy and tendon lengthening or transfer.

Surgery

Selective dorsal rhizotomy

The main neurosurgical intervention for cerebral palsy.^[1]
It involves dissecting some of the afferent nerve fibers in the lumbosacral roots.
This results in decreasing the muscle tone by disrupting the reflex arch without affecting the motor power.
Selective dorsal rhizotomy is proven to improve the muscle strength and the range of motion.^[2]
In certain patients, weakness develops after performing the procedure. The weakness is thought to be unmasked by the relief of spasticity.^[3]

Tendon lengthening or transfer

Tendon manipulations are done when the contracture is interfering with the movement significantly.^[4]
It might improve the range of motion and the ability to ambulate.^[5]

References

↑ Engsberg JR, Ross SA, Collins DR, Park TS (2006). “Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy”. J. Neurosurg. 105 (1 Suppl): 8–15. doi:10.3171/ped.2006.105.1.8. PMC 2423424. PMID 16871864.
↑ Cole GF, Farmer SE, Roberts A, Stewart C, Patrick JH (2007). “Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience”. Arch. Dis. Child. 92 (9): 781–5. doi:10.1136/adc.2006.111559. PMC 2084010. PMID 17475694.
↑ Grunt S, Fieggen AG, Vermeulen RJ, Becher JG, Langerak NG (2014). “Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature”. Dev Med Child Neurol. 56 (4): 302–12. doi:10.1111/dmcn.12277. PMID 24106928.
↑ Vlachou M, Pierce R, Davis RM, Sussman M (2009). “Does tendon lengthening surgery affect muscle tone in children with cerebral palsy?”. Acta Orthop Belg. 75 (6): 808–14. PMID 20166364.
↑ Abel MF, Damiano DL, Pannunzio M, Bush J (1999). “Muscle-tendon surgery in diplegic cerebral palsy: functional and mechanical changes”. J Pediatr Orthop. 19 (3): 366–75. PMID 10344322.

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[pmid16871864-1] Engsberg JR, Ross SA, Collins DR, Park TS (2006). “Effect of selective dorsal rhizotomy in the treatment of children with cerebral palsy”. J. Neurosurg. 105 (1 Suppl): 8–15. doi:10.3171/ped.2006.105.1.8. PMC 2423424. PMID 16871864.

[pmid17475694-2] Cole GF, Farmer SE, Roberts A, Stewart C, Patrick JH (2007). “Selective dorsal rhizotomy for children with cerebral palsy: the Oswestry experience”. Arch. Dis. Child. 92 (9): 781–5. doi:10.1136/adc.2006.111559. PMC 2084010. PMID 17475694.

[pmid24106928-3] Grunt S, Fieggen AG, Vermeulen RJ, Becher JG, Langerak NG (2014). “Selection criteria for selective dorsal rhizotomy in children with spastic cerebral palsy: a systematic review of the literature”. Dev Med Child Neurol. 56 (4): 302–12. doi:10.1111/dmcn.12277. PMID 24106928.

[pmid20166364-4] Vlachou M, Pierce R, Davis RM, Sussman M (2009). “Does tendon lengthening surgery affect muscle tone in children with cerebral palsy?”. Acta Orthop Belg. 75 (6): 808–14. PMID 20166364.

[pmid10344322-5] Abel MF, Damiano DL, Pannunzio M, Bush J (1999). “Muscle-tendon surgery in diplegic cerebral palsy: functional and mechanical changes”. J Pediatr Orthop. 19 (3): 366–75. PMID 10344322.

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