How Surgery Can Help With Cerebral Palsy
If medications or physical therapy do not alleviate severe cerebral palsy symptoms, surgery may be an option. Surgery can significantly reduce the amount of pain that your child feels, especially if they have severe spasticity issues or problems with the curvature of their spine.
Generally, surgery is not recommended until medications and physical therapy have already been tried. Spasticity, or the involuntary contraction of the muscles, is one of the most common and debilitating cerebral palsy symptoms. It is also the symptom that is most often treated with surgery when it becomes severe.
It is important to recognize that surgery has risks and that there is no such thing as a procedure with a 100% success rate. However, in some severe cases of cerebral palsy, surgery is the best option for reducing pain and maximizing functionality.
Surgery may help treat:
- Foot problems: Tightening of the calf muscle and shortening of the Achilles tendon cause contractions in which the foot points downward. Further, a foot may point downward and inward. A heel turning inward can cause “clubfoot.”
- Leg problems: Surgery can lengthen hamstrings to correct a crouching gait. Tendon transfers can be performed to help with “stiff-knee” gait. Surgery to release contractures in the upper legs can relieve pain.
- Hip problems: Dislocations of the hip can be brought into line and “pigeon-toe” gait can be corrected with surgery.
- Spine problems: Surgery can correct problems including contractures, curvatures or abnormal tilts of the spine.
Types of Surgery for Cerebral Palsy
There are several different types of surgery available to children suffering from severe cerebral palsy symptoms. Common surgical procedures for cerebral palsy include stereotactic surgery, selective dorsal rhizotomies and tenotomies.
Each surgery has its own set of benefits and potential drawbacks. Make sure to discuss any potential surgical decisions with your medical provider to determine whether surgery is the right decision for your child.
A stereotactic surgery identifies and removes lesions. Generally, these lesions are found in the brain. They are removed with the help of a computer system that creates a three dimensional image of the brain prior to surgery. Surgeons will use the three dimensional image, along with MRI and CT scans, to guide the removal of the lesion through a small incision.
Lesions on the brain can cause seizures, nerve pain and other mobility issues in cerebral palsy patients. If your child has seizures or extreme headaches that cannot be controlled with medication, they may be a candidate for stereotactic surgery.
The risks involved in stereotactic surgery include brain bleeds during surgery. Removal of the tumor or lesion can cause bleeding that can lead to stroke, coma or death.
Surgeons estimate that the bleeding risk is about 5% after surgery with a mortality risk of around 1%.
Selective Dorsal Rhizotomy
A selective dorsal rhizotomy, or SDR, is a surgical procedure that treats severe muscle spasticity. Muscle spasticity is caused in part by the brain sending abnormal signals through nerves to specific muscle groups. This problem is corrected through SDR as surgeons cut the problematic nerve rootlets in the spinal cord that send the abnormal signals.
During a selective dorsal rhizotomy, surgeons first remove bones (vertebrae) in the spine. They expose the spinal cord and the roots of nerves. They then separate the roots into rootlets. Each rootlet is separated from the others. Next, the doctors electrically stimulate each rootlet.
SDR is usually a procedure performed on children, and it can reduce spasticity and improve walking gait. Depending on the success of the procedure, the patient may regain or improve their range of motion. This can help the patient to gain more independence and perform tasks such as getting out of bed and putting on clothes without assistance.
SDR is irreversible. Therefore, it is critical that the patient receives an evaluation from a neurosurgeon, pediatric rehabilitation physician, a physical therapist and an orthopedic surgeon before the surgery is performed.
Tenotomy for Cerebral Palsy
A tenotomy is a surgical procedure that lengthens the muscles or tendons in a particular group that have become stretch-resistant. In children with cerebral palsy, certain muscles can remain in a shortened position for an extended period of time, which makes it difficult for them to extend and release.
When the tendon that attaches muscle to bone shortens, the muscle can develop fibrous tissue which prevents full range-of-motion. This entire process leads to what is called a contracture. A tenotomy can prevent or correct contractures.
Baclofen is a muscle spasticity drug. The drug causes unwanted side effects such as drowsiness and dizziness when taken orally. Therefore, medical professionals developed a new system that delivers the drug through a pump inserted under the skin. This new system is referred to as a baclofen pump.
How Do Baclofen Pumps Work?
A baclofen pump is inserted under the skin in the abdomen area after the patient has been sedated. After the pump has been inserted, a catheter is inserted along with the pump to ensure that the medicine is delivered to the spinal canal. Every month, the pump must be refilled by a doctor.
What to Expect from Cerebral Palsy Surgery
Surgery can be an effective way to treat the symptoms of cerebral palsy, but it cannot cure the condition. It is important to work with a medical provider to determine the severity of your child’s symptoms and whether surgery is necessary.
If your child has been diagnosed with cerebral palsy and does need surgery, the cost of the procedure can be expensive. If your child’s case of cerebral palsy was caused by medical negligence, you may be eligible for a financial settlement that can pay for some or all of the procedure.