Are There any Surgical Techniques to Treat People With Cerebral Palsy?
Cerebral palsy varies widely in both nature and severity. In some cases, surgical intervention may be appropriate for individuals with cerebral palsy. When muscle shortening, stiffness, or spasticity are severe enough to impede everyday functioning, surgical intervention can be a good way to improve outcomes. Orthopedic surgery can help improve the appearance of a gait, overall mobility and functioning, and improve quality of life.
Surgery is a viable option for many people with cerebral palsy, but the approach is unique for each individual. Certain muscles are responsible for irregularities in a gait, and the first step in any surgical intervention is identifying them. For example, it can take more than 30 muscles working in harmony to create a stride and take two steps. Any one of these muscles can throw off the balance and create an abnormal walking pattern. Unfortunately, there is no consistency in the kinds of muscles cerebral palsy affects, so the problems are often unique to the individual.
To further complicate matters, the body naturally compensates for issues like low tone and muscle imbalances, common in people with cerebral palsy. As a result, the body's compensation could actually be a part of the problematic gate, not part of the solution. Doctors have a unique challenge before them: determining the muscles involved in the creation of an abnormal gait, and performing the appropriate orthopedic intervention.Gait Analysis
A tool called gait analysis serves an important purpose in identifying the muscles responsible for a problematic walking pattern. This diagnostic technique uses cameras that analyze how an affected individual walks using special recording techniques. By leveraging modern technology, doctors can locate the muscles that would benefit from orthopedic surgery with increased precision. A gait analysis can also reveal how much a surgical intervention can be expected to improve a person's ambulation.When do Doctors Treat Gait Issues?
In the past, orthopedic surgery was invasive - as such, surgeons preferred to complete all the necessary interventions a child needed at once. As a result, children were often bedridden for weeks following surgery. Now, thanks to modern technology, orthopedic surgeons can perform many surgeries on an outpatient basis and with minimal downtime.
Because surgical intervention is far less invasive, surgeons now can stagger medical procedures and time them based on a child's development. Surgeons have pinpointed the best time to operate on a child based on the emergence of the abnormal gait pattern. For example, the spasticity associated with the "scissor walk" pattern typically emerges between ages 2 and 4. By correcting the issue within this time frame, doctors can maximize a child's mobility.Common Surgical Procedures for Cerebral Palsy
Each case of cerebral palsy is unique, so surgical procedures to address muscle strengthening vary widely. However, two separate procedures exist to address severe spasticity:
- A selective dorsal rhizotomy (SDR) is a treatment reserved for severe spasticity when all other treatments fail to address the negative effects, such as chronic pain. This procedure involves the selective severance of nerves that cause the spasticity and other symptoms. Since it has serious potential side effects - such as sensory loss, numbness, or neuropathy - it's considered a treatment of last resort.
- Spinal cord stimulation works to treat cerebral palsy by decreasing the motor neurons responsible for spasticity. Since it involves the implantation of an electrode directly at the base of the spinal cord, doctors only consider it when other, more conservative treatments fail.
Surgical interventions can be extremely effective in helping those with cerebral palsy experience less pain and achieve more mobility. Surgery generally focuses on increasing quality of life and reducing spasticity, though some techniques are reserved for instances in which all other treatments fail.