Surgical Intervention

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In addition to physiotherapy and medical treatment, children with spastic CP are often treated surgically. Depending on the individual child, muscle or tendon lengthening, tendon transfer, and bone correction aim to restore the functional range of motion, diminish muscle strength imbalance, and align the limbs to a functionally correct position. The aims of these interventions are to minimize the development of contractures and deformities by normalizing the muscle tone, facilitating adequate stretch to muscles, and increasing the active range of motion, to strengthen weak muscles, to improve mobility and acquire functional motor skills, and to promote functional independence in the house, at school, and in the community. Physiotherapy applications after surgery may differ depending on the child’s general health, site of surgery, and surgical approach. The purposes of the applications are to increase range of motion, provide muscle strength balance, protect gains by positioning, develop new movement abilities, maintain biomechanical regularity, and provide re-ambulation.

Orthopedic surgery is often recommended when spasticity and stiffness are severe enough to make walking and moving about difficult or painful. The spine is monitored for scoliosis, and the hips for progressive subluxation. In younger children, lengthening or transfer of contracted tendons may suffice, supplemented by bracing to prevent early recurrences. For older children with bony deformities, corrective osteotomies (resetting of the bony alignment) may be required. If surgery becomes necessary, it is wise to do as much as possible at one setting both to keep multiple levels in balance as well as to avoid having to operate too frequently through childhood. Indications for surgery are generally different in ambulatory as opposed to non ambulatory children.