Surgical Treatment Options for Cerebral Palsy

The Role of Surgery in Cerebral Palsy Treatment

Surgical interventions are considered an additional treatment option for cerebral palsy. The most common procedures are orthopedic surgeries aimed at correcting muscle shortening and skeletal deformities.

For children who have the potential to walk in the future, the main goal of surgery is to improve mobility.
For children without prospects for independent walking, surgical treatment may focus on improving sitting ability, facilitating personal hygiene, and, in some cases, reducing pain.

Common Orthopedic Surgical Procedures

The most frequently performed surgical procedures in cerebral palsy include:

• correction of scoliosis,
• treatment of hip dislocation or subluxation,
• tendon lengthening or tendon transfer to reduce spastic muscle imbalance,
• osteotomy to correct abnormal limb positioning.

Timing of Surgical Intervention

At present, there is no single consensus regarding the optimal timing of surgical treatment in cerebral palsy.

When deciding whether surgery is appropriate, clinicians consider:

• the maturity of the nervous system,
• the child’s potential for independent walking,
• the rate of development and progression of musculoskeletal deformities.

Evidence on the Effectiveness of Surgical Treatment

The effectiveness of surgical interventions in cerebral palsy remains a subject of ongoing discussion.

Within a scientific program conducted by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), a large review analyzed published data on adductor release surgery for the prevention of hip subluxation in children with cerebral palsy.

The literature review demonstrated that radiographic improvement after adductor release was observed in only 168 out of 530 cases. Furthermore, no high-quality studies have convincingly shown improvements in quality of life following this procedure, including:

• reduction of pain,
• improved pelvic hygiene,
• increased hip range of motion,
• improved sitting ability,
• reduced pelvic obliquity.

Functional Neurosurgery in Cerebral Palsy

In addition to traditional neuro-orthopedic approaches—where the surgeon operates directly on spastic muscles, tendons, or deformed joints—functional neurosurgical methods have increasingly been applied in Western countries.

Selective Dorsal Rhizotomy

One such method is selective dorsal rhizotomy (SDR).
After performing a laminectomy to access the spinal cord, approximately 70–90% of the sensory dorsal nerve roots at levels L2–S1 are selectively severed.

In some patients with cerebral palsy, this procedure may reduce muscle spasticity and improve the ability to sit, stand, or walk. However, careful patient selection is essential, as postoperative muscle weakness may significantly reduce functional independence.

Intrathecal Baclofen Therapy

Another neurosurgical approach used in cerebral palsy is intrathecal baclofen therapy. Baclofen is a derivative of gamma-aminobutyric acid (GABA) and acts by inhibiting the presynaptic release of excitatory neurotransmitters from afferent nerve fibers.

The medication is delivered directly into the cerebrospinal fluid via an implanted infusion system consisting of:

• a pump placed subcutaneously in the anterior abdominal wall,
• a catheter is inserted into the spinal canal below the conus medullaris.

The pump provides continuous drug delivery, and the reservoir is refilled approximately every three months.

This method offers several advantages:

• direct delivery of baclofen to the site of action,
• stable drug concentration in cerebrospinal fluid,
• avoidance of fluctuations associated with oral administration.

Limitations of Neurosurgical Approaches

Many researchers note that both intrathecal baclofen therapy and selective dorsal rhizotomy are less effective in patients with fixed limb deformities.

These methods appear to be most effective in cases of non-fixed, reflex-related contractures that occur in an upright position and are associated with muscle spasticity and strength imbalance.

Need for Further Research

The wide range of available surgical treatment options for cerebral palsy highlights the need for continued research to define clear indications and contraindications for patients of different ages and with various clinical forms of the condition.

References

1. Lilin ET, Stepanchenko OV, Bryl AG. Modern technologies of restorative treatment and rehabilitation of patients with cerebral palsy. Detskiy Doktor. 1999;(2).
2. Stott NS, Piedrahita L; AACPDM. Effects of surgical adductor releases for hip subluxation in cerebral palsy: an AACPDM evidence report. Developmental Medicine & Child Neurology. 2004;46(9):628–645.
3. Peacock WJ, Arens LJ, Berman B, et al. Selective posterior rhizotomy for relief of spasticity in cerebral palsy. South African Medical Journal. 1982;62:119–124.

About the author

Anna Kushnir

Pediatrician and senior research fellow specializing in pediatric rehabilitation. Member of EACD and AACPDM.