PM&R
Volume 1, Issue 9 , Pages 834-838, September 2009

Surgical Management of Spasticity in Persons with Cerebral Palsy

  • Abigail K. Lynn, MD

      Affiliations

    • Rady Children's Hospital, University of California at San Diego, San Diego, CA†
    • ,
  • Michael Turner, MD

      Affiliations

    • Indianapolis Neurosurgical Group, Indianapolis, IN‡
    • ,
  • Henry G. Chambers, MD

      Affiliations

    • Orthopedic Surgery, Rady Children's Hospital, University of California at San Diego, 3030 Children's Way, Suite 410, San Diego, CA 92123§
    • Corresponding Author InformationAddress correspondence to: H.G.C.

Received 14 July 2009; accepted 30 July 2009.

Cerebral palsy is a disorder that primarily affects the neurologic system but secondarily affects the musculoskeletal system through the effects of spasticity, dystonia, and other movement disorders. The treatment of cerebral palsy requires a multidisciplinary approach with treatment aimed at modulating the movement disorder through oral medication, injectable drugs (phenol, botulinum toxin), and physical and occupational therapy. Treatment of the neurologic effects of the central movement disorders include selective dorsal rhizotomy, intrathecal baclofen pump placement, and potentially deep brain stimulation. Although any effect on tone is temporary, orthopedic surgery has an important role in the treatment of the musculoskeletal deformities and contractures present in the child with cerebral palsy. Orthopedic surgery improves function by lengthening the musculotendinous structures, transferring tendons, performing osteotomies to reduce dislocated joints, and normalizing rotation and fusion of selected joints to improve stability. Neurosurgical techniques are not as widely used, but may reduce spasticity in select individuals. The combined approach of managing tone and normalizing the biomechanics of the spine and upper and lower extremities through orthopedic surgery and neurosurgery and subsequent rehabilitation is the cornerstone of treatment of the child and adult with cerebral palsy.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosures: 2B, Medtronic, Solstice; 3B
  • § Disclosures: 2A, Allergan

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

PII: S1934-1482(09)00761-8

doi:10.1016/j.pmrj.2009.07.016

PM&R
Volume 1, Issue 9 , Pages 834-838, September 2009

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