Long-Term Results of Orthopaedic Surgery in Cerebral Palsy

¹ BALTIMORE, MARYLAND

Orthopaedic surgery has a definite place in the treatment of cerebral palsy. However, of the many surgical procedures which are successful in poliomyelitis not all are adaptable to cerebral palsy, since the characteristics of the two conditions are entirely different.

The effects of growth and consequent recurrence of deformities must be considered in evaluating the functional results. Tendon lengthenings and tenotomies are more successful after growth has been completed. They are seldom successful when performed during the period of growth unless the desired tendon length can be maintained by use of a brace.

The status of the antagonists of all muscles for which surgery is contemplated must be carefully determined.

Muscle transplantation in both spastic and athetoid patients always fails because the injury in cerebral palsy does not involve individual muscles, as in poliomyelitis or other lower motor neuron lesions, but affects total joint function or position, which is mediated through the upper motor neurons.

In spasticity there is stimulation and in athetosis, release of the upper motor neurons. Thus good long-term results cannot be obtained from muscle transplantation in either of these conditions.

The presence of athetoid shift must be recognized. In some instances external fixation with a brace or cast can be used to determine whether a favorable or unfavorable shift would result from surgery.

Bone surgery statistically has proved highly successful and should be the basis for further development In the field of cerebral palsy. This was also Pollock's conclusion. This author also noted that among tendon procedures hamstring and adductor tenotomies produced a relatively higher incidence of successful results, thus confirming the results of this study.

It is hoped that this survey will be a guide in the development of orthopaedic surgical procedures for the treatment of cerebral palsy in the future.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?