Cerebral Palsy Treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka
Surgery in cerebral palsy is one of the techniques of management which is used very often many times, with unpredictable outcome and is not without side effects. If it is not executed properly then walker children can become non walker. Surgery in the cerebral palsy can be neurosurgical or orthopedic surgery. In cerebral palsy, neurosurgery also has been used but not always with successful outcome. Selective dorsal rhizotomy and selective neurectomy are two neurosurgical procedures which are used commonly.
Selective dorsal rhizotomy – In selective dorsal rhizotomy, about 20-40% dorsal nerve rootlets are sacrificed by laminectomy / laminoplasty from L1 to S1. SDR is indicated in patient with Spasticity and not useful in patient with contracture and fixed deformity. Orthopedic surgery is often required after SDR. Complications rate is very high as selection of affected nerve root is difficult. Some centers claim good outcome with this procedure but in most of the hands, may not give expected outcome.
Complication- this surgery is associated with complications like sensory disturbance, spinal deformity, and permanent weakness of extremity by loss of antigravity stability and bladder dysfunction. Once this procedure has been executed then is not reversible by any means.
Selective Neurectomy – This technique is also used at some centers; most commonly performed on obturater & tibial nerve. Identification of nerve fiber requires per-operative electromyography assessment of affected nerve root distribution. Some time it can cause fibrosis of muscle & tendon that lead to progressive deformity and permanent paresthesia.
Orthopedic Surgery – Orthopedic surgery has been used since long time. This surgery is being used to correct the deformity present in body but it is being done in staged manner, and usually done in elder children. In Routine surgeries, tendon lengthening, tendon transfer and bony surgery were done. But by this concept most of the deformity correction cannot give good functional recovery and ultimately child remains disable. Few procedures are very common in this concept like tendoachilis lengthening, adductor tenotomy, hamstring lengthening. Child usually requires admission many times for surgery even 6-8 times in some cases. Unfortunately some times walker children become non walker with this surgery. Also with this concept loss of antigravity action can occur, selective control of spasticity is not possible, and child is often left out with deformity despite repeated surgery. It is not helpful in severely affected patient.
Delayed surgery leads to development of non correctable deformities like Genu Recurvatum, crouch gait, permanent neglect of hand function and plano-valgus feet.
Cerebral palsy treatment surgery center children symptom India US UAE Europe Pakistan Nepal Bangladesh Sri Lanka
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Dr. Jitendra Kumar Jain
Twitter : TrishlaOrthoped