Minimally Invasive Orthopaedic Care for Children with Cerebral Palsy

Orthopaedic surgery can be an important part of a successful outcome for children with cerebral palsy. In fact, roughly half of all kids with cerebral palsy will have at least one surgery during their lifetime.

Children with cerebral palsy may need orthopaedic surgery to:

• Realign bones
• Relax spastic muscles
• Relieve pain
• Repair joints

At our Orthopaedic Cerebral Palsy Clinic, we’ll evaluate your child’s abilities and use that baseline to come up with a plan—one that focuses on nonsurgical interventions first but includes surgical options, as well, whether they’re needed now or in the future.

We also provide second opinions for patients and offer long-term recommendations as needed.

What to Expect

During your child’s appointment, your orthopaedic surgeon will:

• Answer your questions
• Ask your child to move in specific ways or perform basic tasks
• Evaluate the fit of your child’s assistive device or wheelchair (if applicable)
• Observe your child playing and walking
• Provide a thorough physical exam
• Take necessary X-rays
• Talk to you about your concerns, goals and expectations for treatment

The surgeon may recommend hip and spine surveillance techniques designed to preserve the hip joint and help your child avoid major surgery later. And they may order additional tests, such as imaging studies or functional assessments, to help determine the underlying causes of your child’s concerns, analyze what therapies could help and choose the least invasive option.

After your child’s appointment, you’ll receive a personalized treatment plan from the orthopaedic surgeon, which may include surgical or nonsurgical treatment options—or a combination of the two.

Orthopaedic Surgical Options for Children Who Walk or Who Have the Potential to Walk

Orthopaedic surgery often maximizes a child’s ability to walk. Surgeries for children who walk or who have the potential to walk include:

• Tendon and muscle lengthening. This procedure treats muscle contractures and can help improve motor control and gait. The surgeon uses tiny incisions to minimize pain and shorten recovery time.
• Tendon transfer. This surgery involves cutting a tendon and attaching it at a different location to improve alignment and muscle strength.
• Osteotomy. This surgery is designed to correct bone abnormalities that develop over time. It usually involves realignment of the bone in the hips and upper or lower extremities. The surgeon may use plates, rods or screws to hold the newly shaped or repositioned bone in place.
• Guided-growth surgery. This type of minimally invasive procedure harnesses your child’s own growth to help realign their bones or prevent abnormalities, with far fewer surgeries and a much easier rehabilitation.

Orthopaedic Surgical Options for Children Who Are Not Able to Walk

Orthopaedic surgery for children with cerebral palsy who aren’t able to walk typically focuses on reducing pain and preventing long-term disability. These surgeries may treat:

• Arthritis – inflammation of the joints
• Contractures – very tight, stiff muscles
• Hip dysplasia – abnormal growth of the hip joint
• Progressive scoliosis – a sideways curvature of the spine that worsens over time

Benefits of Our Team Approach

The orthopaedic surgeons in the Cerebral Palsy Program at Cincinnati Children’s take a minimally invasive, less-is-more approach to caring for children with cerebral palsy. Our goal is to help children become more independent, reduce their discomfort and pain, and achieve a better quality of life.

Sometimes, this means delaying surgery. Other times, it means performing several procedures at once to avoid multiple surgeries later. Each surgical plan is as unique as the patient it’s designed to treat.

Minimally Invasive Techniques

Providing the right surgery at the right time requires well-honed evaluation and surgical skills. Our pediatric orthopaedic surgeons are leading the way internationally, using minimally invasive techniques to achieve excellent results in the form of strong outcomes and low complication rates.

Some of the minimally invasive techniques our orthopaedic surgeons offer include:

• Single-event, multilevel surgery (SEMLS), which allows the surgeon to perform multiple procedures at once rather than spreading them out over many years. SEMLS typically results in fewer total surgeries and only one course of rehabilitation. SEMLS can be used to treat soft tissue and bone problems in the legs, hips and upper extremities.
• Guided-growth techniques, which use a child’s natural growth pattern to guide bones, joints and tendons into more natural alignment. Cincinnati Children’s was one of the first pediatric hospitals in the country to use guided-growth techniques, and we continue to lead the way in this type of care.
• Supplemental therapy interventions coordinated with surgery:
  • Serial casting (or extension casting), which involves using a series of casts on a joint. Each cast turns the joint a little farther in the direction it needs to go.
  • Functional electrical stimulation, which delivers a low-energy current to the muscles. Orthopaedic surgeons use this therapy to help improve:
    • Foot and ankle positioning
    • Gait
    • Muscle mass
    • Muscle strength
    • Rate of motion
    • Spasticity
    • Walking speed