Cerebral palsy (CP) is a neurological condition that affects muscle tone, posture, and movement. Over time, the muscle imbalance and spasticity caused by CP can lead to bone deformities, joint contractures, and gait problems.
For many children, these complications cannot be managed by physical therapy alone, making cerebral palsy orthopedic surgery an important treatment option. Orthopedic procedures correct musculoskeletal deformities, reduce pain, and improve mobility, enabling better participation in daily activities.
Why Orthopedic Surgery is Needed in Cerebral Palsy
Children with CP often experience muscle tightness that pulls bones and joints into abnormal positions. Over time, this can cause:
● Contractures (permanent muscle tightening)
● Hip dislocation or instability
● Spine curvature, such as scoliosis
● Leg length discrepancies
● Foot deformities like equinus or flatfoot
When conservative treatments such as physiotherapy, bracing, or medications fail to provide sufficient relief, cerebral palsy orthopedic surgery becomes a crucial step to restore alignment and function.
Common Types of Orthopedic Surgery for Cerebral Palsy
1. Muscle and Tendon Lengthening
Spastic muscles often pull joints into abnormal positions. Lengthening procedures reduces this tightness, allowing improved movement. For example, hamstring lengthening helps children with crouched gait, while Achilles tendon lengthening addresses toe-walking. But muscle are weak in cerebral palsy so overlengthening or un required surgery can weaken the already weak muscle. So muscle or tendon lengthening surgery are less preferred in cerebral palsy
2. Osteotomy (Bone Surgery)
When bones grow abnormally due to uneven muscle pull, surgeons may cut and realign them through osteotomy. Common sites include the femur, tibia, or pelvis. These corrections help stabilize hips, improve walking, and prevent progressive deformities. Cerebral palsy is multi lever arm problem and need multi-level correction. Surgery on bone spared the muscles so chances of weakness of muscle is rare after surgery and even they work in more coordinated manner.
3. Joint reconstruction
In hip displacement or dislocation, procedures may include reconstructing the hip socket or repositioning the femur to restore joint stability. This prevents pain and supports long-term mobility. In very early stage of hip dislocation / subluxation, growth modulation of proximal femur suffice to prevent the progress of hip abnormality and treat early stage of hip dislocation.
4. Spinal Surgery
Scoliosis is common in children with severe cerebral palsy. In such cases, spinal fusion may be performed to correct curvature and prevent further progression, improving posture and breathing capacity.
Other Surgical Options Beyond Orthopedics
While cerebral palsy orthopedic surgery focuses on bones, joints, and muscles, some children benefit from complementary procedures:
● Neurosurgical interventions: Besides SDR, intrathecal baclofen pump implantation helps control severe spasticity.
● Highly selective nurectomy: this procedure in controlling focal spasticity by cutting few fibre of nerve supplying specific group of muscle. .
● Minimally invasive techniques: Advances such as guided growth surgery in proximal / distal femur help correct deformities with smaller incisions and quicker recovery times.
Timing and Multidisciplinary Care
The timing of surgery is critical. Orthopedic surgery is often recommended between the ages of 6 and 11 years, when deformities are established but before permanent disability occurs. Final tuning surgery are usually needed near maturity 11 year in girl and 14 year in boy. A multidisciplinary team—including pediatric orthopedic surgeons, physiotherapists, neurologists, and rehabilitation specialists—ensures that surgical decisions are tailored to each child’s functional needs.
Post-Surgical Rehabilitation
Surgery is not the end of treatment but the beginning of a new phase. Intensive rehabilitation after surgery helps children regain strength, relearn movement patterns, and maximize functional gains. Physiotherapy, gait training, and the use of assistive devices ensure long-term benefits.
Conclusion
Cerebral palsy orthopedic surgery is a vital option for children whose musculoskeletal challenges cannot be managed by therapy alone. With advancements in surgical techniques and post-operative care, many children experience reduced pain, improved mobility, and enhanced quality of life. By addressing both orthopedic and supportive interventions, families can help children with cerebral palsy achieve their fullest potential in movement and independence.
