Orthopaedic surgery is used when complications of spasticity result in joint contractures of the foot, ankle, knee, hip and upper extremities, as well as neuromuscular scoliosis. Often the patient with these contractures has difficulty walking or sitting. There are several surgical procedures to address this condition, which may manage the symptoms or resolve the spasticity issue.
Tendon-lengthening, which is performed by a pediatric orthopaedic surgeon, can relieve muscle contractures caused by spasticity. In this procedure, the surgeon splits the muscle tendon partway down the middle and then sews the two pieces of tendon together. This lengthens to the tendon, relieving tension on the muscle. After recovery, children who have had this procedure are often able to return to normal activity.
In this procedure, the surgeon removes the tendon causing the spasticity and moves it to another muscle, making the joint function in a more normal manner because it pulls in another direction.
A surgical procedure in which a wedge of the femur, tibia or foot bone is removed, allowing it to be redirected or reshaped. The child has a cast to allow the bone to heal in a normal position. This can relieve pain and correct deformities from spasticity.
In children with cerebral palsy-related scoliosis who are suffering from spasticity, a wrist fusion (to restore wrist extension) or spine fusion (to help straighten the spine and deformity that can result from long-term spasticity) is another surgical option.