Surgery to limit pain or future problems
There are a number of procedures, which if effective, can improve posture and mobility, reduce pain or correct a deformity. Surgery can also be used to prevent future complications such as contractures, hip dislocations or spinal curvature. Not only that, surgery can improve a child’s confidence and self-esteem.
There are many different types of surgery performed on muscles, tendons, bones and joints. Although it may seen like the option of last resort, sometimes surgery is recommended at an early age because it can have the most beneficial effect before the body starts to form bad habits and unnatural patterns of movement. Some operations are also commonly performed in later life e.g. a tenotomy to relieve a painful contracture in the wrist or ankle.
Different types of orthopaedic surgery
Soft tissue surgery:
- Muscle lengthening: Can relieve tightness in the hands and fingers.
- Tendon lengthening: Can reduce the pain of contractures and improve a child’s ability to walk.
- Tendon transfer: In this surgery the tendons are fixed to different points on the bone. Used to improve extension and flexing of the wrists.
- Tenotomy: Cutting the tendon to relieve stiffness and tightening in the muscles and joints.
- Osteotomy: realigning joints for better posture and mobility
- Arthrodesis: Fusing bones in the ankle or foot to make it easier for a child to walk.
Selective Dorsal Rhizotomy (SDR)
Selective Dorsal Rhizotomy (SDR) is a relatively new procedure that can significantly reduce muscle stiffness in children with spastic diplegic cerebral palsy to help them walk.
Nerve fibres running from the muscles back to the spinal cord play a major role in maintaining this muscle stiffness. The operation involves dividing and cutting some of the sensory nerve roots in the lower spinal cord, through a small incision to the lower back.
It is not suitable for everyone. Children whose cerebral palsy is related to their prematurity tend to have a good response to SDR, however those with a history of meningitis, hydrocephalus unrelated to prematurity, congenital infection or head trauma do not do so well. More details can be found here in the Great Ormond Street Hospital Guide to SDR, and for a parent's view on weighing up the decision view Charlie's-dad.org.
Surgery for dysphagia (difficulty eating or swallowing)
If a child has problems swallowing or drinking safely (dysphagia), there’s a risk that small pieces of food could enter the lungs and this can cause an infection (pneumonia). Speech and Language therapists can teach workarounds to the parent/carer of a child with mild dysphagia.
However, if the dysphagia is more severe, or if a child is struggling to eat and drink all they need to maintain a healthy weight, they may need a gastrostomy. A gastrostomy is a ‘feeding tube’ that is surgically placed into the stomach, in a short operation lasting around 30-40 minutes. It allows all or some of a child’s nutrition to be given through a special tube.
There are two types of feeding device.
- A gastrostomy button: This feeding device fits into the hole in the stomach (stoma) and is held in the stomach by a balloon filled with water.
- A gastrostomy tube (PEG): is a long tube that first in the stoma and is held in the stomach with a soft plastic disc.
More information about dysphagia can be found on the NHS website.