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Surgical intervention for CP is not a cure, but it can dramatically improve quality of life by addressing musculoskeletal complications. Orthopedic and neurosurgical procedures aim to reduce pain, correct deformities, improve posture and walking ability, and prevent contractures, hip dislocations, or spinal curvature.
These surgical approaches become especially important when conservative measures—such as physical therapy, medications, braces, or botulinum toxin injections—are insufficient. For many children, a well‑timed surgical plan is an essential component of multidisciplinary care.
Orthopedic surgery is the most frequently performed surgical intervention in children with cerebral palsy. A Danish registry study found that between ages 8 and 15, approximately 41% of children with mild motor impairment (GMFCS level I), 54% with level II, and 62% with levels III–V underwent orthopedic procedures.
The focus of orthopedic surgery for patients with cerebral palsy is on improving function, independence, and preventing long-term complications.
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Orthopedic surgeries for CP typically address bones, joints, muscles, tendons, and spine. Recent literature highlights that osteotomies (corrective bone surgeries) account for nearly half of reported procedures, followed by femoral derotation osteotomy (FDO), hamstring lengthening, and varus derotation osteotomy (VDRO).
Surgery may be staged in single-event multilevel surgery (SEMLS), enabling multiple corrections in one session and reducing repeated anesthesia and rehabilitation periods.
Key types include:
Bone deformities such as rotational malalignment are frequent in CP. Osteotomies—like femoral derotation or knee extension corrections—realign the skeletal framework, facilitating improved walking patterns and reducing energy expenditure.
Common foot issues include equinus (toe walking), cavus, or pronation. Procedures—ranging from Achilles tendon lengthening to more complex reconstructive strategies—aim to restore functional alignment, improve balance, and facilitate orthotic use or walking.
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Contact UsSelective dorsal rhizotomy (SDR) is a neurosurgical procedure aimed at permanently reducing lower‑limb spasticity. Sensory nerve rootlets in the spinal cord that contribute to muscle tightness are identified using intraoperative electromyography and selectively severed, preserving voluntary movement.
Benefits include reduced stiffness, improved walking patterns, and prevention of secondary musculoskeletal issues. Candidates are typically children with spastic diplegia who have the ability to walk—or show potential to walk—and can engage in intensive postoperative therapy.
While not common, SDR offers substantial long‑term gains when carefully selected.
In CP, tight muscles or tendons may be surgically released or lengthened to reduce spasticity and improve function. Procedures range from open muscle‑tendon lengthening to minimally invasive techniques such as multi‑level fibrotomy or selective percutaneous myofascial lengthening (SPML).
These surgeries can relieve pain, enhance movement, and support better alignment, with newer methods offering reduced postoperative discomfort and shorter hospital stays.
Scoliosis and other spinal imbalances are common in children with CP, particularly those who are non‑ambulatory. Spine surgery, including spinal fusion or instrumentation, can correct curvature, improve posture, and protect respiratory function.
Early intervention often prevents progression, though these surgeries require multidisciplinary perioperative planning and extended recovery.
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Contact UsJoint‑specific surgeries—such as tendon lengthening, muscle release, or joint realignment—address fixed contractures and improve joint range, reducing pain and supporting function. Arthrodesis, or joint fusion, is reserved for severe stiffness when preserving motion is not possible or beneficial.
Hip displacement is a common concern in CP. Surgical options include adductor muscle release, proximal femoral osteotomy, and pelvic osteotomy to improve hip alignment and reduce the risk of dislocation. These surgeries help preserve long‑term function and manage pain.
No universal age applies; surgical timing depends on the child’s functional level, spasticity progression, and risk of deformity. Spasticity tends to be most severe in preschool years, while growth can drive contracture and hip migration later.
SDR is most often recommended between ages 3 and 10—but children outside this range may still benefit with good candidate screening.
For orthopedic surgeries, earlier intervention may prevent progressive deformity; single-event multilevel approaches (SEMLS) are often timed during school age to reduce repeated admissions. Multidisciplinary input ensures timing is individualized.
Parents can limit the risks of surgery by consulting more than one medical opinion to ensure their child is an appropriate candidate for the recommended procedure.
Also, making sure your child’s various experts (neurosurgical, orthopedic, anesthetic, and rehabilitation) have coordinated treatment plans for before, during and after surgery helps minimize these risks and support stronger outcomes.
Surgical success depends heavily on rehabilitation. Coordinated post‑operative therapy - including physical therapy, occupational therapy and orthotic support therapy—is crucial for regaining function, strength, and mobility.
Many children show long-term improvements in gait, posture, comfort, and independence when surgery is integrated with ongoing therapy and family support.
Surgical intervention offers important benefits for many children with cerebral palsy, particularly when conservative measures are no longer sufficient. Common procedures—such as osteotomies, tendon lengthening, SDR, hip or spine surgery—are tailored to specific functional needs and deformities.
The best surgical outcomes arise from careful selection of the right procedure for each patient, multidisciplinary planning, and vigorous rehabilitation.
Although surgery involves risks and recovery demands, it can be transformative—improving mobility, easing pain, preserving independence, and reducing future complications.
For families navigating the care of a child with cerebral palsy, surgery can be an empowering option that supports growth, mobility, and comfort.
Through thoughtful planning, a skilled and coordinated care team and a clear understanding of surgical options, families can confidently decide whether surgical options will foster their child’s best possible long-term quality of life.
Osteotomy surgery is usually considered when bone deformities—such as hip displacement, twisted thigh bones, or knee alignment problems—interfere with walking or daily activities. Children who continue to develop contractures or abnormal gait despite physical therapy, bracing, or medication may be candidates. Orthopedic surgeons evaluate factors such as:
Early surgical planning can prevent worsening deformities and improve long-term independence.
Selective dorsal rhizotomy (SDR) is typically offered to children with spastic diplegia—a form of CP that mainly affects the legs. Good candidates often:
Neurosurgeons and rehabilitation specialists carefully screen each child. The goal is to permanently reduce spasticity, making movement smoother and therapy gains more lasting.
Like most major surgeries, SDR does involve postoperative discomfort, but pain is carefully managed with medications and supportive care. Children typically remain in the hospital for about a week, where pain control and early rehabilitation begin. Most describe the discomfort as temporary soreness or stiffness rather than sharp pain.
Intensive physical therapy starts soon after surgery, and while it may feel challenging, it is essential for regaining strength and learning to move without spasticity. Long-term benefits usually outweigh the short-term discomfort.
Yes, Medicare generally covers medically necessary surgeries for individuals with cerebral palsy, including orthopedic and neurosurgical procedures such as tendon lengthening, hip reconstruction, or SDR. Coverage typically includes hospital care, physician services, and postoperative rehabilitation.
However, Medicare does not always pay for all associated costs—such as extended inpatient rehab or certain assistive devices—so families may still face out-of-pocket expenses. Prior authorization and detailed medical documentation are often required.
Supplemental insurance or Medicaid can help bridge coverage gaps for children or adults with CP.
