Cerebral palsy can't be cured. But treatment can help your child manage the condition.
Not all treatments involve surgery. We work closely with Seattle Children's physical, speech and occupational therapists to improve your child's ability to move, speak and perform everyday activities, such as going to school. Our orthotics and prosthetics team provides braces and other devices that can help with balance, walking and movement. Medicines can help relax muscles spasms and control pain and seizures.
Some treatments do involve surgery. We screen children in our Spasticity Management Clinic to find out if surgery might benefit them.
Surgery for Cerebral Palsy and Spasticity
Neurosurgeons at Seattle Children’s do two surgeries to lessen spasticity in children with cerebral palsy.
Selective dorsal rhizotomy
Selective dorsal rhizotomy is a surgery done on the lower spinal cord to reduce spasticity or high muscle tone in the legs. Certain nerve fibers that lead to high muscle tone are cut.
The goal of a selective dorsal rhizotomy is to relax the muscles by identifying and cutting those nerve fibers that are causing the abnormal tone. This can improve your child’s ability to move as well as their quality of movement.
After careful screening, our team of doctors, surgeons and rehabilitation therapists will determine if this procedure is appropriate for your child. Input from you and your child’s community therapist is an essential part of the evaluation process.
How does selective dorsal rhizotomy work?
- Your child will be asleep (sedated) during the surgery.
- During the surgery, the neurosurgeon makes a small cut (incision) in the middle of the low back, about one inch long.
- Through this incision, a small window (laminectomy) is made in the spine to expose the nerve fibers (dorsal roots).
- Each nerve fiber is tested with electrical stimulation to find out which nerves respond abnormally (selective). Those abnormal nerve fibers are surgically cut (rhizotomy). Which nerves and how many are cut varies from child to child.
- This provides a long-term improvement in muscle tone because the nerves do not grow back together.
What happens after the surgery?
- If the aim of your child’s surgery is to improve their ability to move, your child will need two to three weeks of inpatient rehabilitation at Seattle Children’s. This therapy will focus on increasing your child’s strength and muscle control, with special focus on walking.
- After going home from the hospital, your child will need outpatient therapy three to four times each week. This may be a combination of private therapy and school-based therapy. Consistent therapy is important to help your child meet their goals following surgery.
- If the goals for your child focus more on ease of care and comfort measures, a five-day hospital stay is usually long enough to make sure their pain is well managed and they are safely recovering from surgery.
In this procedure, neurosurgeons place (implant) a pump about the size of a hockey puck in your child's belly (abdomen). The pump continuously delivers a medicine called baclofen into the fluid surrounding your child's spine. Baclofen is a muscle relaxant that reduces spasticity throughout your child's body. Since the medicine goes directly into your child's nervous system, the dose of baclofen your child gets through the pump can be much lower than doses delivered through the mouth. This helps your child avoid the side effects of higher doses (sedation).
Before neurosurgeons put in the pump, we use a needle to inject a test dose of baclofen into your child's spinal canal. This procedure is called a lumbar puncture. We do this to be sure that baclofen is the right medicine for your child's system. After your child gets the medicine, a physical therapist watches for several hours to see the effect the medicine has on your child's body.
If you and your child's neurosurgeon agree that your child can benefit from a baclofen pump, the neurosurgeon does surgery to put the pump under the skin of your child’s belly. Once the pump is in place, the neurosurgeon attaches a thin tube (catheter) to it. Then the neurosurgeon threads the catheter under the skin at waist level to your child's spine. They insert the catheter into the spinal canal.
Next, the neurosurgery team fills the pump with baclofen and sets it to deliver the exact amount of medicine your child needs. The pump begins slowly releasing the medicine through the tube and into the spinal canal.
The baclofen pump must be filled with medicine every one to six months, depending on your child’s dose. You can refill it at Seattle Children’s or at another medical facility. It's important not to let the pump run of medicine. This could harm your child.
The pump lasts about five years. Afterward, it must be removed and replaced during another surgery.