Orthopedic surgery for patients with Cerebral Palsy requires considerable experience, knowledge of the subject, and ongoing training.
It is essential to turn to centers with experience in this field for both minor and more complex procedures.
Functional Surgery for Cerebral Palsy: An International Experience
Dr. Lampasi has been treating cerebral palsy in children for many years, first at the Rizzoli Orthopedic Institute (Bologna, Italy) and Meyer Hospital in Florence (where he founded and directed the Neuro-Orthopedic Specialistic Center for years, pioneering many complex procedures in this field at that hospital), and subsequently at various public and private Italian hospitals, also providing consultancy and training to other pediatric orthopedic surgeons.
The results of this experience have been shared at national and international conferences.
Functional Surgery in Cerebral Palsy: Treatment Principles
Our group applies modern management principles, learned from the UKBB School in Basel (Switzerland) of Professor Reinald Brunner, one of the Masters of Neuroorthopaedics worldwide, with whom Dr. Lampasi has collaborated for many years.
Functional surgery for cerebral palsy: what does it mean? And what opportunities does it offer?
Modern functional orthopedic surgery offers the possibility of optimizing the functionality of patients affected by Cerebral Palsy.
By contacting a Specialist Center like ours, it will be possible to evaluate all the therapeutic options and not limit yourself to a single option as happens in single-specialty centers (centers that only perform toxin, centers that only perform selective dorsal rhizotomies (SDR), centers that only perform fibrotomies, etc.).
The experience gained with different techniques (from fibrotomies to complex multilevel interventions) and on patients of different complexity (from very mild to very serious conditions) allows us to be able to dose the indication more appropriately.
Functional surgery for cerebral palsy: very satisfactory clinical results
Families and professionals often view orthopedic surgery with fear or as a defeat. In reality, in recent years, innovations in functional orthopedic surgery have led to significant improvements in outcomes and postoperative patient management.
Functional surgery in children with cerebral palsy: which surgical procedures are available?
Among the various surgical options that can be performed in our Center:
Multiple fibrotomies
Please refer to the dedicated sheet.
Correction of foot deformities
Treatment of equinus foot, valgus foot, varus foot, flat foot, cavus foot, talus foot, midfoot break, etc. with more or less complex procedures: tendon lengthening, tendon shortening, tendon transfers, osteotomies, arthrodesis, etc.
Correction of knee deformities
Treatment of flexed and hyperextended knees, genu varum, valgus, patella alta, and crouch gait with more or less complex procedures: tendon lengthening, fibrotomies, tendon shortenings, epiphysiodesis, osteotomies, patellar realignments, etc.
Hip deformity correction
Retractions, flexed hip, adducted hip, abducted hip, windblow, hip dislocation/subluxation , femoral internal rotation, etc. through more or less complex procedures: tendon lengthening, fibrotomies, osteotomies, hip reconstructions, epiphysiodesis, etc.
Correction of rotational deformities
Internal rotation, external rotation, malalignments: femoral, tibial derotation osteotomies, etc.
Multilevel Corrections
The above procedures are included within the same surgical intervention (see below)
Correction of deformities of the upper limbs (shoulder, elbow, wrist) through procedures of varying complexity
Tendon lengthenings, transfers, osteotomies, arthrodesis
Functional surgery in children with cerebral palsy: is it necessary to lengthen the muscles as much as possible?
Traditional approaches to these children focus on generously lengthening their muscles and tendons (fibrotomies, tenotomies, etc.). More modern approaches recognize the importance of preserving muscles and optimizing their length and function.
Functional surgery in children with cerebral palsy: is it really that important to treat spasticity?
The old concept of treating these children focused on reducing spasticity using botulinum toxin, selective rhizotomies, etc.
The modern therapeutic approaches we use have diminished the usefulness of this approach.
Orthopedic surgery, fibrotomy or SPML?
We often hear parents ask this question in our clinics, but in reality it is a contradiction that doesn’t exist.
Fibrotomy / SPML is one of the surgeon’s potential “weapons”, and is recommended in specific cases that may benefit from it. On the one hand, it’s important to know how to use this technique in cases that may benefit from it, but on the other, it’s important not to overdo the indications for fibrotomy (for example, treating all children the same way or just as a “trial”). However, it’s a procedure that isn’t without risks; see the dedicated factsheet.
The correct indication is always the basis for a better outcome. It’s not uncommon, for example, to see children undergoing tendon lengthening or excessive fibrotomies who initially appear to improve (“finally he puts his foot on the ground”) but quickly show a worsening of the condition and a collapse in flexion (crouch gait, see sheet) that is difficult to reverse.
Functional surgery: but is it necessary to “touch” the bones? Isn’t a minimally invasive procedure better?
Bone procedures are recommended in cases where minimally invasive surgery or soft tissue intervention is not sufficient.
This recommendation often clashes with the fear of families and professionals in the sector, who advise against bone surgery, regardless of the type of problem present.
However, it is important to understand that in these cases the problem must be addressed with the most appropriate procedure and not based on irrational fears: sometimes a poorly performed or not indicated soft tissue procedure can cause more damage than a bone procedure.
Functional surgery: is a treatment plan important?
Yes. Treatment does not end with surgery but it is necessary to set up a plan that includes
- early intensive rehabilitation (our team collaborates with high-level intensive rehabilitation centers)
- an appropriate orthosis (the experienced surgeon must know and prepare the most appropriate orthosis for post-operative recovery)
Functional surgery: is rapid functional recovery important?
Yes. It is important to minimize patient immobilization.
For many procedures we have abolished the need for a cast: for example, in the case of reconstruction of a dislocated hip or in the case of a femoral osteotomy for crouch gait, patients are not casted and can quickly begin rehabilitation.
Where possible, our patients begin their rehabilitation process quickly. Our center collaborates with leading centers for intensive post-operative rehabilitation.
Single-Event Multilevel surgery (SEMLS): what does it mean?
In complex situations, where the patient is involved on multiple levels (for example: hip, knee, foot bilaterally), it is important to treat the various issues present in a single surgical procedure to limit the number of surgeries required and to allow for a single functional recovery.
These are complex operations that require teams with extensive experience in each individual procedure included in the surgical plan.
Patients from abroad: can OrthoChildren Center treat foreign patients?
Yes, many patients come from all countries (Europe and USA):
- the surgical equipe has a wide experience with these procedures
- an intensive rehabilitation program can be included
- the procedure is less expensive than in USA and other countries
- Families take advantage of this opportunity to combine a trip to the beauties of Italy