Orthopedic treatment of the lower limbs in spastic paralysis

Abstract

Spastic paralysis of the limb mainly results from the central lesion, in which spastic cerebral palsy is the common cause. Due to durative muscle spasm in spastic cerebral palsy, it is often accompanied by the formation of secondary musculoskeletal deformities, resulting in limb motor disability. Based on its pathogenesis, surgical treatment is currently applied: selective posterior rhizotomy (SPR) or orthopedic surgery. The primary purpose of early orthopedic surgery was simply to correct limb deformities, which usually led to the recurrence of deformity as a result of the presence of spasticity. With the application of SPR, high muscle tone was successfully relieved, but limb deformity was still present postoperatively. Therefore, this study aimed to elaborate on the management of orthopedic surgery, common deformities of the lower limb, and orthopedic operative methods; discuss the relationship between SPR and orthopedic procedure for limb deformity; and focus on the indications, timing of intervention, and postoperative outcome of different surgical methods.

Ultrasound-Guided Sciatic Nerve Block vs. Caudal Analgesia in Cerebral Palsy Undergoing Lower Limb Surgeries

“…Multiple surgical procedures have been described for the correction of lower limb deformities in patients with spastic CP, including soft tissue (tendon) release, lengthening, transfer, and femoral or tibial osteotomies, which can be performed either uni-or bilaterally (3)(4)(5). In this study, we chose only 1 type of surgery (soft tissue procedure) to standardize the degree of intensity of painful stimuli that could affect the pain scores recorded postoperatively.…”

“…Cerebral palsy (CP) is a chronic movement disorder caused by a permanent nonprogressive lesion of the developing brain during the antenatal, perinatal, or postnatal period (1, 2) Spastic CP is the most prevalent type, affecting 70 -80% of patients with CP. Children with spastic CP often require lower-limb bone and soft tissue corrective surgeries to correct joint deformities and help their ambulation (3)(4)(5).…”