New surgical interventions for cerebral palsy and the place of gait analysis

Abstract

In the past few years there have been a number of new surgical interventions in the treatment of cerebral palsy (CP) and these were reviewed in a meeting at the London Royal Society of Medicine, arranged by the Mac Keith Meetings committee, in October 1997. One such intervention, selective dorsal rhizotomy (SDR), is a modification of a technique first used at the turn of this century. In the mid-1980s, SDR was reintroduced by Peacock and Arens for children with CP. It was established in South Africa and the United States, then spread to Canada and parts of Europe. The continuous infusion of intrathecal baclofen (CIBI) to relieve spasticity in CP has only been used this decade. It was pioneered mainly in North America, and followed experience with its use in spinal spasticity, for which it is particularly effective. Lastly, we considered the practice of multilevel orthopaedic surgery which started over 20 years ago, but has recently become popular throughout North America and Europe. Guided by clinical examination and information from laboratory gait analysis, this approach addresses all of the mechanical problems in the lower limb at one stage and attempts to avoid the need for separate procedures throughout childhood – the ‘birthday’ syndrome. All of these new techniques are costly in effort and time for the child and all involved, and thus need careful evaluation. This was provided at the meeting by speakers from a variety of backgrounds and countries.