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Surgery

When contractures are serious enough to cause severe movement problems surgery is  recommended. A surgeon can lengthen muscles and tendons that are short but first they must pinpoint the specific “offending” muscles, since lengthening the wrong muscle could exacerbate the problem.

 

Determining the problem muscles can be very difficult and it requires great skill. The simple act of walking two strides with a normal gait, involves the precise coordination of 30 major muscles exerting exactly the proper force. If there is a problem in even a single muscle, this can result in an abnormal gait. Adding to the complexity of determining the precise problem muscle is the body’s natural inclination to make slight adjustments to compensate for muscle problems.  A tool was recently devised that allows doctors to see gait abnormalities, pinpoint the specific problem muscle(s), and separate the genuine problems from those which the body is merely compensating, is called gait analysis. Gait analysis relies on sophisticated cameras that record the individual while they are walking, computers that interpret the images captured by the cameras to analyze each segment of the patient’s gait force, plates that sense when each foot touches the floor, and a recording device that detects electromyography, the muscle activity. Using the data thus collected and analyzed, the doctors can intervene and correct significant muscle problems. Gait analysis is also effective in checking surgical results.

 

Surgery for contractures generally requires months of recovery because lengthening a muscle makes it weaker. Doctors, therefore try to repair all of the affected muscles during one surgical procedure whenever possible.  If multiple operations are deemed necessary, the surgeon will try to schedule operations close to each other as possible.

 

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An alternate surgical procedure – selective dorsal root rhizotomy – reduces spasticity in the legs because it reduces the stimulation that the nerves transmit to the muscles in the legs. The surgeon selects and cuts some of the over-stimulated nerves that control leg muscle tone. Although there is controversy as to the effectiveness of this technique, there are significant indications that it has succeeded in reducing spasticity in many patients, particularly those who suffer from spastic diplegia.  Medical research is continuously monitoring the procedure’s long-term advantages.

 

Two experimental surgical techniques – chronic cerebellar stimulation and stereotaxic thalamotomy are generating a growing following within the medical community.  Electrodes can be implanted on the surface of the cerebellum -the section of the brain that handles coordination, during chronic cerebellar stimulation, which stimulate specific cerebellar nerves. While it was assumed that the procedure would improve motor function by decreasing spasticity, results have been inconclusive.

 

Stereotaxic thalamotomy involves surgically removing parts of the thalamus, the brain’s message relay center from the muscles and sensory organs. This procedure reduces hemiparetic tremors (uncontrollable shaking) of the limbs on the spastic side of the body in patients who have spastic hemiplegia.

 

 

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