Orthopedic care can make a great difference in the lives of some children with cerebral palsy, muscle disorders, and spina bifida. Many orthopedic training programs put little emphasis on neuromuscular disorders, spina bifida or cerebral palsy. Caring for these patients can be time consuming and heart-wrenching.
It takes special doctors and a team of experts to care for these children. A pediatric orthopedist and a well-trained physical therapist are the two most important professionals needed. Sometimes, a pulmonologist or other specialists are important also.
Children with cerebral palsy be helped in several ways. One is by botox injections into spastic muscles, but this must be done by an orthopedist who has had wide experience in the technique. Not every child with cerebral palsy will improve, so careful selection must be made for the right candidates. If a child has a spastic diplegia, where just the legs are involved, he or she may improve greatly with a surgery called a rhizotomy. This surgery would be performed by a neurosurgeon, not an orthopedic surgeon. Back surgery for scoliosis or curvature of the spine may or may not help a patient with cerebral palsy. Thus, the pros or cons of surgery should be carefully weighed and often a second opinion is wise.
Arthrogryposis is a condition where one or more joints are fixed and surgery or serial casts may be helpful. Once again this should only be done by an orthopedist with wide experience with the disorder. Neuromuscular disorders can present real challenges, but scoliosis should be aggressively treated. If surgery is done, a child must never lie in bed after the surgery. I have seen a tragic result when the orthopedist would not allow a child to be upright and have physical therapy. Back braces after the surgery may or may not be indicated or needed.
Hip surgery in Type II spinal atrophy may not be successful because with too much muscle weakness the hip bone will not stay in the socket and will dislocate even if surgery is done. I have seen this occur several times.
Boys with Duchenne muscular dystrophy usually start walking on their toes at an early age because of heel cord tightness. Simple heel cord surgery, called percutaneous surgery, can help the boys walk much longer. Also, short leg splints and night splints, plus stretching can help keep the heel cords stretched out.