Monday, September 16, 2013

OSSCS

Orthopedic Selective Spasticity Control Surgery for Children with Spastic Cerebral Palsy

Control of spasticity has become an urgent need for orthopedic surgeons in the treatment of cerebral palsy. Many approaches for control of spasticity have been advocated. However, control of spasticity is not so easy and at times seems to cause serious drawbacks such as sensory disturbance, recurrence and loss of stability.
Orthopedic selective spasticity control surgery [OSSCS] is an orthopedic procedure designed to control or reduce hypertonicity in cerebral palsy. Various types and severity of hypertonicity can be appropriately controlled by the use of selective muscle release surgery. The spasticity control surgery not only corrects deformities such as shoulder retraction, elbow deformity, scoliosis, flexion deformity of hip, knee and ankle- foot, but also promises better hand and finger skills and reach movements of the upper extremity, stabilizes the trunk and lower extremities and relives the hypertonicity in the cervical, thoracic and lumbar spine. It also facilitates respiration and speech while lessening drooling remarkably. By combining the spasticity control surgery with conventional orthopedic surgery, such as open reduction, VDRO, pelvic osteotomy for dislocation of hip, arthrodhesis of wrist and ankle, spinal fusion, we can deal with wide range of problems in motor activities and activities of daily living with encouraging results while providing a new path for functional improvement and for active life styles in most patients with cerebral palsy. OSSCS can provide us with an opportunity to assist physiotherapist and occupational therapist by controlling hypertonicity in the whole body while making it easy to facilitate basic motor functions such as rolling, crawling, sitting, kneeling, standing and independent gait.
The fundamentals of OSSCS are clear and uncomplicated and are based on the physical and biological findings. OSSCS is based on the concept that muscles are classified into two types – monoarticular and multiarticular. Electromyographic studies proved that multiarticular muscles are spastic or hypertonic and are responsible for various deformities in cerebral palsy and the monoarticular muscles are normal and responsible for joint stability and erect posture in human being. Thus by selectively releasing these multiarticular muscles we can activate the monoarticular muscles to facilitate function and erect posture.
The most important aspect of OSSCS is postoperatively there is no decrease of motor function as monoarticular muscles are preserved. There is no loss of sensations as seen in many spasticity reducing procedures. The technique is quite reliable and promising procedure for control of spasticity.
Another important aspect of OSSCS is that its indications are wide and hypertonicity in the entire body can be relieved. All kinds of hypertonicity – spasticity, rigospasticity and athetosis can de corrected.
The decision making and treatment techniques are demanding. In order to achieve successful results, orthopedic techniques should be skillfully conducted since we are going to correct complex motor disorders which have not responded to other procedures. Which muscles should be released? Which end should be released proximal or distal? What kind of release should be done? Intramuscular lengthening? Sliding lengthening? Z lengthening? Tenotomy? How much and how long these lengthening should be done? What other conventional orthopedic surgeries should be combined? All these questions and problems have to be answered correctly.
When the Orthopedic surgeon applies these principles of OSSCS accurately in the management of cerebral palsy, he will be able to promise definite improvements for patients with cerebral palsy. Here, we would like to present ideas and techniques of OSSCS and show how these approaches can be used in the treatment of cerebral palsy.