What is cerebral palsy? Cerebral palsy (CP) is a non-progressive brain injury or developmental defect caused by various reasons from before birth to one month after birth, which mainly manifests as central movement disorders and postural abnormalities. What are the characteristics of spastic cerebral palsy? The spastic type accounts for about 60% of children with cerebral palsy, and most of the mixed type are spastic combined with tardive dyskinesia. These two types account for about 3/4 of all cases of cerebral palsy. The upper extremity is characterized by inward flexion of the elbow joint, flexion of the elbow and wrist joints, inward clenching of the thumb and clenching in the palm, and clumsy, stiff and uncoordinated movements of the upper extremity. The lower limbs are stiff and crossed, the hip joints are internally rotated, and the ankle joints are plantar flexed. When standing, both feet droop and turn inward, the toes land on the ground, the soles of the feet cannot step flat, and the gait is scissor-like when walking. The gait is small, walking on the tips of the feet, and cannot run. Due to joint spasm, voluntary movement is very difficult. He walks with a circular gait and has difficulty in flexion due to the extension of the affected side. He needs to raise his pelvis and rotate his lower limbs outward in a semicircular motion when walking. What are the principles of treatment for spastic cerebral palsy? The treatment of cerebral palsy should be systematic and individualized, and rehabilitation training will accompany the whole process of cerebral palsy treatment. For patients with predominantly spasticity, the spasticity must be lifted first through surgery before rehabilitation can be carried out effectively and receive good results. In addition, if the patient also has bone and joint deformities, tendon contractures, etc. during the rehabilitation process, orthopedic surgery is required. What are the surgical methods? 1.Selective posterior spinal nerve root partial resection (SPR): the efficacy is clear and widely used; 2.Peripheral nerve microdissection: good for single-site spasticity; Why is neurosurgery effective? Neurosurgical treatment of spasticity is effective by interrupting the detrusor reflex circuit at different sites or increasing the inhibitory function of spinal alpha motor neurons to reduce the excitability of the affected muscles. It is performed under the supervision of a neurophysiological instrument to identify and cut off the Ia class fibers with low electrical stimulation threshold and strong and diffuse muscle contraction, blocking the gamma loop of the spinal cord detrusor reflex, and selectively preserving the sensory fibers of the limbs, thus reducing the muscle spasticity. Why is neurosurgery necessary? Only through neurosurgery can the problem of excessive excitability of the innervation of the spastic muscles be solved, so as to reduce the patient’s muscle tone and relieve spasticity. Patients who need orthopedic surgery for bone and joint deformity and tendon contracture should be treated after SPR, and the order of the two should not be reversed! In cases where severe spasticity persists, orthopedic surgery can only temporarily “mask” the symptoms and almost certainly results in a recurrence. What are the advantages of SPR microsurgery? 1. Previously, surgery was performed on the anterior spinal nerve roots, which resulted in excessive postoperative loss of muscle strength and paralysis, whereas SPR is performed on the posterior spinal nerve roots, which reduces spasticity by decreasing nerve reflexes. 4. Using micro-neurosurgery techniques, the lamina is minimally removed and the nerve is separated and cut under the microscope for safety and accuracy. Which patients are suitable for SPR surgery? 1, contracture-type cerebral palsy or mixed-type cerebral palsy with spasticity grade III or above, with severe spasticity, which affects the patient’s daily life and rehabilitation training; 2, good random body movement function, no obvious muscle weakness, fixed joint contracture and irreversible bone and joint deformity; 3, spasticity has stabilized; 4, normal or near normal intelligence to facilitate postoperative rehabilitation training.