A thorough examination is needed to help the surgeon determine which muscles and nerves are affected and what surgical options are needed to treat them. If the patient can walk, gait analysis should be part of the examination. Before a child undergoes orthopedic surgery, it is important to determine if he or she will be able to walk after surgery. The goals are expected to be different for children who can walk and those who cannot. The usual age for SDR surgery is 2 to 6 years old. Opinions about orthopedic surgery vary: some surgeons believe that children with cerebral palsy under the age of 2 benefit the most because the surgery allows them to grow and develop more like other normal children. Other medical professionals believe that all surgery should wait until the child is 2 years old or older. Some even prefer to wait until after the ages of 6 and 8. They believe that if surgery is delayed until the child is older than 2 years old, the surgeon may be able to release multiple tight muscles in a single procedure, rather than one muscle at a time. Avoiding multiple surgeries has many benefits, such as lowering the number of hospital visits and reducing the total time spent in physical rehabilitation, thus disrupting the child’s school and social life less. In general, it is better to stage the surgery according to the child’s age and motor development level. For example, spasticity of the upper leg muscles (adductors) that cause gait disorders results in a “scissor gait”. The optimal age for correction of adductor spasm is 2 to 4 years. On the other hand, the best time for N cord tendon lengthening or Achilles tendon lengthening surgery is 7 to 8 years of age. If the adductor release surgery is delayed until the same time as the N cord lengthening, the child has learned to compensate for the adductor spasm. By the time the N cord muscle surgery is done, the child’s abnormal gait may be too severe to be easily corrected. However, for some young children, surgery may be considered delayed if it is possible to reduce the number of surgeries in the future. The timing of orthopaedic surgery has also changed in recent years. Previously, orthopedic surgeons generally recommended that all necessary surgeries required by the child be performed at one time, usually between the ages of 7 and 10 years. Because lengthening the muscle weakens the muscle, surgery for contractures usually requires several months of recovery. For this reason, doctors try to lengthen as many muscles as possible at once. Addressing all of the problems at once shortens the amount of time the child is bedridden. If multiple surgeries are unavoidable, the surgery should be scheduled closer together. With shorter recovery times and the advent of new, minimally invasive surgical techniques, surgeons can choose the timing of surgery to get the best results based on the child’s age and developmental ability.