What is cerebral palsy? Cerebral palsy is a non-progressive brain injury caused by various causes from before birth to 1 month after birth, manifested by central motor dysfunction and postural abnormalities, mostly accompanied by varying degrees of mental retardation, epilepsy, psychological and behavioral abnormalities, speech disorders, swallowing difficulties, visual, hearing and sensory impairments, and learning difficulties. The symptoms mostly appear before the age of 2 years. In recent years, with the development and progress of domestic medicine, many dying newborns have been rescued and survived, and also many children with cerebral palsy have survived for a long time; therefore, the incidence of cerebral palsy is on the rise compared to the past. Treatment principles of cerebral palsy During clinical consultations, we found that many cerebral palsy patients or their families are very blind in choosing treatment. Due to the desire to seek medical treatment urgently, they often waste a lot of energy and financial resources, and more unfortunately, they miss the best time for treatment. In response to this situation, we feel it is necessary to remind cerebral palsy patients or their families to choose treatment carefully. There are eight types of cerebral palsy, 75% of which are spastic cerebral palsy and can be treated surgically. However, there are many methods of surgical treatment, and it is especially important to choose the best timing and surgical method. Many patients choose the orthopedic rehabilitation method, which will cause the deformity to recur within a very short time after surgery, and the possibility of spasticity still exists. At present, we use intraoperative electrophysiological monitoring technology in the clinic and choose the treatment pathway of rehabilitating orthopedic rehabilitation by releasing limb spasticity, which is consistent with foreign treatment models, ensuring the surgical effect, reducing surgical risk, improving surgical efficacy, also avoiding spasticity recurrence, improving motor function, improving the patient’s quality of life and working ability, and achieving the goal of returning the disabled to society. What is SPR surgery? In recent years, with the advancement of basic medicine, the update of equipment, the application of multi-conductor electrophysiological recorders, and the introduction of multi-surgical combination of treatment protocols, SPR (selective posterior spinal nerve root dissection) has made great progress, from anatomical level surgery to functional level surgery, which is SPR, i.e. functional selective posterior spinal nerve root dissection. SPR is performed by intraoperative monitoring through multi-conductor electrophysiological techniques to determine the proportion of posterior spinal nerve roots to be resected, making the extent and proportion of sensory nerves to be resected more scientific and objective. The patient’s muscle tone is adjusted comprehensively so that the muscle tone of spastic muscles is as close to normal as possible. The muscle spasm in cerebral palsy patients is not limited to a single muscle, but often manifests as spasm of multiple muscles or muscle groups, and this surgery can achieve comprehensive adjustment of muscle tone, and can provide long-term, stable and complete solution to the pain of muscle spasm in patients, providing the prerequisite for the maximum recovery of their motor functions. It is worth mentioning that SPR only selectively blocks part of the posterior nerve root fibers and does not affect the anterior nerve roots and motor functions that govern muscle movement. The specific site of surgery can depend on the patient’s specific condition: surgery in the lumbar spine can address lower extremity spasticity, and surgery in the cervical spine can address upper extremity spasticity. The efficacy of surgery in the lumbar and lumbosacral regions is basically the same, but surgery in the lumbar region is risky and has many complications. Currently, the main choice is to operate in the caudal part of the lumbosacral region, which reduces the risk of surgery and complications. The efficacy of SPR in the neck is not as good as that in the lumbosacral area, so the improvement of symptoms in the upper extremity is not as good as that in the lower extremity. We will make a set of scientific and reasonable individualized treatment plan including preoperative assessment and selection of appropriate methods for different patients before each surgery, and we should also insist on long-term formal rehabilitation training after the implementation of SPR, so as to ensure the rehabilitation efficacy. In addition, some patients should also undergo orthopedic surgery after SPR, such as corrective treatment for deformities such as scissor gait and clubfoot. Spastic cerebral palsy is the most common form and currently consists of three steps in terms of treatment mechanism: release of spasticity, correction of deformity and rehabilitation. What are the indications for SPR surgery? Although SPR is the first choice of treatment for patients with spastic cerebral palsy at home and abroad, and the effect is most direct and significant, SPR surgery also has its indications, and not every patient with cerebral palsy is suitable for SPR surgery. 2. The patient has some motor function in the trunk and limbs, only abnormal gait and power deformity due to contracture. 3.The spasticity involves the whole limb or bilaterally. 4.Severe spasticity and rigidity, affecting daily life, care and rehabilitation training 5.Normal or near-normal intelligence, age 3 years or older, in order to cooperate with postoperative rehabilitation training. SPR is selective and functional because there are many types of cerebral palsy and not all of them need surgical treatment. SPR is only suitable for the treatment of spastic cerebral palsy. The relationship between SPR and orthopedic surgery should be corrected. SPR cannot completely replace orthopedic surgery, but it should be noted that SPR surgery to relieve spasticity should be performed first and then surgical orthopedic surgery later, and this order should not be reversed. The choice of selective posterior spinal nerve rhizotomy (SPR) has three implications: first, the selection of the appropriate case, second, the selection of the nerve segment to be released from spasticity, and third, the selective cut of the posterior root with a small bundle of low threshold for electrical stimulation. All three should be missing, and anyone who blindly expands cases without regard to quality is not in compliance with this principle. Functionality means to preserve nerve function as much as possible to prevent numbness, intractable pain, sensory abnormalities and bladder function. There are several principles that should be followed for the improvement of surgical methods: rational basis with clear conclusions; demonstration at the stage of animal experiments; repeated testing by clinical practice; no increase in the difficulty and danger of surgery and reduction of complications; and improvement of the efficacy of surgery. Differences between spinal nerve surgery and peripheral nerve surgery Posterior spinal nerve root surgery has a wide range of applications and suitable procedures have their surgical indications. Peripheral nerve surgery currently has no uniform specifications and should be performed with caution. This type of surgery was performed in China as early as the 1950s and was later eliminated because of its inconsistent efficacy. If peripheral nerve surgery is chosen, orthopedic surgery should be added at the same time. Selecting patients with single limb symptoms for this type of surgery can be a necessary supplement to SPR surgery and should not become the mainstream of surgical treatment for cerebral palsy. The problem of recurrence and the formation of severe opposing deformities in peripheral nerve surgery is something that currently has no solution. The cause of recurrence is not the regeneration of severed nerves, but the regeneration of motor endplates. Warm tip: The diagnosis and treatment of cerebral palsy diseases have high requirements on the technical equipment and expert experience level of the hospital, so the treatment of cerebral palsy must be done in regular tertiary hospitals. In addition to SPR surgery, Nanjing Medical University Cerebral Palsy Treatment Center also carries out peripheral nerve microsurgery to treat cerebral palsy limb spasms; common carotid artery epicraniectomy to treat hand-foot tardive dyskinesia and mixed cerebral palsy; modified Foerster-Dandy surgery to treat cerebral palsy combined with spastic diagonal neck. The surgeries are all performed under microscopic magnification, with minimal trauma, few complications and positive efficacy.