Surgical Treatment of Cerebral Palsy in Budapest
Cerebral palsy is an umbrella term. It covers conditions in which a child’s movement and posture do not develop in the usual way because of early damage to the central nervous system. The injury usually occurs around the time of birth and is static: it does not deteriorate over time. The musculoskeletal problems that follow from it, however, do.
This difference is precisely what makes surgical treatment worthwhile. Orthopedics cannot influence the brain injury itself. It can, however, treat its consequences: the stiff muscles, the restricted joints and the deformed bones.
At the Budapest Musculoskeletal Private Clinic, the musculoskeletal treatment of cerebral palsy is handled by Dr. Ákos Morvai, chief physician in pediatric and neuro-orthopedics. He sees families for consultation in Óbuda and Buda, and the operations also take place in Budapest.
Why might surgery be needed?
The damaged areas of the brain do not send the right control signals to the muscles. As a result, certain muscle groups become excessively tight — this is what we call spasticity. Others remain insufficiently strong; this is paresis. The muscles no longer work in balance with one another.
As the child grows, this has consequences. The bone lengthens, but the constantly tightened muscle cannot keep pace with it. The joint is held in a poor position over the long term. At first this is still a flexible state; later it turns into a fixed restriction of movement, which we call a contracture. On the basis of these contractures, secondary bone and joint deformities develop, and these in turn change the body’s alignment. From here the path leads to worsening gait disorders and to recurring weight-bearing pain.
Many parents experience exactly this, and find it confusing: the diagnosis has not changed, yet the child’s mobility has declined. The brain injury has not worsened. The body has grown.
What surgery can and cannot achieve?
The orthopedic surgeon does not treat the neurological cause; that is the field of neurology and neurosurgery. What orthopedics works with is the musculoskeletal consequence: releasing contractures and restoring the body’s structural balance.
The goal is always functional:
The goal is always functional:
- More natural movement, better suited to how the body itself works
- Greater independence in everyday life
- Easier caregiving tasks for the family
- Less pain of musculoskeletal origin
What surgery cannot do:
Cure cerebral palsy. According to our current knowledge, the condition cannot be cured.
It can, however, be managed — and managed well: children’s quality of life can be meaningfully improved with targeted therapies.
Dr. Ákos Morvai
Chief Pediatric and Neuro-Orthopedic Physician
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Budafoki Street surgery: Monday
Bokor Street surgery: Wednesday, Sunday
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Where does surgery fit into the treatment sequence?
The treatment strategy always moves from less invasive procedures toward more complex ones.
Conservative foundation
Ongoing physiotherapy and conductive education. These are combined with orthoses — custom-made external splints and braces that position the joints, prevent contractures from developing, and provide more stable support for walking. Specially designed footwear completes this.
Targeted nerve treatments
If the child has extensive, severe muscle tightness affecting the entire lower limb or even the whole body, a neurosurgical solution may also be considered. In selective dorsal rhizotomy (SDR), the neurosurgeon cuts only a precisely defined portion of the sensory nerve roots leaving the spinal cord. If the tightness is limited to one or two specific muscle groups, locally acting selective peripheral neurotomy may be the answer. It is important to emphasize that these specific nerve procedures are performed by a neurosurgeon, not an orthopedic specialist.
Orthopedic correction
Once a contracture or bone deformity has developed, it cannot be reversed with exercise. This is the point at which surgery comes into consideration.
Minimally invasive orthopedic procedures
As surgical technique has advanced, in many cases the classic operations — with wide exposure, significant blood loss and long casting — are no longer necessary. The procedures below are tissue-sparing, targeted, and place a considerably lighter burden on the child’s body.
- Percutaneous muscle and fascia release (myofasciotomy): A procedure performed through the skin, from tiny punctures or minimal openings. The surgeon releases the tight muscle and connective-tissue sheaths. No wide exposure is required, so tissue damage and scarring remain minimal.
- Tendon lengthening through a small incision: Used to release contractures that have already formed. The most important shortened tendons are lengthened with anatomical precision through tiny incisions, instead of a large and painful exposure.
- Targeted correction at multiple levels: Several joints can be corrected in a single operative session — for example the hip, knee and ankle at once. This restores the biomechanical balance of the lower limb as a whole, and the child does not have to undergo several consecutive operations. Meanwhile the local burden remains lower.
- Correction of bone deformity by guided growth: In a growing bone, part of the growth plate is temporarily blocked with a small metal implant. The bone then gradually corrects the axial deviation using its own growth force.
- Low-impact joint stabilization: Fixation procedures that prevent pathological displacement and instability of the joint while preserving the greatest possible functional range of motion.
What does this mean in practice?
These techniques involve a smaller surgical burden than traditional open procedures. Tissues heal faster, early rehabilitation can begin sooner, the child can bear weight earlier, and less pain can be expected after the procedure.
The question of timing
Cerebral palsy is always individual. There is no treatment scheme that works for every child, and there is no age to which the procedure could automatically be matched.
A significant proportion of patients can be managed excellently by conservative means. When conservative therapy reaches its limits, however, a procedure carried out at the right time — matched to the child’s growth phases and motor development — can make a serious difference to independent movement later on. This is why regular follow-up carries so much weight: the decisive question is not whether surgery happens, but when.
Frequently Asked Questions
No. According to our current knowledge, the condition cannot be cured, but it can usually be managed well, and the child’s quality of life can be meaningfully improved with targeted therapies.
No. The injury to the central nervous system is static; no progressive deterioration takes place within it.
Because the body grows. Spastic muscle does not lengthen at the same rate as bone, and over time this imbalance leads to contracture and then to deformity.
No. A significant proportion of patients do well with conservative treatment. Surgery comes into consideration when physiotherapy, conductive education and orthoses reach their limits.
The surgical burden is smaller, tissues heal faster, rehabilitation can begin sooner, and less pain is expected after the procedure.
Yes. With targeted correction at multiple levels, deviations of the hip, knee and ankle, for example, can be addressed in a single operative session.
This has to be determined individually, matched to the child’s growth phases and motor development. Regular follow-up examinations serve exactly this purpose.
The parent is the most important observer. They are with the child twenty-four hours a day, so they are the first to notice subtle changes. It is worth requesting a pediatric orthopedic examination if you notice that:
- he child’s movement is unusually tight or stiff,
- they reach motor milestones (sitting, crawling, standing up) with more difficulty, and their development lags behind that of their peers,
- they walk oddly or move about on tiptoe,
- or they hold their leg asymmetrically.
Related reading from Dr. Ákos Morvai
Pediatric Orthopedics
Toe walking in children – from a pediatric orthopedic perspective
When is toe walking simply age-appropriate, and when is investigation warranted?
Read moreFor parents
5 Signs That It’s Time to See a Specialist in Pediatric Orthopedics
Gait, posture, pain, frequent falls – what parents should watch for.
Read morePediatric Orthopedics
Leg pain at night in children – what do “growing pains” mean?
The typical pattern of benign night-time leg pain, and the signs that do not fit it.
Read more
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