Cerebral palsy in childhood consists of a series of permanent disorders of development, movement and posture, resulting in a limitation of the child’s motor and intellectual capacities, and it is due to irreversible damage to the central nervous system that occurs during the development of the fetus, infant or infant brain. The causes can be different and in our country one in every five hundred births is affected.
Functional surgery is one of the few options available for children with cerebral palsy, which can improve their quality of life. Professor Nicola Portinaro, Head of pediatric orthopedics at Humanitas, who was a studio guest at Unomattina on Rai1, spoke about this topic.
What is the link between infantile cerebral palsy and neuromotor disorder?
“The central disorder is an irreversible disorder and is brain-dependent. This disorder results in increased muscle activity, increased tone and spasticity of these muscles, which grow less than bones. The deformities that therefore occur in the musculoskeletal system are progressive and especially affect the joints. Very early surgery helps to avoid serious cases in the future.
This disease affects every child differently, there are very light and very serious forms, in which the child is in bed and cannot move. We talk about monoplegia, diplegia, and quadriplegia, depending on the amount of the body and limbs that are involved.
Help from technology
“Surgery today uses technological means, such as studying the analysis of the path and biomechanics of the path, which allow us to quantify the error of both the movement and the strength of each child’s joints.
For ten years now, Humanitas has had a protocol called E.M.M.A., which means early, multilevel, functional surgery, which ensures that the patient recovers all his motor possibilities. There is also the possibility of late surgery, which is much more demanding and biologically expensive,” says Prof. Portinaro.
Intervention in the hips
“It is very common in these patients that the head of the femur is no longer contained in its cavity (the acetabulum). Early surgery involves the insertion of a small screw (inside the neck of the femur) in the hip and this is sufficient to contain, with the development of the child, the head of the femur inside the acetabulum.
In the case of hip dysplasia, therefore, early surgery allows immediate rehabilitation with a minimum hospitalization.
“The knees are another fundamental motor station, the flexion that one has (precisely because the bone grows more and the muscle grows less proportionally) prevents a normal path. In early surgery, small screws and knee plates can correct flexion. The day after the operation, the child can start rehabilitation.
“A deformity of the foot does not allow normal walking and normal thrust during the step phases. Early surgery in this case involves the insertion of a screw and the foot is thus corrected immediately, the patient is in hospital for a few hours and can walk right away,” concludes Professor Portinaro.