Basic problem in surgical treatment of spastic cerebral palsy

Cerebral palsy (CP) is one of the most common disabling diseases of children's nervous system, and its treatment is an obvious challenge in medical area. Spastic CP is the main type of CP, accounting for about 70% of CP patients, with increased muscle tone as its main characteristic. Spasticity has always been a major problem in the treatment of CP. Surgical intervention plays an important role in its treatment and also greatly promotes the rehabilitation process. Relieving spasm is the goal of surgical treatment. Surgical intervention should follow the principle of "multidisciplinary collaboration and integration of surgery and rehabilitation", regardless of whether neurosurgery, orthopedic surgery or rehabilitation is used. Dr. Lin Xu, a pioneer in the development of Chinese CP surgery, introduced selective dorsal/posterior rhizotomy (SDR/SPR) to China in 1990s, and has developed the principle mentioned above. The articles in this issue focus on the basic principles of surgical intervention for CP, in hopes of achieving a general consensus on the treatment of CP among healthcare providers. We were so lucky to combine 5 articles for this special issue centered around the surgical treatments to spastic patients. The treatment schemes include SDR/ SPR, selective peripheral neurotomy (SPN), orthopedic surgeries and deep brain stimulation (DBS). Qi Sun and Lin Xu et al. described the history and development of the SDR and defined the patient selection criteria. The outcome and complications were also discussed in this paper. In addition, the authors further elaborated the advancing techniques in dealing with spasticity. Wenbin Jiang and Bo Xiao et al. explained the intraoperative neurophysiological monitoring in detail, which is used to guide SDR. This amazing paper provided us with not only a better understanding of intraoperative neurophysiological monitoring, but also an approach to better understand the neuronal electrophysiological circuits in spinal cord in spastic CP patients, therefore giving the potential to optimize treatment. Juan Fan and Shijie Wang et al. described another most common used surgical method, the SPN, which was introduced into China by Dr. Shijie Wang in early 2000s. This article talked about the mechanism, indications, preoperative assessments, techniques, and complications of SPN. Xiaohong Mu and Lin Xu et al. gave us an insight into the adjunct interventional surgery for spastic patients, the orthopedic surgery. The common deformities of the lower extremities in spastic CP as well as the indications, operational strategies, and efficacy assessment of different orthopedic procedures were discussed in their work. All the above may be suitable for for spastic CP, which represents the most common clinical form of CP. However, these treatments are not suitable for dystonic CP. Hongjie Jiang et al. have written about DBS used in the treatment of dystonic CP, where they discussed the targets for DBS and the mechanisms of action in treatment of dystonic CP. Overall, this topic issue is just a review of some common treatments, much work is still needed to make patients’ life better.