Operations involving the the bones, tendons, and muscles (orthopedic surgery) are used to treat the consequences of long-standing spasticity. Surgical procedures often include cutting muscles or lengthening tendons to help reduce the effect of increased muscle tone. Surgery may be performed to allow more normal bone and muscle growth. While each surgical approach has certain strengths and weaknesses, none completely eliminate increased tone or its effects. Surgery should not considered only when other treatments have failed. Instead, surgery should be considered when a permanent reduction is needed in muscle tone or when muscle force needs to be redirected. Patients with chronic hypertonia should have a thorough evaluation of their current level of function, and realistic expectations for improvement in function should be established before the operation takes place. As with any other treatment for hypertonia, surgical intervention must be incorporated into an overall tone management plan. An ongoing physical therapy program following surgery is important to maximize the benefits available from the operation.
For some children with spasticity affecting both legs, a surgical technique called selective dorsal rhizotomy may permanently reduce spasticity and improve the ability to sit, stand and walk. In this procedure, doctors identify and cut some of the sensory nerve fibers that are contributing most to spasticity. This procedure is usually recommended only for children with severe leg spasticity who have not responded well to other treatments.