Which of the following are surgical management options for cerebral palsy?

• A. Spinal fusion, craniectomy, laminectomy, and shunt placement
• B. Tendon release, distal femoral extension osteotomy, acetabular/femoral osteotomies, and selective dorsal rhizotomy
• C. Physical therapy, occupational therapy, speech therapy, and aquatherapy
• D. Botox injections, tendon release, acute care, and joint fusion

Answer: (B)

In cerebral palsy, surgical management targets correcting deformities and reducing spasticity to improve function. The best answer combines procedures that lengthen tight soft tissues, realign bones to enable better movement, and lower neural drive to overactive muscles. Tendon or muscle releases lengthen overactive muscle-tendon units to improve range and alignment. Distal femoral extension osteotomy and acetabular/femoral osteotomies realign the knee and hip joints, addressing contractures and joint instability that limit gait and chair-to-stand transfers. Selective dorsal rhizotomy is a neurosurgical approach that reduces spastic input from the spinal cord, facilitating easier movement and often enabling more effective participation in rehabilitation.

Other options mix non-surgical therapies or procedures not routinely used to manage CP-related motor impairments. Physical, occupational, speech therapies, and aquatherapy are rehabilitative modalities rather than surgical interventions. Botox injections are a minimally invasive adjunct to reduce spasticity but are not a definitive surgical management plan. Acute care, shunt placement, craniectomy, laminectomy, or spinal fusion address different conditions or indications and are not standard, primary surgical strategies for CP management aimed at improving functional movement.