Surgical Tone Reduction in Cerebral Palsy

Phys Med Rehabil Clin N Am. 2020 Feb;31(1):91-105. doi: 10.1016/j.pmr.2019.09.008. Epub 2019 Nov 8.


This article overviews the surgical options for hypertonia management in cerebral palsy, both spasticity and dystonia. We review the history and use of intrathecal baclofen. We contrast its use with the indications for selective dorsal rhizotomy and review how it is the optimal technique to lower tone in the ambulatory spastic diplegic patient with cerebral palsy. This article reviews the advent of deep brain stimulation, with an emphasis on selection criteria and expected outcomes in this population. The article reviews the principles and use of selective peripheral neurotomy as it is applied to focal spasticity not requiring systemic tone reduction.

Keywords: Deep brain stimulation; Dystonia; Intrathecal baclofen; Spasticity.

Publication types

  • Review

MeSH terms

  • Baclofen / therapeutic use
  • Cerebral Palsy / drug therapy
  • Cerebral Palsy / physiopathology
  • Cerebral Palsy / surgery*
  • Deep Brain Stimulation
  • Dystonia / drug therapy
  • Dystonia / physiopathology
  • Dystonia / surgery*
  • Humans
  • Injections, Spinal
  • Muscle Relaxants, Central / therapeutic use
  • Muscle Spasticity / drug therapy
  • Muscle Spasticity / physiopathology
  • Muscle Spasticity / surgery*
  • Rhizotomy*


  • Muscle Relaxants, Central
  • Baclofen