Surgical Tone Management in Cerebral Palsy: Indications, Techniques, and Outcomes

Hypertonia in cerebral palsy, including spasticity and dystonia, contributes to progressive musculoskeletal deformity, impaired mobility, pain, and challenges with care. When conservative measures fail, surgical tone management offers targeted interventions to reduce pathologic tone and improve function, comfort, and quality of life. This article provides a practical, technique-focused review of the principal neurosurgical strategies for tone management, including intrathecal baclofen pump placement, selective dorsal rhizotomy, ventral–dorsal rhizotomy, and deep brain stimulation with consideration of both lower and upper extremity involvement. Emphasis is placed on context driven and phenotype-driven patient selection, differentiation of dynamic tone abnormalities from fixed deformities, and integration of surgical decision-making within a multidisciplinary care framework. Key operative steps, technical nuances, and procedure-specific pitfalls are highlighted. A tailored, multidisciplinary approach is essential to optimize outcomes. As surgical techniques continue to evolve, including minimally invasive and precision-based approaches, treatment paradigms are increasingly shifting toward individualized, goal-directed strategies for tone management in cerebral palsy.