A micro-scalpel (only 1 millimeter of width) to intervene on the damaged muscle fibers and correct the disorder without incisions or stitches, reducing pain and the recovery time. It is the new minimally invasive surgical technique to treat spasticity developed by the Neuro-Orthopedics Team at Bambino Gesù Children’s Hospital, the only Center in Italy that performs this surgery. Approximately 500 children have been successfully treated since 2018. The new method, that in most cases may replace the traditional “open surgery” technique, was described in the scientific journal Osteology MDPI.

Spasticity is a condition affecting on average 3 children out of 1,000 live births worldwide. It results from a damage to the areas of the brain or spinal cord that control the tone and activity of muscles in motion. It is characterized by an excessive increase in muscle tone, and spasms of multiple muscles causing stiffness, difficulty in controlling voluntary movements, vitiated movements that over time turn into joint deformities. Muscle fibers lose elasticity and change into fibrous tissues that progressively leads to the shortening of muscles and tendons.

The treatment of spasticity usually requires surgical treatments to higher and lower limbs. These surgeries are performed as from 6-7 years of age and involve the extension and sectioning of muscles and tendons. They are commonly performed by using the open surgery technique, with a skin incision of variable size, followed by immobilization of the treated area with a plaster brace. For the recovery of post-operative joint function, a personalized physiotherapy program is required.

The new surgical technique for the treatment of spasticity, called “percutaneous fibrotomy surgery“, is a conservative and minimally invasive surgery developed 4 years ago – on the basis of a similar technique developed in Russia – by the Neuro-Orthopedics team of the Bambino Gesù Hospital, aimed to reduce postoperative troubles and accelerate the functional recovery of patients.

The surgery is performed with a micro-scalpel with which the surgeon progressively wears out the fasciae and muscle fibers affected by spasticity, until the desired correction is obtained. The incisions are minimal, do not require stitches and can be performed simultaneously in multiple areas. The new technique can be performed as from 2-3 years of age, reduces the time of anesthesia (10/20 minutes of surgery versus over 60 minutes of the traditional technique) and allows to replace the plaster with a removable brace to start physiotherapy as from the day following the surgery.

“For children eligible for this type of surgery, namely most of spasticity cases – underlines prof. Pier Francesco Costici, Head of Orthopedics at Bambino Gesù -, the advantages are considerable: the functional results are comparable to the open technique; no wounds are visible; the pain is significantly lower, and patients can be discharged the day after the surgery. A further advantage for children and their families is represented by a quicker and simpler postoperative management, including at home ».

Bambino Gesù Orthopedics Unit is a national reference center for the treatment of spasticity. Over the years, more than 4,000 “open surgeries” have been carried out. Approximately 500 patients from all over Italy have been treated with the new surgical technique since 2018. The results of the minimally invasive surgery finetuned by the Bambino Gesù orthopedic team – the only Italian center where this type of surgery is performed nowadays – were described in a recent study published in the scientific Osteology MDPI journal.