This book is an English version of my books titled "Cerebral 
Palsy and Orthopaedics" published in 1991 and " Orthopaedic 
Treatment of Cerebral Palsy" published in 1998 in Japanese. Many 
orthopaedic surgeons have understood the idea of orthopaedic 
selective spasticity-control surgery through these books and accepted 
the idea as an useful and effective concept with promising results. 
These books and another titled " Cerebral Palsy and Therapeutic 
Management" are now widely read as textbooks on orthopaedic and 
therapeutic management of cerebral palsy in Japan. Many orthopaedic 
surgeons in Japan involved in orthopaedic treatment of cerebral palsy 
supported our idea and practice. Orthopaedic surgeons from China, 
France, India, Malaysia, Mexico, New Zealand, Thailand, Turkey and 
United States have also visited us during the last 10 years. In this 
regard, doctors from overseas requested me to publish these books in 
an international language. The result is this book. In spite of a 
language barrier and ignorance about overseas publishers, 
perseverance of my overseas colleagues who were convinced by this 
concept helped me in publication of this book.
 
　　Recently, in the treatment of cerebral palsy and control of spasticity 
has become an urgent task for personnel involved. Many approaches for 
control of spasticity have been advocated. However, as I have mentioned 
in the clause on review of "current treatment of spasticity", control of 
spasticity is not so easy and at times seems impossible, if it is 
attempted without sacrificing body stability and other serious 
drawbacks such as sensory disturbance. If it is carried out without 
considering about antigravity stability and sensory problems, 
drawbacks such as sacrifice of stability and sensory disturbance are 
likely to occur. Other safer spasticity-control approaches need to be 
considered. That is why I am publishing this book in English, which 
will describe all about orthopaedic selective spasticity-control surgery 
in detail, as a spasticity-control surgery without these drawbacks. 

     Orthopaedic Selective Spasticity-Control Surgery (OSSCS) is an 
orthopaedic procedure designed to control or reduce hypertonicity in 
cerebral palsy. Various types and severity of hypertonicity can be 
appropriately controlled, by the use of selective muscle release 
surgery. This spasticity control surgery not only corrects deformities 
such as shoulder retraction, elbow deformity, scoliosis, flexion 
deformity of the hip, knee and ankle-foot, but also promises better 
hand and finger skills and reach movements of the upper extremity, 
stabilizes the trunk and lower extremities and relieves the 
hypertonicity in cervical, thoracic and lumbar spine. It also facilitates 
respiration and speech while lessening drooling remarkably. By 
combining the spasticity-control surgery with conventional 
orthopaedic surgery, such as open reduction, derotation varus 
osteotomy and pelvic osteotomy for dislocation of the hip, 
arthrodesis of the wrist and ankle, and anterior fusion of cervical and 
thoraco-lumbar spine, we can deal with a wide range of problems in 
motor activities and activities of daily living with encouraging results 
while providing a new path for functional improvement and for active 
life styles in most patients with cerebral palsy. Furthermore, 
orthopaedic selective spasticity-control surgery can provide us with an 
opportunity to assist physiotherapy and occupational therapy by 
controlling hypertonicity in the whole body while making it easy to 
facilitate basic motor functions such as rolling, crawling, sitting, 
kneeling, standing and independent gait.

	Fundamentals of the OSSCS are clear and uncomplicated and 
are based on the physical and biological findings that can be 
understood by any scientist. As is discussed later, we distinguished 
muscles of the vertebrate body into two groups: the multiarticular 
muscle group and the monoarticular muscle group. We clinically and 
electromyographically defined the multiarticular muscles as 
hypertonic in cerebral palsy and have controlled hypertonicity by 
releasing them selectively. The monoarticular muscles that are 
responsible to keep the body upright are carefully preserved and their 
activity is facilitated.
	The most important aspect of our surgery is that postoperatively 
no decrease in motor functions is observed. Postoperative weakness 
of the muscle is avoided by carefully preserving the monoarticular 
muscles that act as antigravity muscles. We can now conduct various 
kinds of surgical procedures without any complications. There is no 
loss of sensation and stereognosis, no increase in occurrence of 
dislocation and deformities and also no muscle weakness. 
Orthopaedic selective spasticity-control surgery is quite a reliable and 
promising procedure for patients, parents, physiotherapists and 
occupational therapists and even for school teachers.

	Another important aspect of our surgery is that its indications for 
surgery are wide. The hypertonicity in the whole body can be relieved. 
Hypertonicity of the neck, trunk, shoulder, elbow, forearm, wrist, 
thumb, fingers, hip, knee and ankle-feet can all be relieved 
appropriately, with the same generalized idea. All kinds of 
hypertonicity such as spasticity, rigo-spasticity, and athetosis could 
be suitable candidates for surgery. Even for mentally handicapped 
children, emotionally disturbed children, and even totally involved 
cerebral palsy patients with abnormal postural reflexes, functional 
improvement could be promising with orthopaedic selective 
spasticity-control surgery. All patients with cerebral palsy can be 
treated with successful results while enriching their quality of life if 
they have suffered from some kind of hypertonicity.

ﾊﾊﾊﾊﾊHowever, the decision making and treatment techniques are
demanding. In order to achieve successful results, orthopaedic 
techniques should be skillfully conducted since we are going to 
correct the complex motor disorders, which have not responded to 
other procedures. Which muscles should be released?  Which end 
should be released, proximal or distal? What kind of release should be 
done? Intramuscular lengthening? Sliding lengthening? or Z 
lengthening?  Tenotomy or detachment? How much and how long 
these lengthening should be done? Which kinds of conventional 
orthopaedic surgeries should be combined? All these questions and 
problems have to be managed appropriately. Even in treatment of 
dislocation of the hip, the approach is totally different from the 
ordinary procedure. Standard procedures such as division of the 
adductor longus do not bring excellent result. If adductor tenotomy is 
carried out too aggressively, dislocation may be reduced; however, 
functional disadvantages will be caused because of loss of antigravity 
activity of the adductors. In OSSCS, an elaborate surgery that preserves 
the antigravity adductors is advocated even for reduction of the 
dislocated hip. Profound understanding of the motor functional 
characteristics in cerebral palsy and its relation to the basic motor 
development is also necessary. 

     When the orthopaedic surgeon applies the principles of OSSCS 
accurately and applies it properly in his orthopaedic surgery, he will 
be able to promise definite improvements for cerebral palsy patients. 
Here, we would like to present ideas and techniques of the 
"Orthopaedic Selective Spasticity-Control Surgery" and show how these 
approaches can be used in treatment of cerebral palsy.

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