Cerebral spastic paralysis in children is a common disorder constituting one of the unsolved problems of orthopedic and neurologic surgery. The multiplicity of methods and procedures used for its relief bears witness to the difficulties of its treatment.
There are two main varieties, the one occurring at or before birth and the other acquired in infancy or early childhood. The usual causes of the congenital form are intracranial hemorrhage and lack of development of the cerebral cortex. In premature infants, lack of cerebral development is the usual cause, and the reason for this agenesis can seldom be determined. Hemorrhage is very rare in these premature infants, because the child's head is small and there is usually not enough compression of the skull during birth to cause a rupture of the longitudinal sinus or the middle meningeal artery. In these infants there may be very little spasticity at birth. They are