Surgery is often recommended when the patient is suffering from extreme contractures that are unresponsive to other forms of cerebral palsy therapy. Severe contractures will inhibit movement, balance, and coordination. Many surgeons would prefer to see contractures avoided and gait and upper limb mobility improved through good physical therapy. There are still numerous instances, however, where surgery is advised. Doctors can fix contractures by surgically lengthening, shortening or cutting tendons and muscles which are causing bones to distort and severely affecting a patient’s ability to function. Doctor’s can also improve bone deformation using instrumentation, which involves inserting a rod next to the deformed bone in order to straighten it.

Pre-operative analysis is the key to a successful surgery. Because movements like walking require more than 30 different muscles working in unison, it is important that the proper tendons and ligaments be adjusted. Using specialized computers, doctors and specialists can analyze a patient's gait when walking, which can help the specialist to pinpoint muscles that need help. In addition to using specialized computers, they key to a successful surgery is a sensitive and appropriate appraisal of the effect any procedure may have on the rest of the body. For instance many incorrect postures are a result of the patient compensating for a causative, or fundamental, deformity elsewhere. “Surgery on a secondary deformity runs the risk of further disabling the patient by removing compensation she may need in order to function.” Total gait and posture analysis is therefore advised before any surgical procedure is even contemplated. In addition to whether or not the pre-surgical analysis is thorough and sensitive and finds that the procedure is quite likely to aide the patient, many doctors feel it imperative for the child to believe that he or she will benefit from the surgery and have an intelligence level that will enable him or her to understand the procedure he or she will be undergoing.

Surgery aimed at improving deformities caused by Cerebral Palsy is still being researched. Because the human body’s muscular and skeletal structures are so complex, the slightest alteration of a muscle or tendon may have huge, unforeseen effects. For instance, “weak muscles may have hidden strengths which could be removed by surgery… [and] in the first three to four years of life it may not be possible to establish where the main problems will occur.” Walking is also thought to be difficult to achieve through surgery after the age of eight. It is for this reason that surgery is most often a last resort. Research is currently underway to find new, more effective ways to use surgical measures in treating cerebral palsy.