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Published on: August 9, 2024
Short-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural
Martin Gough1, Linda C Eve, Richard O Robinson
1One Small Step Gait Laboratory, Guy's Hospital, London SE1 9RT, UK. martin.gough@gstt.sthames.nhs.uk
Insights
Multilevel surgical intervention improved gait in children with spastic diplegic cerebral palsy, enhancing knee flexion and ankle dorsiflexion. The control group showed gait deterioration, questioning long-term surgical effects.
Area of Science:
- Orthopedics
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Spastic diplegic cerebral palsy (CP) often requires interventions to improve ambulation.
- Gait analysis is crucial for planning surgical interventions in CP.
- Understanding surgical outcomes is vital for optimizing treatment strategies.
Purpose of the Study:
- To review the outcomes of multilevel surgical intervention in ambulant children with spastic diplegic CP.
- To compare the gait kinematics of children who underwent surgery with a control group.
- To assess the impact of surgery on walking ability and assistive device use.
Main Methods:
- A retrospective review of 24 ambulant children with spastic diplegic CP.
- Division into a treatment group (n=12) undergoing surgery and a control group (n=12) not undergoing surgery.
- Three-dimensional gait analyses performed pre- and post-intervention, with interval measurements.
Main Results:
- The treatment group showed significant improvements in minimum knee flexion and ankle dorsiflexion during stance.
- The control group exhibited a significant increase in hip and knee flexion in stance, indicating gait deterioration.
- Parents reported increased walking distance for 9 children post-intervention; assistive device use varied.
Conclusions:
- Multilevel surgery positively impacts gait kinematics in children with spastic diplegic CP.
- The natural progression of gait in the control group suggests surgery's effects may be underestimated in short-term comparisons.
- Further research is needed to address long-term outcomes and potential concerns regarding surgical intervention in CP.
Abstract:
Outcome in 24 ambulant children with spastic diplegic cerebral palsy, in whom multilevel surgical intervention was recommended following gait analysis, is reviewed. Twelve children had surgical intervention (treatment group; eight males, four females; mean age 9 years 10 months, SD 3 years 4 months) while the other 12 did not (control group; five males, seven females; mean age 10 years 1 month, SD 2 years 11 months). All children had interval three-dimensional gait analyses (mean time between analyses: control group, 14.1 months; treatment group, 17.9 months). At follow-up the control group (mean age 11 years 9 months) showed a significant increase in minimum hip and knee flexion in stance which was not related to age, the interval between analyses, changes in the passive joint range of motion, nor changes in anthropometric measurements. The treatment group (mean age at follow-up 11 years 3 months) showed a significant improvement in minimum knee flexion and in ankle dorsiflexion in stance. Parents of nine children said their child's walking distance had increased following intervention. Of five children using posterior walkers preoperatively, two continued to use them postoperatively; two were using crutches or sticks and the remaining child walked independently. Two children who walked independently preoperatively used sticks postoperatively for community ambulation. The deterioration seen in the kinematics of the control group suggests that previous outcome studies comparing postoperative gait with preoperative gait have underestimated the immediate effects of surgery. It also raises concerns about the long-term effects of surgical intervention.
