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Gait analysis in patients operated on for sacrococcygeal teratoma
Antonio Zaccara1, Barbara D Iacobelli, Ottavio Adorisio
1Newborn Surgery and Pediatric, Bambino Gesù Children's Hospital, Rome, Italy.
Insights
Sacrococcygeal teratoma (SCT) surgery in infants can alter gait kinetics despite normal walking patterns. Muscle power and joint moments are affected, independent of tumor size, necessitating long-term follow-up.
Area of Science:
- Pediatric Surgery
- Orthopedics
- Biomechanical Engineering
Background:
- Sacrococcygeal teratoma (SCT) surgery often involves extensive pelvic and perineal muscle dissection.
- The long-term impact of this muscle disruption on gait and ambulatory function is not well understood.
Purpose of the Study:
- To evaluate the gait patterns and kinetics of patients who underwent surgery for SCT in infancy.
- To determine if surgical disruption of pelvic and perineal muscles affects long-term walking ability.
Main Methods:
- Gait analysis using a Vicon 3-D motion system was performed on 13 patients operated on for SCT.
- Results were compared to 15 age-matched healthy controls.
- Statistical analysis included Mann-Whitney tests and Spearman's correlation.
Main Results:
- Patients demonstrated normal walking velocity and stride length.
- Abnormalities were observed in earlier toe-off, reduced hip extensor and ankle moments, and altered knee and ankle power generation.
- These kinetic changes were independent of tumor size.
Conclusions:
- SCT surgery patients exhibit near-normal gait but with significant underlying kinetic alterations.
- The observed muscle power and joint moment modifications require further investigation for long-term implications.
- Long-term follow-up is crucial to assess the stability of these gait modifications and their potential impact on ambulatory function and joint health.
Background:
Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, little is known about the effects of extensive surgery in the pelvic and perineal region, which involves disruption of muscles providing maximal support in normal walking.
Methods:
Thirteen patients operated on at birth for SCT with extensive muscle dissection underwent gait studies with a Vicon 3-D motion analysis system with 6 cameras. Results were compared with 15 age-matched controls. Statistical analysis was performed with Mann-Whitney test; correlations were sought with Spearman's correlation coefficient.
Results:
All subjects were independent ambulators, and no statistically significant differences were seen in walking velocity and stride length. However, in all patients, toe-off occurred earlier (at 58% +/- 1.82% of stride length) than controls (at 65.5% +/- 0.52%; P <.05). On kinetics, all patients exhibited, on both limbs, a significant reduction of hip extensory moment (-0.11 +/- 0.11 left; -0.16 +/- 0.15 right v 1.19 +/- 0.08 Newtonmeter/kg; P <.05) and of ankle dorsi/plantar moment (-0.07 +/- 0.09 right; -0.08 +/- 0.16 v -0.15 +/- 0.05 Nm/kg, p < 0.05). Knee power was also significantly reduced (0.44 +/- 0.55 right, 0.63 +/- 0.45 left v 0.04 +/- 0.05 W/kg), whereas ankle power was increased (3 +/- 1.5 right; 2.8 +/- 0.9 left v 1.97 +/- 0.2 W/kg; P <.05). No statistically significant correlation was found between tumor size and either muscle power generation or flexory/extensory moments.
Conclusions:
Patients operated on for SCT exhibit nearly normal gait patterns. However, this normal pattern is accompanied by abnormal kinetics of some ambulatory muscles, and the extent of these abnormalities appears to be independent of tumor size. A careful follow-up is warranted to verify if such modifications are stable or progress over the years, thereby impairing ambulatory potential or leading to early arthrosis.
