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Published on: February 2, 2024
Outcome of single-event multilevel surgery in untreated cerebral palsy in a developing country
1Park Lane Hospital, 56 Old Clifton, Sharah-e-Iran, Karachi, Pakistan. makbonedoc@cyber.net.pk
Insights
Untreated children with cerebral palsy (CP) who cannot walk can achieve walking ability after single-event multilevel surgery. This surgical intervention, combined with rehabilitation, offers significant functional improvements for non-walking CP patients.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Neurology
Background:
- Children with cerebral palsy (CP) in developing countries often receive treatment later than in developed nations.
- Late presentation in CP patients may lead to the belief that walking is unlikely if not already achieved.
- This study addresses the outcomes of surgical intervention for untreated, non-walking children with CP.
Purpose of the Study:
- To evaluate the effectiveness of single-event multilevel surgery (SEMS) in improving walking ability in older, untreated children with spastic diplegic cerebral palsy.
- To assess the functional outcomes of SEMS in patients who achieved sitting balance but not independent walking by a certain age.
Main Methods:
- Eighty-five spastic diplegic patients (age 5-12 years) who were untreated non-walkers underwent SEMS.
- Patients received post-operative physiotherapy and orthotic support.
- Outcomes were assessed using a modified functional walking scale at 2-5 years post-surgery.
Main Results:
- Static joint contractures resolved significantly post-surgery.
- All 85 patients improved their walking ability.
- Post-operative functional ambulation included 21.2% exercise walkers, 45.9% household walkers, and 33% community walkers.
Conclusions:
- Single-event multilevel surgery is a viable treatment option for children with cerebral palsy who present as untreated non-walkers at an older age.
- Successful outcomes are contingent upon adherence to inclusion criteria and implementation of a structured, supervised rehabilitation program.
- This approach can significantly enhance functional mobility in a previously untreatable population of CP patients.
Abstract:
In developed countries, children with cerebral palsy are treated from the time of diagnosis. This is usually not the case in developing countries where such patients often present at an age when it is traditionally believed that if walking has not already commenced, it is unlikely to. This study reports the outcome of the surgical treatment of 85 spastic diplegic patients at a mean of 8.5 years (5 to 12). All presented as untreated non-walkers and had achieved sitting balance by the age of five to six years. They underwent single-event multilevel surgery followed by physiotherapy and orthotic support. For outcome assessment, a modified functional walking scale was used at a mean of 3.5 years (2 to 5) post-operatively. At all levels, static joint contractures had resolved almost completely. All patients improved and became walkers, 18 (21.2%) as exercise, 39 (45.9%) as household and 28 (33%) as community walkers. This study shows that children with cerebral palsy who cannot walk and have not been treated can be helped by single-event multilevel surgery, provided that inclusion criteria are followed and a structural, supervised rehabilitation programme is in place.
