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[Outcomes of multilevel orthopedic surgery in children with cerebral palsy]
Kenan Koca1, Cemil Yıldız, Yüksel Yurttaş
1Department of Orthopedics and Traumatology, Gülhane Military Medical Academy, Ankara, Turkey.
Insights
Single-event bilateral multilevel orthopedic surgery significantly improved gross motor function and gait parameters in children with cerebral palsy. This effective intervention enhances physical examination findings and joint kinematics for better mobility.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Management
Context:
- Cerebral palsy (CP) presents significant motor challenges in children.
- Multilevel orthopedic surgery aims to correct deformities and improve function in CP.
- Evaluating outcomes of single-event, bilateral procedures is crucial for treatment optimization.
Purpose:
- To assess the outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy.
- To evaluate improvements in physical findings, Gross Motor Function Measure (GMFM) scores, joint kinematics, and gait parameters.
- To determine the effectiveness of this surgical approach in ambulatory and non-ambulatory CP patients.
Summary:
- A retrospective study analyzed 24 children with CP (mean age 12 years) undergoing multilevel orthopedic surgery.
- Postoperative evaluations at an average of eight months showed significant improvements in GMFM scores across all functional domains.
- Gait analysis revealed enhanced joint kinematics (hip, knee, ankle) and improved time-distance parameters (walking velocity, stride length, cadence).
Impact:
- Single-event bilateral multilevel orthopedic surgery demonstrates efficacy in improving gross motor function and gait in children with CP.
- The findings support the surgical approach for selected CP patients, leading to better physical examination results and kinematic profiles.
- This study provides evidence for optimizing surgical strategies to enhance functional outcomes in pediatric cerebral palsy.
Objectives:
Outcomes of single-event bilateral multilevel orthopedic surgery in children with cerebral palsy were retrospectively investigated by physical findings, and gross motor function measurement (GMFM) score in all patients and additionally by joint kinematics, and time-distance parameters in ambulatory patients.
Patients And Methods:
A total of 24 patients (17 ambulatory; 7 non ambulatory; mean age 12 years; range 5 to 19 years) treated with multilevel orthopedic surgery between December 2003 and December 2005 were included in the study. Patients were evaluated with physical examination and GMFM score. In addition, computed gait analysis was used to evaluate joint kinematics and time-distance parameters in ambulatory children. The following surgeries were performed on the children in the study cohort: adductor tenotomy (n=24); psoas lengthening (n=14); hamstring lengthening (n=46); distal rectus femoris transfer (n=18); bilateral Achilles tendon lengthening (n=22); distal femoral derotation osteotomy (n=1); open reduction and Dega osteotomy (n=1), and proximal femur resection (n=2). Patients were evaluated with the same parameters after an average of eight months postoperatively. The pre- and postoperative results were statistically compared.
Results:
Improvements were achieved in the lying-rolling (7%), sitting (9%), crawling-kneeling (7%), standing (5%), and walking-running-jumping (5%) activities of GMFM score. An increase in hip abduction angle and external rotation and a decrease in the Thomas test results were observed. A decrease in popliteal angle and an increase in active and passive knee extension were provided. Active and passive ankle dorsiflexion increased. In the kinematic parameters, the minimum hip and knee flexions in the stance phase were significantly decreased, while no significant decrease was seen in the maximum hip and knee flexion in the swing phase. Both the ankle dorsiflexion in the stance and swing phase and the time-distance parameters consist of walking velocity, stride length and the cadence were significantly improved.
Conclusion:
Single-event bilateral multilevel orthopedic surgery performed in the right indication was shown to be effective with improvements in physical examination findings GMFM scores, joint kinematics and time-distance parameters in children with cerebral palsy.
