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Multilevel surgery in adults with cerebral palsy
C Putz1, L Döderlein2, E M Mertens1
1Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
Insights
Single-event multilevel surgery (SEMLS) effectively improves gait in adults with bilateral spastic cerebral palsy (BSCP). This safe procedure benefits both those with and without prior childhood surgery, though longer rehabilitation is needed.
Area of Science:
- Orthopedic Surgery
- Neurology
- Gait Analysis
Background:
- Single-event multilevel surgery (SEMLS) is a long-established intervention for pediatric bilateral spastic cerebral palsy (BSCP).
- Evidence for SEMLS efficacy in adults with BSCP is limited, making its application in this population a subject of ongoing debate.
Purpose of the Study:
- To evaluate the short-term outcomes of SEMLS in ambulatory adults with BSCP.
- To assess the effectiveness of SEMLS in improving gait parameters in adult BSCP patients.
Main Methods:
- The study involved 97 ambulatory adults with BSCP undergoing SEMLS.
- Three-dimensional gait analysis was performed pre- and post-operatively.
- Outcomes were analyzed based on prior surgical history (no surgery, other surgery, or previous SEMLS).
Main Results:
- SEMLS demonstrated significant improvement in gait, evidenced by a decrease in the Gait Profile Score (GPS) (p = 0.001).
- Significant improvements were observed in both the right and left GGI (p = 0.01).
- Positive gait outcomes were noted across all subgroups, including those with prior SEMLS, though the effect was less pronounced in previously operated patients.
Conclusions:
- SEMLS is a safe and effective surgical intervention for improving gait disorders in adults with BSCP.
- Adult patients with BSCP can expect positive gait outcomes following SEMLS, even if they have undergone the procedure in childhood.
- A longer rehabilitation period should be anticipated for adults compared to children post-SEMLS.
Aims:
Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate.
Methods:
This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution.
Results:
Two objective gait variables were calculated pre- and post-operatively; the Gillette Gait Index (GGI) and the Gait Profile Score (GPS). The results were analysed in three groups according to their childhood surgical history (group 1 = no surgery, group 2 = surgery other than SEMLS, group 3 = SEMLS). Improvements in gait were shown by a significant decrease of GPS (p = 0.001). Similar results were obtained for both legs (GGI right side and left side p = 0.01). Furthermore, significant improvements were found in all subgroups although this was less marked in group 3, where patients had undergone previous SEMLS.
Discussion:
SEMLS is an effective and safe procedure to improve gait in adults with cerebral palsy. However, a longer rehabilitation period is to be expected than found in children. SEMLS is still effective in adult patients who have undergone previous SEMLS in childhood.
Take Home Message:
Single-event multilevel surgery is a safe and effective procedure to improve gait disorders in adults with bilateral spastic cerebral palsy.
