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Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study
Thomas Dreher1, Pam Thomason2, Martin Švehlík3
1Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Insights
Multilevel surgery (MLS) significantly improves gait in children with bilateral spastic cerebral palsy long-term. This safe intervention maintains gait improvements for over 9 years, aiding surgical planning for families.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Bilateral spastic cerebral palsy (CP) significantly impacts ambulatory function.
- Multilevel surgery (MLS) is a surgical approach to address complex gait deviations in CP.
- Long-term outcomes of MLS in pediatric CP populations require further investigation.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of multilevel surgery (MLS) in ambulatory children diagnosed with bilateral spastic cerebral palsy (CP).
- To assess the durability of gait improvements following MLS over an extended follow-up period.
Main Methods:
- A cohort of 231 ambulatory children with bilateral spastic CP underwent clinical examination and gait analysis.
- Gait Profile Score (GPS) changes were analyzed at short-term (average 1.1 years) and long-term (average 9.1 years) follow-up.
- The study compared preoperative GPS to post-operative scores, referencing the minimally important clinical difference.
Main Results:
- Children showed a significant improvement in GPS from 16.3° preoperatively to 11.3° at short-term follow-up (a 5° improvement).
- This improvement was well-maintained at long-term follow-up, with GPS at 11.4°.
- Approximately 76.6% of children sustained their gait improvement 9 years after MLS.
Conclusions:
- Multilevel surgery (MLS) is a safe and effective intervention for improving gait kinematics in children with bilateral spastic CP.
- The positive effects of MLS on gait function are durable, persisting for at least 9 years.
- This study provides valuable long-term data to inform clinical decision-making and patient counseling regarding MLS for bilateral spastic CP.
Aim:
We investigated the long-term efficacy and safety of multilevel surgery (MLS) in ambulatory children with bilateral spastic cerebral palsy (CP).
Method:
Two hundred and thirty-one children were evaluated at short term (1.1y, SD 0.4) and long term (9.1y, SD 3.0) follow-up using clinical examination and gait analysis. MLS was investigated by studying changes in the Gait Profile Score (GPS) referenced to the minimally important clinical difference.
Results:
Ambulatory children aged 10 years and 7 months (SD 2y 11mo) at MLS in Gross Motor Function Classification System levels I (19), II (144), and III (68) showed a decrease (improvement) in preoperative GPS from 16.3° (SD 4.8) to 11.3° (SD 3.2) at short-term follow-up, an improvement of 5°. At long-term follow-up, GPS was maintained at 11.4° (SD 3.1). Overall, 177 (76.6%) children maintained their improvement in GPS after 9 years.
Interpretation:
Multilevel surgery is a safe and effective surgical intervention, which leads to a significant improvement in gait kinematics in children with bilateral spastic CP. This study improves our understanding of MLS in the long term and will help to inform families and children when planning for MLS.
What This Paper Adds:
Largest study of multilevel surgery (MLS) for children with bilateral spastic cerebral palsy, with longest follow-up. MLS resulted in significant long-term improvements in gait function. Minor adverse events were common, while events requiring intervention were uncommon (4% of children). Thirty-nine per cent of children required additional surgery during follow-up. 'Single-event multilevel surgery' was changed to the more realistic term 'multilevel surgery'.
