Predictors affecting outcome after single-event multilevel surgery in children with cerebral palsy: a systematic...

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) affects motor function in children.
• Single-event multilevel surgery (SEMLS) is a complex intervention for improving gait in children with CP.
• Identifying predictors of surgical success is crucial for patient selection and outcome optimization.

Purpose of the Study:

• To systematically review potential predictors of outcome following SEMLS in children with CP.
• To synthesize evidence on factors influencing gait improvement and patient satisfaction post-surgery.

Main Methods:

• A comprehensive literature search was conducted across six electronic databases.
• Studies included children with CP undergoing SEMLS with a minimum 12-month follow-up.
• Predefined predictors included demographics, Gross Motor Function Classification System (GMFCS) level, and kinematic data (Gait Profile Score - GPS).
• Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) and Oxford Centre for Evidence-Based Medicine scale.

Main Results:

• Seven studies met the inclusion criteria, with quality scores indicating moderate evidence (MINORS 9-11, Oxford 2b).
• Limited evidence supported sex, topographical distribution, or socioeconomic status as predictors.
• Preoperative Gait Profile Score (GPS) emerged as the strongest predictor of kinematic improvement.
• Children in GMFCS level II reported higher satisfaction and showed better GPS outcomes.
• Optimal long-term results were observed in children aged 10-12 years.

Conclusions:

• The optimal candidate for SEMLS is a child aged 10-12 years, classified as GMFCS level II, with a poor preoperative GPS.
• These findings can guide surgical decision-making and patient selection for SEMLS in pediatric CP.
• Further research may refine predictive models for SEMLS outcomes in children with cerebral palsy.