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Orthopaedic Surgery in Dystonic Cerebral Palsy

Francesco C Blumetti¹, Jenny Chia Ning Wu¹, Federica Barzi²

¹Orthopaedic Department.

Journal of Pediatric Orthopedics

|March 7, 2019

Insights

Orthopaedic surgery in children with dystonic cerebral palsy (DCP) yields predictable outcomes, improving functional mobility and hip morphology. Recurrence of deformity is uncommon, challenging historical views on DCP surgical results.

Area of Science:

Orthopaedic surgery
Pediatric orthopaedics
Cerebral palsy

Background:

Historically, outcomes of orthopaedic interventions for dystonic cerebral palsy (DCP) have been unpredictable.
This study evaluates the overall outcomes of orthopaedic surgery in children diagnosed with DCP.

Purpose of the Study:

To assess the predictability of orthopaedic surgery outcomes in children with DCP.
To evaluate improvements in functional mobility and hip morphology following surgical interventions.

Main Methods:

A cohort of children with DCP undergoing lower limb orthopaedic surgery (minimum 12-month follow-up) was analyzed.
Patients were stratified by Gross Motor Function Classification System (GMFCS) levels (I-III and IV-V) and Barry Albright Dystonia Scale (BADS) scores.
Outcomes included surgical predictability, deformity recurrence, functional mobility (Group 1), and hip migration percentage (Group 2), analyzed using linear mixed models.

Main Results:

In Group 1 (mild dystonia), 3/18 experienced unpredictable results, 2/18 had early deformity recurrence, and 1/18 improved functionally.
In Group 2 (moderate-severe dystonia), 1/19 had unpredictable results and 2/19 had early deformity recurrence.
Hip migration percentage showed a significant increasing trend up to 21 months post-surgery (P=0.0002), stabilizing thereafter (P=0.18).

Conclusions:

Orthopaedic surgery in children with DCP is associated with predictable outcomes and low rates of early deformity recurrence.
Surgical interventions can lead to improvements in functional mobility and hip morphology in this patient population.

Read full analysis

Abstract

Background:

Outcomes after orthopaedic interventions in patients with dystonic cerebral palsy (DCP) are historically regarded as unpredictable. This study aims to evaluate the overall outcome of orthopaedic surgery in children with DCP.

Method:

Children with DCP who underwent lower limb orthopaedic surgery with a minimum follow-up of 12 months were included. Data collected included age at time of surgery, surgical procedures performed, Gross Motor Function Classification System (GMFCS) level, and Barry Albright Dystonia Scale (BADS) score. The cohort was divided into 2 groups. Group 1 (GMFCS levels I to III), mean age 12 years 7 months and group 2 (GMFCS levels IV to V), mean age 10 years 7 months. Group 1 had surgery aimed at deformity correction to improve gait and mobility, and group 2 for the management or prevention of hip displacement. Outcome measures analyzed were: the incidence of unpredictable results related to surgery and early recurrence of deformity in both groups. Functional mobility scale scores were evaluated for group 1 and hip migration percentage for group 2. Linear mixed models were used to take into account repeated measures over time and correlations between measurements from the same patient.

Results:

Group 1 (n=18); had low BADS scores and were considered to have mild dystonia. Three children experienced unpredictable results, 2 had early recurrence of deformity, 3 had a decline, and 1 child improved in the functional mobility scale.Group 2 (n=19); had high BADS scores and were considered to have moderate to severe dystonia. Nine surgical events involved bony procedures and 15 were soft tissue surgery only. One surgical event lead to unpredictable results and 2 children had early recurrence of deformity. Postoperatively, a linear trend of increasing migration percentage [0.49% (95% confidence interval, 0.23-0.74; P=0.0002)] was seen up to 21 months. There was no significant change after 21 months [-0.08% (95% confidence interval, -0.24 to +0.041; P=0.18)].

Conclusions:

This study suggests that unpredictable results and early recurrence of deformity following orthopaedic surgery in children with DCP are not as common as previously regarded. Furthermore, functional mobility and hip morphology can be improved.

Level Of Evidence:

Level IV-this is a case-series.

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