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Analysis of orthopedic surgical procedures in children with cerebral palsy
Ignacio Rehbein1, Viviana Teske1, Ignacio Pagano1
1Clínica de Traumatología y Ortopedia Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo 11200, Uruguay.
Insights
Orthopedic surgeries in children with cerebral palsy (CP) vary by functional level. Bone surgeries increase in higher Gross Motor Function Classification System (GMFCS) levels, while soft tissue procedures are more common in lower levels.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Cerebral Palsy Management
Background:
- Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities.
- Patient age and functional level are key factors in surgical decision-making for CP.
- Limited data exists on orthopedic surgery patterns in relation to functional levels in Latin America.
Purpose of the Study:
- To analyze orthopedic surgical procedures in children with CP.
- To correlate surgical types with patient age and Gross Motor Function Classification System (GMFCS) levels.
Main Methods:
- Retrospective analysis of 227 children with CP undergoing elective orthopedic surgery (2010-2016).
- Data collected included demographics, GMFCS levels, and surgical procedures.
- Statistical analysis (chi-squared, ANOVA, t-test) used to compare surgery types and frequencies across GMFCS levels.
Main Results:
- A total of 711 procedures were performed; the mean age at first surgery was 8.0 years.
- Lower leg soft tissue surgery (27%), hip tenotomy (19%), and hamstring tenotomy (14%) were most common.
- Children with GMFCS levels II-V underwent significantly more surgeries than GMFCS level I.
- Soft tissue procedures predominated in GMFCS levels I-III (80-85%), while bone surgeries increased in levels IV (68%) and V (55%).
Conclusions:
- The number of surgical procedures per child did not significantly increase beyond GMFCS level I.
- A higher proportion of bone surgeries was observed in GMFCS levels IV-V compared to I-III.
- Surgical patterns in children with CP are influenced by functional motor level.
Background:
Orthopedic surgery in children with cerebral palsy (CP) aims to improve function and prevent deformities. Each child's condition in CP is unique and many co-variables influence surgical decision-making including a patient's age and their functional level. Little is known about the frequency of different types of orthopedic surgery in children with CP who have varied functional levels, particularly in countries from Latin America.
Aim:
To assess the type of orthopedic surgical procedures in relation to age and gross motor function in children with CP.
Methods:
This retrospective study included all children with CP (n = 245) treated with elective orthopedic surgery at a Uruguayan university hospital between October 2010 and May 2016 identified from a surgical database. Eighteen children (7%) were lost to follow-up due to missing medical charts. Demographics, gross motor function classification (GMFCS), and orthopedic surgeries were obtained from the medical records of 227 children. Chi-squared tests and analysis of variance were used to assess the frequency of surgery, accounting for GMFCS levels. Mean age for soft tissue vs bone surgery was compared with the independent samples t-test.
Results:
A total of 711 surgical procedures were performed between 1998 and 2016. On average, children had 3.1 surgical procedures and the mean age at first surgery was 8.0 years. There were no significant differences in age at first surgery among GMFCS levels (P = 0.47). The most common procedures were lower leg soft tissue surgery (n = 189, 27%), hip tenotomy (n = 135, 19%), and hamstring tenotomy (n = 104, 14%). For children with GMFCS level I, the mean number of surgeries per child [1.8 (range 1-9)] differed significantly at P < 0.05 in children with GMFCS levels II [3.2 (1-12)], III [3.2 (1-8)], IV [3.3 (1-13)], and V [3.6 (1-11)]. Within II, III, IV, and V, there was no significant difference in mean number of surgeries per child when comparing across the groups. The proportion of soft tissue surgery vs bone surgery was higher in GMFCS levels I-III (80%-85%) compared to levels IV (68%) and V (55%) (P < 0.05).
Conclusion:
The frequency of surgical procedures per child did not increase with higher GMFCS level after level I. However, the proportion of bone surgery was higher in GMFCS levels IV-V compared to I-III.
