Minimally Invasive SPML Surgery for Children with Cerebral Palsy: Program Development.

Area of Science:

• Pediatric Orthopedics
• Neurosurgery
• Rehabilitation Medicine

Background:

• Cerebral palsy (CP) is the leading cause of childhood physical disability.
• Surgical interventions like selective percutaneous myofascial lengthening (SPML) aim to improve ambulation in children with CP.
• Limited data exists on the efficacy and safety of SPML for CP.

Purpose of the Study:

• To evaluate the proof-of-principle for multisite SPML in improving functional mobility in children with CP.
• To assess the safety, reoperation rates, and long-term efficacy of SPML in larger patient cohorts.

Main Methods:

• Phase 1: A repeated measures case series of 17 children undergoing SPML, assessing knee/ankle motion and Functional Mobility Scale (FMS) pre- and post-surgery.
• Phase 2: Retrospective analysis of multisite SPML surgeries in larger cohorts (2006-2017), focusing on complications, reoperations, and efficacy.

Main Results:

• Phase 1 showed significant improvements in knee/ankle motion and FMS scores post-SPML, with sustained benefits at long-term follow-up.
• Phase 2 reported a 2.4% complication rate and 8-13% reoperation rates.
• SPML successfully corrected ankle equinus in 498 cases.

Conclusions:

• Multisite SPML is a safe and effective surgical option for improving ambulatory motion and daily mobility in children with CP.
• Further training and educational studies are needed for surgeons adopting the SPML technique.