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The Ability to Run in Young People with Cerebral Palsy before and after Single Event Multi-Level Surgery
Roman Rethwilm1, Harald Böhm2, Leonhard Döderlein3
1Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria.
Insights
Single Event Multi-Level Surgery (SEMLS) impacts running ability in spastic cerebral palsy patients. More procedures and lower pre-surgical function increase the risk of losing running ability post-SEMLS.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy (CP) affects motor function in children and young adults.
- Running ability is a key functional outcome following orthopedic interventions in CP.
- Single Event Multi-Level Surgery (SEMLS) aims to improve gait and function in CP patients.
Purpose of the Study:
- To identify factors influencing the ability to run before and after SEMLS in young patients with spastic CP (GMFCS I-II).
- To evaluate the impact of surgical procedures and pre-surgical function on running outcomes.
- To compare SEMLS outcomes with a conservatively treated control group.
Main Methods:
- Retrospective analysis of 98 patients (6-25 years) undergoing SEMLS and 71 controls.
- Analysis of surgical procedure type and number, recovery time, and 3D gait analysis variables.
- Comparison of pre- and post-surgical running ability, correlating with surgical and functional factors.
Main Results:
- Of 60 pre-surgery runners, 17 (28%) lost the ability; 8 of 38 non-runners gained it.
- A higher number of surgical procedures predicted loss of running ability (mean 5.9 vs. 3.5 procedures).
- Pre-surgical function (e.g., gait speed) was significantly different (p < 0.001) between groups.
Conclusions:
- Pre-surgical function and the number of surgical procedures are critical factors for maintaining or gaining running ability after SEMLS.
- Patients with lower pre-surgical function and existing running ability face a higher risk of losing this ability post-surgery.
- Careful patient selection and expectation management are crucial for SEMLS in spastic CP.
Abstract:
The objective of the study is to identify and evaluate possible factors that influence the ability to run before and after single event multi-level surgery (SEMLS). Young patients (6-25 years) with spastic cerebral palsy (GMFCSI-II) were retrospectively included. Type and number of surgical procedures, time for recovery and 3D gait analysis variables were analyzed with respect to the ability to run. In total, 98 patients (38 females; 60 males) who received SEMLS (12 years, SD 3.4) were included and compared to a control group of 71 conservatively treated patients. Of 60 runners pre-surgery, 17 (28%) lost the ability, while gained in 8 of 38 (21%) non-runners. The number of surgical procedures was a significant predictor and those who lost their ability to run had significantly more (mean = 5.9, SD = 1.7), compared to the patients who gained the ability (mean = 3.5, SD = 0.9). Further, pre-surgical function (e.g., gait speed) was significantly different (p < 0.001). Pre-surgical function and the number of surgical procedures seem to play an important role for the gain or loss of the ability to run after surgery. Caution is warranted in patients with lower pre-surgical function and the ability to run, as they seem at a higher risk to lose the ability.
