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Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study
Corrado Borghi1, Daniela Pandarese2, Debora Formisano3
1Pediatric Rehabilitation Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy - corrado.borghi@gmail.com.
Insights
Single-event multilevel surgery significantly enhances gait efficiency and quality in children with cerebral palsy. This intervention optimizes joint mechanics for improved functional mobility.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Biomechanical Engineering
Background:
- Single-event multilevel surgery (SEMS) is a common intervention for children with cerebral palsy (CP).
- While SEMS effects on kinematics and spatiotemporal parameters are known, its impact on gait efficiency is less understood.
- This study addresses the underexplored area of SEMS's effect on gait efficiency in pediatric CP.
Purpose of the Study:
- To evaluate the impact of single-event multilevel surgery (SEMS) on gait efficiency and quality in children with cerebral palsy (CP).
- To compare outcomes between surgically treated and non-surgically managed children with CP.
- To identify specific improvements in joint kinematics and dynamics post-SEMS.
Main Methods:
- Retrospective analysis of gait data from 109 children with CP (2011-2022).
- Comparison between a surgical group (81 patients undergoing SEMS) and a non-surgical group (28 patients).
- Assessment of gait efficiency (joint extension, push-off power/energy) and quality (Gait Profile Score, Gait Variable Scores).
Main Results:
- SEMS group showed significant improvements in knee (6.1°) and hip (1.6°) extension.
- Ankle push-off power (+24.1%) and energy (+19.8%) increased, while knee energy production decreased (-14%).
- Gait Profile Score improved significantly (-2.8°), with notable reductions in knee, ankle, and foot progression angle deviations. Non-surgical group showed no significant changes.
Conclusions:
- Single-event multilevel surgery (SEMS) significantly enhances gait efficiency and quality in children with cerebral palsy (CP).
- SEMS optimizes joint kinematics and dynamics, leading to improved gait mechanics.
- The findings support SEMS as a crucial intervention for enhancing functional mobility in pediatric rehabilitation.
Background:
Single-event multilevel surgery is a widely used intervention for improving gait in children with cerebral palsy. While its effects on kinematics and spatiotemporal parameters are well documented, its impact on gait efficiency remains underexplored.
Aim:
To evaluate the impact of single-event multilevel surgery on gait efficiency and quality in children with cerebral palsy.
Design:
Retrospective study.
Setting:
Pediatric Rehabilitation Unit at AUSL-IRCCS, Reggio Emilia, Italy, using pre- and post-surgical gait analysis data collected from 2011 to 2022.
Population:
The study included 109 children with cerebral palsy, categorized into a surgical group (81 patients) who underwent single-event multilevel surgery and a non-surgical group (28 patients).
Methods:
Single-event multilevel surgery targeted lower limb pathologies using soft tissue and skeletal corrections. Gait efficiency was assessed through maximum knee and hip extension, and push-off power and energy. Gait quality was evaluated using the Gait Profile Score and Gait Variable Scores. Spatiotemporal parameters were also measured.
Results:
In the surgical group, maximum knee extension improved by 6.1° (P<0.001) and hip extension by 1.6° (P=0.023). Ankle push-off power (+24.1%) and energy (+19.8%) increased significantly, while knee energy production decreased (-14%). Gait Profile Score improved by -2.8° (P<0.001). Significant gait variable score reductions included knee flexion-extension (-4.0°), ankle plantarflexion-extension (-3.8°), and foot progression angle (-4.0°). Spatiotemporal metrics remained largely unchanged. Correlations revealed a modest inverse relationship between age and push-off power (rho=-0.28, P=0.012) and an association between Gross Motor Function Classification System levels and push-off power (P=0.018). The non-surgical group showed no significant changes in any efficiency or quality metrics.
Conclusions:
Single-event multilevel surgery significantly improves gait efficiency and quality in children with cerebral palsy by enhancing joint kinematics and dynamics.
Clinical Rehabilitation Impact:
these findings highlight single-event multilevel surgery's capacity to optimize gait mechanics, prioritizing efficiency and quality improvements over maximal walking performance. This supports its use as a key intervention for improving functional mobility in rehabilitation settings.
