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Biomechanical and functional outcomes of high-burden and low-burden multilevel surgery in young people with cerebral
Victoria Hinchberger1, Brittany A Virgil1, Chris Church1
1Department of Orthopedics, Nemours Children's Health, Wilmington, DE, USA.
Insights
Young people with cerebral palsy (CP) undergoing low-burden multilevel orthopedic surgery (MLS) showed greater functional improvements than those with high-burden MLS. Gait patterns improved in both groups, aiding clinical decision-making for CP treatment.
Area of Science:
- Orthopedic Surgery
- Biomechanical Analysis
- Pediatric Rehabilitation
Background:
- Cerebral palsy (CP) affects motor function, often requiring surgical intervention.
- Multilevel orthopedic surgery (MLS) aims to improve gait and mobility in young individuals with CP.
- The impact of surgical burden on functional outcomes requires further investigation.
Purpose of the Study:
- To compare changes in gait biomechanics and mobility function between low-burden and high-burden MLS in ambulatory young people with CP.
- To identify factors influencing outcomes after MLS in this population.
Main Methods:
- Retrospective cohort study of 287 young people with CP (GMFCS levels I-III).
- Analysis of preoperative and postoperative gait data, including Gait Deviation Index (GDI), Gross Motor Function Measure-Dimension D (GMFM-D), gait velocity, and Pediatric Outcomes Data Collection Instrument (PODCI).
- Statistical analysis using paired t-tests and linear regression to evaluate the impact of surgical burden and preoperative factors.
Main Results:
- Both low-burden and high-burden MLS groups showed improved GDI. GMFCS level and baseline GDI significantly influenced GDI changes.
- The low-burden group demonstrated significant functional improvements in GMFM-D, gait velocity, and PODCI.
- The high-burden group showed decreased gait velocity but improved PODCI scores. Worse baseline functioning correlated with greater postoperative improvements.
Conclusions:
- While both low-burden and high-burden MLS improved gait patterns, low-burden MLS led to greater functional gains.
- Findings support clinicians in surgical decision-making, expectation setting, and resource allocation for young people with CP undergoing MLS.
Aim:
To compare changes in gait biomechanics and mobility function in ambulatory young people with cerebral palsy undergoing low-burden or high-burden multilevel orthopedic surgery (MLS).
Method:
This retrospective cohort study examined young people with cerebral palsy (classified in Gross Motor Function Classification System [GMFCS] levels I-III) using preoperative and postoperative gait analysis data, including Gait Deviation Index (GDI), Gross Motor Function Measure-Dimension D (GMFM-D), gait velocity, Pediatric Outcomes Data Collection Instrument (PODCI), and walking activity. The impact of surgical burden and preoperative factors on outcomes was evaluated with paired t-tests and linear regression.
Results:
A total of 287 young people (GMFCS level I = 13.9%, II = 58.9%, III = 27.2%; mean age 12 years 4 months [SD 3 years 10 months]) were included. Both low-burden (67.0 [SD 16.0] to 73.2 [SD 14.9]) and high-burden (67.0 [SD 14.3] to 70.7 [SD 12.9]; p < 0.001) groups exhibited improved GDI. GMFCS level (p < 0.01) and baseline GDI (p < 0.001) were significant factors for a change in GDI. The low-burden group exhibited functional improvements in GMFM-D (29.2 [SD 8.4] to 30.7 [SD 6.9]; p < 0.001), gait velocity (83.4 [SD 27.2] to 87.9 [SD 27.5]; p < 0.01), and PODCI (68.5 [SD 16.0] to 72.4 [SD 15.2]; p < 0.001); the high-burden group exhibited worse or lower gait velocity (76.2 [SD 27.5] to 71.1 [SD 31.4]; p < 0.01) and improvements in PODCI (65.1 [SD 15.9] to 67.4 [SD 16.2]; p < 0.05). GMFCS level and baseline measures were significant for changes in GMFM-D (p < 0.01) and gait velocity (p < 0.05) as worse baseline functioning was associated with greater improvements postoperatively.
Interpretation:
While gait pattern improved in both groups, young people undergoing low-burden MLS had greater functional improvements. These findings provide evidence to help clinicians make surgical decisions, set expectations, and implement resources after MLS.
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