Long‐term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study

Abstract

Aim We investigated the long‐term efficacy and safety of multilevel surgery (MLS) in ambulatory children with bilateral spastic cerebral palsy (CP). Method Two hundred and thirty‐one children were evaluated at short term (1.1y, SD 0.4) and long term (9.1y, SD 3.0) follow‐up using clinical examination and gait analysis. MLS was investigated by studying changes in the Gait Profile Score (GPS) referenced to the minimally important clinical difference. Results Ambulatory children aged 10 years and 7 months (SD 2y 11mo) at MLS in Gross Motor Function Classification System levels I (19), II (144), and III (68) showed a decrease (improvement) in preoperative GPS from 16.3° (SD 4.8) to 11.3° (SD 3.2) at short‐term follow‐up, an improvement of 5°. At long‐term follow‐up, GPS was maintained at 11.4° (SD 3.1). Overall, 177 (76.6%) children maintained their improvement in GPS after 9 years. Interpretation Multilevel surgery is a safe and effective surgical intervention, which leads to a significant improvement in gait kinematics in children with bilateral spastic CP. This study improves our understanding of MLS in the long term and will help to inform families and children when planning for MLS. What this paper adds Largest study of multilevel surgery (MLS) for children with bilateral spastic cerebral palsy, with longest follow‐up. MLS resulted in significant long‐term improvements in gait function. Minor adverse events were common, while events requiring intervention were uncommon (4% of children). Thirty‐nine per cent of children required additional surgery during follow‐up. ‘Single‐event multilevel surgery’ was changed to the more realistic term ‘multilevel surgery’.

Classifying Adverse Events Following Lower Limb Orthopaedic Surgery in Children With Cerebral Palsy: Reliability of the Modified Clavien-Dindo System

“…In children with CP, skin complications were frequent as were medical AEs including gastrointestinal and respiratory complications. 8 Most recently, Dreher et al 9 utilized the MCD in a long-term multicenter retrospective study, reporting the outcomes of surgery to improve gait in ambulant children with CP. Nearly half of the children suffered from an AE, most of which were self-limiting.…”

The Gait Outcomes Assessment List (GOAL): a new tool to assess cerebral palsy

“…This has led to the development of aggressive surgical interventions (simultaneously correcting soft tissue contractures and skeletal malalignments) that are followed with complex rehabilitation (physical therapy, orthotics, assistive devices, etc.). Recent studies utilizing IGA have shown that children with CP managed through this paradigm have improved kinematic and kinetic outcomes at 10 years after surgery . The changes noted in these studies are presumed to be for the better because the magnitude of the deviations from typical kinematic and kinetic profiles has diminished following the interventions …”

Gait research in cerebral palsy: should we zoom in or zoom out?

“…Patients undergo extensive rehabilitation following MLS; the availability and quality of such services differ between regions, and are difficult to quantify. A long‐term study on the effect of MLS on gait quality showed that 94% of patients improved, but 5% deteriorated after MLS …”