Are Results After Single-event Multilevel Surgery in Cerebral Palsy Durable?
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Gait and function may deteriorate with time in patients with spastic diplegia. Single-event multilevel surgery often is performed to either improve gait or prevent deterioration. However it is unclear whether the presumed gait improvements are durable.
We therefore determined whether (1) single-event multilevel surgery improves gait in patients with spastic diplegia and (2) whether the improved function is durable.
We retrospectively reviewed the data of 14 patients with spastic diplegia. At the time of surgery, one patient had gross motor Level I function, 10 patients had Level II function, and three patients had Level III function. There were four females and 10 males with a mean age of 13 years (range, 7–18 years). The mean number of orthopaedic procedures per single-event multilevel surgery session was 7.4 ± 2.8 (median, 6.5; range, 4–15). We used instrumented gait analysis to determine joint ROM, movement analysis profiles, and the gait profile score. The minimum followup was 1 year (mean, 2 years; range, 1–3 years).
At last followup, movement analysis profiles for knee flexion, for ankle dorsiflexion, and for foot progression improved as did the gait profile score. Additional surgery after the index procedure was performed in nine of the 14 patients because of relapse of the original or new gait problems. Major surgical adverse events occurred in one of the 14 patients.
Severe gait dysfunction in patients with spastic diplegia can be improved short-term in one operative session by single-event multilevel surgery, but to preserve the early improvements many patients require additional surgery. It is unknown whether the improvements will last for decades.
Level of evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
We thank Mary Sheedy and H. Kerr Graham, MD, FRCS (Ed), FRACS for help with preparation of this manuscript. In addition we thank Alejandra Speiser for help in copyediting the final version of this manuscript.
- 10.Gorton GE 3rd, Abel MF, Oeffinger DJ, Bagley A, Rogers SP, Damiano D, Romness M, Tylkowski C. A prospective cohort study of the effects of lower extremity or orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy. J Pediatr Orthop. 2009;29:903–909.PubMedCrossRefGoogle Scholar
- 13.Hermens HJ, Freriks B, Merletti R, Stegeman D, Blok J, Rau G, et al. European Recommendations for Surface Electromyography (SENIAM). Enschede Roessingh Research and Development. Available at: http://seniam.org/. Accessed October 17, 2012.
- 17.Love SC, Novak I, Kentish M, Desloovere K, Heinen F, Molenaers G, O’Flaherty S, Graham HK; Cerebral Palsy Institute. Botulinum toxin assessment, intervention and after-care for lower limb spasticity in children with cerebral palsy: international consensus statement. Eur J Neurol. 2010;17(suppl 2):9–37.PubMedCrossRefGoogle Scholar
- 35.Rutz E, Tirosh O, Thomason P, Barg A, Graham HK. Stability of the Gross Motor Function Classification System after single event multi level surgery in cerebral palsy. Dev Med Child Neurol. 2012;Oct 16. [Epub ahead of print].Google Scholar
- 43.Thomason P, Selber P, Graham HK. Single Event Multilevel Surgery in children with bilateral spastic cerebral palsy: a 5 year prospective cohort study. Gait Posture. 2012 Jul 18. [Epub ahead of print].Google Scholar