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Long-term follow-up after multilevel surgery in cerebral palsy

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Single-event multilevel surgery (SEMLS) is frequently used to correct pathological gait patterns in children with bilateral spastic cerebral palsy (BSCP) in a single session surgery. However, in-depth long-term evaluation reports of gait outcomes are limited. Therefore, we investigated if SEMLS is able to correct lower extremity joint and pelvic angles during gait towards typically developing gait patterns (TDC) in children with BSCP, and if so, if this effect is durable over a 10-year period.

Materials and methods

In total 13 children with BSCP GMFCS level II at time of index-surgery between the ages of 7.7–18.2 years at the time of SEMLS were retrospectively recruited. Three-dimensional gait data were captured preoperatively, as well as at short-, mid-, and long-term post-operatively, and used to analyze: movement analysis profile (MAP), gait profile score (GPS), and lower extremity joint and pelvic angles over the course of a gait cycle using statistical parametric mapping.

Results

In agreement with previous studies, MAP and GPS improved towards TDCs after surgery, as did knee extension during the stance phase (ɳ2 = 0.67; p < 0.001), while knee flexion in the swing phase (ɳ2 = 0.67; p < 0.001) and pelvic tilt over the complete gait cycle (ɳ2 = 0.36; p < 0.001) deteriorated; no differences were observed between follow-ups. However, further surgical interventions were required in 8 out of 13 of the participants to maintain improvements 10 years post-surgery.

Conclusions

While the overall gait pattern improved, our results showed specific aspects of the gait cycle actually deteriorated post-SEMLS and that a majority of the participants needed additional surgery, supporting previous statements for the use of multilevel surgery rather than SEMLS. The results highlight that the field should not only focus on the overall gait scores when evaluating treatment outcomes but should offer additional long-term follow-up of lower extremity function.

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Acknowledgements

The authors thank the Ralf-Loddenkemper Stiftung for their financial support to this project and they thank the members of the gait analysis lab at the University Children’s Hospital Basel for their assistance in data collection and their continuous support.

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Author notes

  1. Rosa Visscher and Nadine Hasler shared first authorship.

Authors and Affiliations

  1. Laboratory for Movement Biomechanics, Institute for Biomechanics, ETH Zurich, HCP H16.1, Leopold-Ruzicka-Weg 4, 8093, Zurich, Switzerland

    Rosa Visscher, Nadine Hasler, Navrag B. Singh & William R. Taylor

  2. Laboratory of Movement Analysis, University Children’s Hospital Basel (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland

    Marie Freslier, Reinald Brunner & Erich Rutz

  3. Murdoch Children’s Research Insitute, Pediatric Orthopedic Department, The University of Melbourne, The Royal Children’s Hospital RCH, 50 Flemington Road, Parkville, Melbourne, 3052, Australia

    Erich Rutz

  4. Faculty of Medicine, The University of Basel, 4001, Basel, Switzerland

    Reinald Brunner & Erich Rutz

Authors
  1. Rosa Visscher
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  2. Nadine Hasler
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Contributions

ER, RB, MF, NH and RV contributed to the study conception and design. Material preparation, data collection and analysis were performed by MF, NH and RV. The first draft of the manuscript was written by NH and RV, all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rosa Visscher.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study, approved by the local ethical committee (EKNZ 304/08, PB_2018-00168), was conducted according to the current version of the World Medical Association Declaration of Helsinki.

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All participants and/or their parents gave written informed consent for the study.

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Visscher, R., Hasler, N., Freslier, M. et al. Long-term follow-up after multilevel surgery in cerebral palsy. Arch Orthop Trauma Surg 142, 2131–2138 (2022). https://doi.org/10.1007/s00402-021-03797-0

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  • DOI: https://doi.org/10.1007/s00402-021-03797-0

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