Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study
| Autor: | H. K. Graham, Morgan Sangeux, Pam Thomason, Thomas Dreher, Kohleth Chia, Leonhard Döderlein, Martin Svehlik, Oliver Uehlein, C Putz, Sebastian I. Wolf, Gerhardt Steinwender |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Severity of Illness Index Cerebral palsy 03 medical and health sciences Postoperative Complications 0302 clinical medicine Developmental Neuroscience Outcome Assessment Health Care Spastic diplegia medicine Spastic Humans Orthopedic Procedures Child Gait Disorders Neurologic Retrospective Studies 030222 orthopedics business.industry Cerebral Palsy Gross Motor Function Classification System medicine.disease Gait Biomechanical Phenomena Gait analysis Pediatrics Perinatology and Child Health Ambulatory Physical therapy Female Neurology (clinical) business 030217 neurology & neurosurgery Follow-Up Studies Cohort study |
| Zdroj: | Developmental Medicine & Child Neurology. 60:88-93 |
| ISSN: | 0012-1622 |
| DOI: | 10.1111/dmcn.13618 |
| Popis: | 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'. |
| Databáze: | OpenAIRE |
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