Thomas Dreher1, Pam Thomason2, Martin Švehlík3, Leonhard Döderlein4, Sebastian I Wolf1, Cornelia Putz1, Oliver Uehlein1, Kohleth Chia5, Gerhardt Steinwender3, Morgan Sangeux5, H K Graham6. 1. Clinic for Orthopaedic and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany. 2. Hugh Williamson Gait Analysis Laboratory, Royal Children's Hospital, Melbourne, Victoria, Australia. 3. Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Graz, Austria. 4. Orthopaedic Hospital for Children, Behandlungszentrum, Aschau im Chiemgau, Germany. 5. Murdoch Children's Research Institute, Parkville, Victoria, Australia. 6. The University of Melbourne, Carlton, Victoria, Australia.
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'.
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'.
Authors: Erich Rutz; James McCarthy; Benjamin J Shore; M Wade Shrader; Matthew Veerkamp; Henry Chambers; Jon R Davids; Robert M Kay; Unni Narayanan; Tom F Novacheck; Kristan Pierz; Jason Rhodes; Jeffrey Shilt; Tim Theologis; Anja Van Campenhout; Thomas Dreher; Kerr Graham Journal: J Child Orthop Date: 2020-10-01 Impact factor: 1.548
Authors: Esther E H van Bommel; Marieke M E Arts; Peter H Jongerius; Julia Ratter; Eugene A A Rameckers Journal: Ther Adv Chronic Dis Date: 2019-07-05 Impact factor: 5.091
Authors: H Kerr Graham; Pam Thomason; Kate Willoughby; Tandy Hastings-Ison; Renee Van Stralen; Benan Dala-Ali; Peter Wong; Erich Rutz Journal: Children (Basel) Date: 2021-03-23