Article

Information on the timing and long-term outcome of single-event multilevel
surgery in children with bilateral spastic cerebral palsy (CP) walking with
flexed knee gait is limited. Based on our clinical experience, we hypothesized
that older children with bilateral spastic CP would benefit more from
single-event multilevel surgery than younger children. Moreover, any improvement
in older children could be maintained with fewer additional surgery events.
METHOD: We performed a retrospective analysis of the long-term outcomes of
single-event multilevel surgery. Thirty-two children (17 males, 15 females) who
had received single-event multilevel surgery between 1995 and 2000 with a mean
age at the time of surgery of 10 years 6 months (range 5y 8mo-15y 6mo; SD 3y 1mo)
and in Gross Motor Function Classification System level II (n=12) or III (n=20)
were included in the study. The inclusion criteria required that all children
were ambulatory with spastic bilateral CP, had a flexed knee gait, had a full set
of data for single-event multilevel surgery preoperatively and at 1 year and 10
years postoperatively, had not had previous surgery on their lower limbs, had not
had any treatment with botulinum toxin A before gait assessment, and had not
received intrathecal baclofen medication. The follow-up time lasted for over 10
years until the participants reached adulthood (mean age at the last follow-up 21
years 4 months, SD 3y 4mo). Data were collected on six separate occasions:
preoperatively, at 1 year, at 2 to 3 years, at 5 years, at 7 to 8 years, and at
10 or more years postoperatively. The primary outcome was the Gait Deviation
Index, and the secondary outcomes were the number and type of initial and
additional surgeries. A linear mixed model and Spearman's rank correlation
coefficient were used to prove the hypothesis. RESULTS: The older the child was
at the time of the surgery, the better the long-term result ((Age,Time) =0.15;
p=0.03). We did not find any correlation between age at the time of surgery and
the number of bony or soft-tissue procedures performed initially as well as
during the 10 years of follow-up. INTERPRETATION: Children with CP who require
single-event multilevel surgery at an older age fare better in the long term than
those who are younger at the time of surgery. The pubertal growth spurt is
discussed as a contributing factor to gait deterioration.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS