Long-term results of multilevel surgery in adults with cerebral palsy.
Adults
Cerebral palsy
Gait
Multilevel surgery
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
21
03
2018
accepted:
04
06
2018
pubmed:
21
6
2018
medline:
19
11
2019
entrez:
21
6
2018
Statut:
ppublish
Résumé
Deterioration of gait in adolescent and adult patients with cerebral palsy can be associated with multiple factors. Multilevel surgery (MLS) is one option in adults with cerebral palsy to improve gait function with encouraging short-term results. It is a question whether these improvements are maintained over time. In a retrospective consecutive cohort study, adults with bilateral spastic cerebral palsy (BSCP) treated with MLS between 1995 and 2011 were scanned for potential inclusion. Patients needed to fulfill the following inclusion criteria: age at MLS > 17, standardized three-dimensional gait analysis (3D-GA) including clinical examination at pre-operative (E0), a short-term follow-up (E1) and at least seven years (E2) after the index MLS. Twenty adults (10 women, 10 men) with a Gross Motor Function Classification Level (GMFCS) I-III and a mean age at MLS of 24.8 years were included in this study. The average long-term follow-up was 10.9 years. The Gait Profile Score (GPS) was used as primary outcome measure. The GPS improved significantly from 13.8° before surgery to 11.2° at short-term (p = 0.007) and to 11.3° at long-term follow-up (p = 0.002). Mean GPS showed a slight deterioration between E1 and E2 due to a minority of six patients (30%) who showed a significant loss of correction. Surgical treatment in adults with BSCP was feasible and effective in the long-term. Significant improvement of gait and function was maintained in the majority of patients, while some patients were prone to develop crouch gait, hip flexion contractures, or pain.
Sections du résumé
BACKGROUND
Deterioration of gait in adolescent and adult patients with cerebral palsy can be associated with multiple factors. Multilevel surgery (MLS) is one option in adults with cerebral palsy to improve gait function with encouraging short-term results. It is a question whether these improvements are maintained over time.
METHODS
In a retrospective consecutive cohort study, adults with bilateral spastic cerebral palsy (BSCP) treated with MLS between 1995 and 2011 were scanned for potential inclusion. Patients needed to fulfill the following inclusion criteria: age at MLS > 17, standardized three-dimensional gait analysis (3D-GA) including clinical examination at pre-operative (E0), a short-term follow-up (E1) and at least seven years (E2) after the index MLS. Twenty adults (10 women, 10 men) with a Gross Motor Function Classification Level (GMFCS) I-III and a mean age at MLS of 24.8 years were included in this study. The average long-term follow-up was 10.9 years. The Gait Profile Score (GPS) was used as primary outcome measure.
RESULTS
The GPS improved significantly from 13.8° before surgery to 11.2° at short-term (p = 0.007) and to 11.3° at long-term follow-up (p = 0.002). Mean GPS showed a slight deterioration between E1 and E2 due to a minority of six patients (30%) who showed a significant loss of correction.
CONCLUSION
Surgical treatment in adults with BSCP was feasible and effective in the long-term. Significant improvement of gait and function was maintained in the majority of patients, while some patients were prone to develop crouch gait, hip flexion contractures, or pain.
Identifiants
pubmed: 29922840
doi: 10.1007/s00264-018-4023-7
pii: 10.1007/s00264-018-4023-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255-260Références
Phys Ther. 2000 Oct;80(10):974-85
pubmed: 11002433
Dev Med Child Neurol. 2001 Feb;43(2):76-82
pubmed: 11221908
J Pediatr Orthop B. 2004 Mar;13(2):S1-12
pubmed: 15076595
Lancet. 2007 Jun 30;369(9580):2171-2178
pubmed: 17604799
Phys Ther. 2007 Nov;87(11):1495-510
pubmed: 17895351
Gait Posture. 2009 Oct;30(3):265-9
pubmed: 19632117
Dev Med Child Neurol. 2009 Oct;51 Suppl 4:99-105
pubmed: 19740216
Gait Posture. 2012 Apr;35(4):612-5
pubmed: 22225850
J Bone Joint Surg Am. 2012 Apr 4;94(7):627-37
pubmed: 22488619
Clin Orthop Relat Res. 2012 Aug;470(8):2220-6
pubmed: 22528378
Arch Phys Med Rehabil. 2012 May;93(5):871-81
pubmed: 22541311
Gait Posture. 2013 Jan;37(1):23-8
pubmed: 22818117
J Orthop Res. 1990 May;8(3):383-92
pubmed: 2324857
Arch Dis Child. 2013 Jun;98(6):434-40
pubmed: 23606716
J Neuroeng Rehabil. 2014 Dec 11;11:161
pubmed: 25495688
Bone Joint J. 2016 Feb;98-B(2):282-8
pubmed: 26850437
Acta Paediatr. 2016 Jun;105(6):665-70
pubmed: 26880375
Nat Rev Dis Primers. 2016 Jan 07;2:15082
pubmed: 27188686
Gait Posture. 2016 Sep;49:290-296
pubmed: 27475618
PM R. 2017 Mar;9(3):258-264
pubmed: 27519825
J Multidiscip Healthc. 2016 Sep 22;9:455-462
pubmed: 27703369
Physiother Can. 2016;68(4):398-407
pubmed: 27904240
Bone Joint J. 2017 Sep;99-B(9):1256-1264
pubmed: 28860409
Dev Med Child Neurol. 2018 Jan;60(1):88-93
pubmed: 29171016