Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis

Abstract

The purpose of this study was to determine the effectiveness of muscle-release surgery for children with cerebral palsy (CP) using longitudinal and stratified analysis. Twenty-five children with CP (15 females, 10 males; age range 4 to 16 years; mean age 8 years 2 months, SD 3 years 2 months) were selected from five treatment centres in Japan. Twenty-two children had spastic diplegia, two had spastic quadriplegia, and one had athetospastic quadriplegia. Motor function for each child was assessed using the Gross Motor Function Measure (GMFM). Assessment was conducted on eight separate occasions: 1 month and 1 week before surgery, and 1, 2, 4, 6, 9, and 12 months after surgery. Participants' motor function before surgery was classified using the Gross Motor Function Classification System (GMFCS). Six children were classified at level I, three at level II, six at level III, and 10 at level IV. A significant difference was found after surgery in the GMFCS levels III and IV groups (p<0.05). Improvement in GMFM scores between 1 week before surgery and 12 months after surgery were 1, 5, 8.5, and 8.5 for GMFCS levels I to IV respectively. Results indicate that this treatment is advantageous for improving motor function in children within GMFCS levels III and IV.

Single-Event Multilevel Surgery in Children with Spastic Diplegia

“…Previous investigators have reported mixed results with regard to changes in GMFM scores after single-event multilevel surgery 10,13,14,42 . Kondo et al 10 reported increases in GMFM-66 scores after soft-tissue procedures in a younger cohort of children with cerebral palsy (GMFCS levels I through IV).…”

“…Kondo et al 10 reported increases in GMFM-66 scores after soft-tissue procedures in a younger cohort of children with cerebral palsy (GMFCS levels I through IV). Their study was uncontrolled and included children with GMFCS level IV, who are not expected to be capable of longterm ambulation 42 .…”

“…goal of single-event multilevel surgery in children with cerebral palsy is to improve gait [3][4][5][6][7][8][9][10][11][12][13][14] . Secondary goals may include improvements in gait efficiency 4 and appearance, gross motor function 10,14 , independence 15 , and quality of life 14,16 .…”

“…Secondary goals may include improvements in gait efficiency 4 and appearance, gross motor function 10,14 , independence 15 , and quality of life 14,16 . Several well-designed retrospective cohort studies have demonstrated an improvement in gait or functional ability following singleevent multilevel surgery [4][5][6][7][8][9][10][11][12][13][14] . However, there have been few prospective studies, few studies that included a control group, and no randomized clinical trials to our knowledge 5,8,14 .…”

The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years

“…The GMFM is frequently used to evaluate the effects of various interventions in children with CP, such as intensive physiotherapy, [11][12][13][14] botulinum toxin treatment, 15 selective dorsal rhizotomy, 16 and orthopaedic surgery. [17][18][19] The GMFM is a test specially designed and validated for measuring gross motor function and the change over time in children with CP. The test contains 88 items of gross motor function distributed over five dimensions: lying and rolling; sitting; crawling and kneeling; standing and walking; and running and jumping.…”