Multilevel Surgery in Spastic Diplegia: Evaluation by Physical Examination and Gait Analysis in 25 Children

Saraph, Vinay; Zwick, Ernst B.; Zwick, Gertrude; Steinwender, Christiane; Steinwender, Gernot; Linhart, Wolfgang E.

doi:10.1097/01241398-200203000-00003

Cited by 98 publications

(97 citation statements)

References 21 publications

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“…The mean clinical follow-up, including assignment of GMFCS level by an experienced physiotherapist, was 5 years (SD 2 years 8 months; range 2-12y). The median number of surgical procedures per SEMLS session was eight (range [4][5][6][7][8][9][10][11][12][13][14]. The mean GPS decreased significantly from 15.4°(SD 3.9°; range 8.9-25.9°) to 11.1°(SD 2.5°; range 6.1-18.8°) (p<0.001).…”

Section: Resultsmentioning

confidence: 94%

“…The operative procedures consist of the correction of fixed contractures by muscle recessions and tendon lengthening, the correction of muscle imbalance by tendon transfers, and the correction of torsional bony deformities by rotational osteotomies of long bones and joint stabilization procedures. 9,10 Robust evidence for improvement in gait parameters after SEMLS has been reported in a number of controlled studies and in one randomized controlled trial. [11][12][13] The randomized controlled trial reported a mean improvement in Gross Motor Function Measure (GMFM) 66 of 4.9% at 24 months after SEMLS and that GMFCS levels remained stable in the majority of children.…”

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confidence: 99%

“…9,10 The goal of SEMLS is to improve gait and functioning by correction of fixed musculoskeletal deformities in ambulant children with CP. The operative procedures consist of the correction of fixed contractures by muscle recessions and tendon lengthening, the correction of muscle imbalance by tendon transfers, and the correction of torsional bony deformities by rotational osteotomies of long bones and joint stabilization procedures.…”

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confidence: 99%

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Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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ABBREVIATIONS FMSFunctional Mobility Scale GPS Gait Profile Score SEMLS Single-event multilevel surgery AIM There are conflicting reports about the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) after orthopaedic surgery. We studied the stability of the GMFCS in children with bilateral spastic CP after single-event multilevel surgery, using the Gait Profile Score (GPS) as the primary outcome measure.METHOD This was a retrospective cohort study of 107 children (46 females, 61 males) with bilateral spastic CP, classified as GMFCS level II or III, who underwent surgery at a single tertiary institution between 1997 and 2008. The mean age at surgery was 10 years 7 months (SD 2y 8mo). The primary outcome measure was the GPS. Changes in GMFCS level were studied at multiple time points before and after intervention.RESULTS Gait dysfunction was partially corrected, with a mean improvement of 28% in the GPS.The GMFCS remained stable and unchanged in 95% of children and improved by one level in 5% of children. The improvement in GPS was three times the minimal clinically important difference. The mean age at final postoperative GPS assessment was 11 years 10 months (SD 2y 10mo) and at final GMFCS assessment was 15 years 7 months (SD 3y 9mo).INTERPRETATION Stability of the GMFCS was confirmed in the majority of children with bilateral spastic CP after single-event multilevel surgery, despite statistically and clinically significant improvements in gait dysfunction and functional mobility. This information is important in realistic goal-setting and in counselling families.The Gross Motor Function Classification System (GMFCS) is a standardized method to classify gross motor function in children with cerebral palsy (CP) from 1 to 18 years of age. 1,2It is a five-level categorical grading system which classifies differences in gross motor function that are meaningful and significant to children with CP and their families.3 Distinctions between GMFCS levels are based on functional limitations with an emphasis on sitting and walking and the need for assistive devices and wheeled mobility. Children may be quickly and easily classified at any given time, such as during a clinic appointment or gait laboratory assessment, by determining which level best corresponds to the child's current gross motor function. A set of age-appropriate descriptive criteria are used and good correlations have been demonstrated between classifications assigned by parents and by health professionals. 1,2,4 Since the original description by Palisano et al. 1 in 1997, the GMFCS has become widely accepted, widely used, and is considered by many to be an essential tool to communicate about gross motor function in CP. 5,6The GMFCS is a valid and reliable classification tool which is expected to be relatively stable over time, with or without intervention. Palisano et al. 3 reported that 73% of 610 children with CP remained at the same GMFCS level at multiple ratings over time , and McCormick et ...

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Section: Resultsmentioning

confidence: 94%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rutz

Tirosh

Thomason

et al. 2012

Develop Med Child Neuro

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“…These results are similar to those of Õ unpuu et al [11] and Sutherland et al [19] who reported an average 10°improvement in overall knee ROM. Moreau and Tinsley [8] and Saraph et al [15] reported an increased knee ROM 1 year after RF transfer, which remained stable at 3 years' followup. Saw et al [16] observed a deterioration of the postoperative improvement in knee ROM after a mean followup of 4.6 years.…”

Section: Discussionmentioning

confidence: 92%

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Presedo

Mégrot²,

Ilharreborde

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Children with spastic diplegia frequently show excessive knee extension (stiff-knee gait) throughout swing phase, which may interfere with foot clearance. Abnormal rectus femoris activity is commonly associated with a stiff-knee gait. Rectus femoris transfer has been recommended to enhance knee flexion during swing. However, recent studies suggest the transfer does not generate a knee flexor moment but diminishes knee extension moment in swing and MRI studies show the transferred tendons can be constrained by scarring to underlying muscles. Thus, it is possible knee flexion would be improved by distal rectus release rather than transfer since it would not be adherent to the underlying muscles. Questions/purposes We therefore determined whether rectus femoris distal tendon resection improves knee ROM and kinematic characteristics of stiff-knee gait in patients with spastic diplegia. Patients and MethodsWe studied 45 patients who underwent rectus femoris distal tendon resection as a part of multilevel surgery. Rectus femoris procedures were indicated based on kinematic characteristics of stiff-knee gait. All patients were walkers and had a mean age at surgery of 13 years (range, 6-22 years). We obtained gait analyses before surgery and at mean 2-year followup. We based postoperative assessment on clinical evaluation and gait analysis data. Results At followup, rectus femoris distal tendon resection was associated with improved knee ROM and timing of peak knee flexion in swing, and the absolute values of peak knee flexion became normal for those patients who showed abnormal preoperative values.

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“…Surgical interventions improve the gait as examined by gait analysis [21]. Multilevel surgeries, soft tissue and bony procedures, if well selected have significant improvement in ankle and foot functions as well as the spastic muscle function [22]. Numerous operative procedures have been described in the last decades to correct hindfoot valgus deformities.…”

Section: Discussionmentioning

confidence: 99%

Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy

Bishay¹,

Morshed²,

Tarraf³

et al. 2016

Clin Res Foot Ankle

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Backgound: Mobile (flexible or correctable) hindfoot valgus deformity is common in children with spastic cerebral palsy (CP). It is accompanied by short lateral and long medial foot column. Patients and Methods:Eleven ambulatory children (20 feet) suffering spastic cerebral palsy (CP), two hemiplegic and nine diplegic, presenting with mobile (flexible) hindfoot valgus deformity, were evaluated neurologically, orthopaedically, and radiographically, and operated upon in the National Institute of Neuromotor System between September 2012 and September 2013. Double column foot osteotomy with medial cuneiform closing-wedge and cuboid opening-wedge without attacking the calcaneus was performed in all of them. Results:The results were followed-up clinically and radiographically over a period ranging from a year and half (18 months) to two years (24 months) with an average of a year and 9 months (21 months), and were graded into four categories as excellent, good, fair, and poor according to the total calculated score. According to the suggested grading system, there were 8 excellent results, 8 good results, 4 fair results, and no poor results. Conclusion:Double column foot osteotomy shortening the medial foot column and lengthening the lateral foot column to correct moderate to severe hindfoot valgus in ambulatory children with spastic cerebral palsy (CP), compared favourably with similar series, and offered option for achieving foot alignment, improving pain and skin problems and avoiding the problems associated with arthrodesis. Level of Evidence:The study is type IV therapeutic level of evidence.

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Multilevel Surgery in Spastic Diplegia: Evaluation by Physical Examination and Gait Analysis in 25 Children

Cited by 98 publications

References 21 publications

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Stability of the Gross Motor Function Classification System after single‐event multilevel surgery in children with cerebral palsy

Rectus Femoris Distal Tendon Resection Improves Knee Motion in Patients With Spastic Diplegia

Double Column Foot Osteotomy to Correct Flexible Valgus Foot Deformity in Children with Spastic Cerebral Palsy

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