The use of minimally invasive techniques in multi-level surgery for children with cerebral palsy

Abstract

This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed corticotomy and fixation with titanium elastic nails and percutaneous lengthening of muscles where possible. A prospective cohort study of two matched groups was undertaken. Ten children with diplegic cerebral palsy with a mean age of ten years six months (7.11 to 13.9) had multi-level minimally invasive surgery and were matched for ambulatory level and compared with ten children with a mean age of 11 years four months (7.9 to 14.4) who had conventional single-event multi-level surgery. Gait kinematics, the Gillette Gait Index, isometric muscle strength and gross motor function were assessed before and 12 months after operation. The minimally invasive group had significantly reduced operation time and blood loss with a significantly improved time to mobilisation. There were no complications intra-operatively or during hospitalisation in either group. There was significant improvement in gait kinematics and the Gillette Gait Index in both groups with no difference between them. There was a trend to improved muscle strength in the multi-level group. There was no significant difference in gross motor function between the groups. We consider that minimally invasive single-event multi-level surgery can be achieved safely and effectively with significant advantages over conventional techniques in children with diplegic cerebral palsy.

Single‐event multilevel surgery for children with cerebral palsy: a systematic review

“…is particularly noteworthy because of its large sample size, inclusion of a control group (non‐randomized) and the use of a wide range of outcome measures addressing all the domains of the ICF 21 . The most recently published study was a non‐randomized comparison of conventional SEMLS with minimally invasive SEMLS using both the GGI and the GMFM 34 …”

“…Eighteen of the 31 studies were retrospective and 15 of these were cohort follow‐up studies. Thirteen studies were prospective, and five of these 32–36 had concurrent, non‐randomized controls. One reprospective study compared SEMLS with multilevel injections of botulinum toxin A 37 .…”

Muscle strength and walking ability in Diplegic Cerebral Palsy: Implications for assessment and management

“…These two studies highlight a significant loss of strength in the hip extensors, knee extensors and the hip abductors with increasing GMFCS classification and these are key muscle groups associated with sagittal and coronal plane stability during independent walking. Targetting key muscle groups in strength training programmes to maximise walking ability is an important consideration during routine therapy treatment, during rehabilitation following surgery, as well as targeted sparing of muscle strength during surgery [23].…”

Correction of Foot Deformities using Triple Arthrodesis and Its Effect on Soft Tissue Blood Supply at Surgical Site in Patients with Cerebral Palsy

“…Подход к оперативному лечению ортопедических осложнений ЦП заключается в выполнении многоуровневых одномоментных оперативных вмешательств [1,8,14,23,24,29,30]. В нашей серии 119 (87,5%) стоп имели вальгусную девиацию.…”