title: Does unilateral single-event multilevel surgery improve gait in children with spastic hemiplegia? A retrospective analysis of a long-term follow-up.
abstract: Single event multilevel surgery (SEMLS) has become a standard intervention for children with cerebral palsy (CP). SEMLS proved to improve the gait in bilateral spastic cerebral palsy and those improvements can be maintained in the long term. However there is no evidence on the long-term outcome of unilateral SEMLS in children with unilateral spastic cerebral palsy. The gait analyses and clinical data of 14 children (9 male/5 female, mean age 12.1) with unilateral CP (6 children Gross Motor Function Classification System Scale level I and 8 children level II) were retrospectively reviewed at four time-points: preoperatively, 1year, 3-5 years and approximately 10 years after unilateral SEMLS. The Gait Profile Score (GPS) of the affected leg was used as a main and the number of fine tuning procedures as well as complications rate (Clavien-Dindo classification) as secondary outcome measures. The gait improved postoperatively and the GPS of the affected leg significantly declined by 3.73° which is well above the minimal clinical important difference of 1.6°. No deterioration of GPS occurred throughout the follow-up period. Therefore the postoperative improvement was maintained long-term. However, additional fine-tuning procedures had to be performed during the follow-up in 5 children and three complications occurred (one level II and two level III). The results indicate that children with unilateral cerebral palsy benefit from unilateral SEMLS and maintain gait improvements long-term.
authors.affiliation: Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria. Electronic address: christian.schranz@stud.medunigraz.at.
authors.forename: Christian
authors.initials: C
authors.lastname: Schranz
authors.affiliation: Institute of Sport Science, University of Graz, Mozartgasse 14/I, A-8010 Graz, Austria.
authors.forename: Annika
authors.initials: A
authors.lastname: Kruse
authors.affiliation: Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Tanja
authors.initials: T
authors.lastname: Kraus
authors.affiliation: Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Gerhardt
authors.initials: G
authors.lastname: Steinwender
authors.affiliation: Paediatric Orthopaedic Unit, Department of Paediatric Surgery, Medical University of Graz, Auenbruggerplatz 34, A-8036 Graz, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Svehlik
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005684:Gait; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Gait; Gait profile score; Single-event multilevel surgery; Unilateral cerebral palsy