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Yamada HH, de Moraes Barros Fucs PM. Quality of life and clinical outcomes in severely involved cerebral palsy patients and spastic hips undergoing Castle surgery: a cross-sectional study. Int Orthop 2024; 48:1657-1665. [PMID: 38483563 DOI: 10.1007/s00264-024-06135-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/29/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE As progressive hip dislocation causes pain in children with spastic cerebral palsy (CP) and spasticity needs surgical correction, we aimed to describe clinical and radiographic outcomes in CP patients with painful hip deformity treated with the Castle salvage procedure. METHODS We included all patients operated in the same hospital between 1989 and 2017 with painful spastic hips and femoral head deformity making joint reconstruction unfeasible. We collected clinical and functional data from medical records and evaluated radiographies to classify cases for femoral head shape and migration, type of deformity, spinal deformity, and heterotopic ossification. We investigated quality of life one year after surgery. RESULTS We analyzed 41 patients (70 hips) with complete medical records. All had severe function compromise GMFCS V (Gross Motor Function Classification System) and heterotopic ossifications, all but one had scoliosis, and most had undergone other surgeries before Castle procedure. Patients were followed up for 77.1 months (mean) after surgery. The mean initial migration index was 73%. Seven patients had complications, being three patients minor (two femur and one tibial fracture) and four majors (patients requiring surgical revision). Quality of life was considered improved by most of the carers (35 children; 85.3%) as level 4/5 according to CPCHILD instrument. No child was able to stand or walk, but moving in and out of bed, of vehicles, and to a chair, remaining seated, or visiting public places was "very easy." CONCLUSION We considered most patients (37 patients-90%, 66 hips-94%) as having satisfactory outcomes because they had no or minor complications, absence of pain, free mobility of the lower limbs and were able to sit in a wheelchair.
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Affiliation(s)
- Helder Henzo Yamada
- Orthopaedic Department, Neuromuscular Clinic, Santa Casa Medical School and Hospitals, São Paulo, Brazil.
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2
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Baril R, Joffe AR, Andersen JC, Khademioureh S, Dinu IA, Robertson CMT. The Alberta Infant Motor Scale as an Outcomes Measure of Gross Motor Abilities after Early Complex Cardiac Surgery. Pediatr Cardiol 2024; 45:1079-1088. [PMID: 38512487 DOI: 10.1007/s00246-024-03458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/20/2024] [Indexed: 03/23/2024]
Abstract
To address the research hypothesis that the Alberta Infant Motor Scale (AIMS) completed following complex cardiac surgery (CCS) is a useful outcomes measure this study determined: (1) AIMS scores at age 8 months after CCS; (2) predictive validity of AIMS at 8 months for Bayley Scales of Infant and Toddler Development-III Gross Motor-scaled scores (GMSS) and diagnosis of cerebral palsy (CP) at 21 months; and (3) predictive demographic and surgical variables of AIMS scores. A prospective cohort study of 250/271 (92.3%) surviving children from Northern Alberta (born 2009-2020) who had CCS at age < 6 months determined AIMS scores at age mean (SD) 8.6 (2.4) and the GMSS at 21.9 (3.8) months. Gross motor delay was defined as AIMS < 5th percentile and GMSS as < 4 (-2SD). Predictions using multiple logistic regressions were expressed as Odds Ratios (OR) and 95% Confidence Interval (CI). Of children, 100/250 (40%) had AIMS < 5th predicting GMSS < 4 (n = 43); sensitivity, specificity, positive, and negative predictive values were 88%, 71%, 40%, and 97%. Hospitalization days were independently associated with AIMS < 5th, OR 1.02 (95% CI 1.007, 1.032; p = 0.005). Excluding hospital days, ventilation days independently predicted AIMS < 5th, OR 1.08 (95% CI 1.038, 1.125, p < 0.001. Gross motor delay determine by AIMS scores of < 5th percentile occurred in 40% of survivors with good prediction of continued delay. Delay determined by AIMS was predicted by longer hospitalization and ventilation; further investigations about the causes are required. AIMS results provide opportunity for early motor intervention.
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Affiliation(s)
- Rebecca Baril
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | - Ari R Joffe
- Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - John C Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Canada
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada
| | | | - Irina A Dinu
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Charlene M T Robertson
- Department of Pediatrics, University of Alberta, Edmonton, Canada.
- Department of Pediatrics, Glenrose Rehabilitation Hospital, Room 242A Glen East, 10230-111 Avenue, Edmonton, AB, T5G 0B7, Canada.
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Hosseinzadeh P. Response to Commentary on "Failure of Hip Reconstruction in Children With Cerebral Palsy: What Are the Risk Factors?". J Pediatr Orthop 2024; 44:e476-e477. [PMID: 38348898 DOI: 10.1097/bpo.0000000000002637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Pooya Hosseinzadeh
- Department of Orthopedic Surgery Washington University School of Medicine, St. Louis, MO
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Niedzwecki C, Barbuto A, Mitchell K, Wirt S, Seymour M, Thomas S, Schwabe A. Comparison of outcomes following surgical intervention and inpatient rehabilitation stays in children with cerebral palsy. PM R 2024; 16:449-461. [PMID: 37801614 DOI: 10.1002/pmrj.13075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Literature is limited on functional outcomes in children with cerebral palsy (CP) following surgical procedures and a subsequent inpatient rehabilitation unit (IRU) stay. OBJECTIVE To compare functional outcomes and length of stay (LOS) in children with CP following a surgical procedure and IRU stay based on the surgical procedure performed, pattern of involvement, etiology, and Gross Motor Function Classification System (GMFCS) level. DESIGN Retrospective cohort study. SETTING Tertiary care pediatrics. PARTICIPANTS Pediatric patients with CP who underwent one of three surgical procedures followed by an IRU stay. INTERVENTIONS Selective dorsal rhizotomy (SDR), single-event multilevel orthopedic surgery (SEMLS), or intrathecal baclofen (ITB) pump implantation and subsequent IRU stay. MAIN OUTCOME MEASURES IRU LOS, Functional Independence Measure for Children (WeeFIM) total score, sub-scores, and efficiency. RESULTS Children undergoing SDR had a longer LOS (p ≤ .015). Children with spastic diplegia, GMFCS level II, and prematurity-based CP had higher WeeFIM efficiency scores (p ≤ .046, ≤.021, and .034 respectively). Greater changes in WeeFIM™ scores were associated with spastic diplegia, SDR, GMFCS level II, longer LOS, and higher admission scores (p ≤ .045). CONCLUSIONS Although statistically and functionally significant improvements in children with CP following surgical interventions and an IRU stay were seen, those with higher WeeFIM change scores tended to have spastic diplegia, to have undergone SDR, GMFCS level II, longer LOS, and higher admission scores.
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Affiliation(s)
- Christian Niedzwecki
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Amy Barbuto
- Department of Physical and Occupational Therapy, Texas Children's Hospital-The Woodlands, The Woodlands, Texas, USA
| | - Katy Mitchell
- Department of Physical Therapy, Texas Woman's University-Houston, Houston, Texas, USA
| | - Steven Wirt
- Department of Physical and Occupational Therapy, Texas Children's Hospital-Main Campus, Houston, Texas, USA
| | - Michelle Seymour
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Sruthi Thomas
- Departments of Physical Medicine & Rehabilitation and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Aloysia Schwabe
- Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
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Assumpcao de Monaco B, Alves Du Rocher Candido A, Jacobsen Teixeira M, Lopes Alho EJ. Impact of selective dorsal rhizotomy to cerebral palsy children caregivers' burden. Childs Nerv Syst 2024; 40:1461-1469. [PMID: 38252157 DOI: 10.1007/s00381-024-06291-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
PURPOSE It is known that cerebral palsy (CP) children's caregivers suffer from burden, depression, and stress, impairing their quality of life (QoL). The more severe the CP, the more burden the caregiver has. Psychosocial support, education, therapies, and financial support are inversely related to the level of stress of the caregiver. Most parents of CP patients submitted to selective dorsal rhizotomy (SDR) report improvement not just on spasticity, but also in the functional role of the children, what can impact on caregiver's QoL. Our objective was to evaluate the burden of CP children's caregivers with and without previous SDR. METHODS Spastic CP children caregivers were divided into two groups: those who take care of children without previous SDR (control group) and those that children were previously submitted to SDR (surgical group). The burden index was compared between groups using Burden Interview Questionnaire (BIQ). For statistical analysis, we used SPSS. RESULTS The control group had enrolled 31 participants and the surgical group 36. The mean GMFCS level on the control and surgical groups was 3.94 ± 1.26 and 3.74 ± 1.12 (p = 0.61), respectively. The surgical group caregivers presented less burden related to the feeling that they should be doing more to their child (p = 0.003) and if they could do a better job in caring (p = 0.032), compared to controls. The total BIQ index was not significantly different between groups (surgical 32.14 ± 12.34 vs. control 36.77 ± 12.77; p = 0.87). Low economic status had a weak correlation to a higher BIQ index (R2 = 0.24). After age-matching, there was a significative higher BIQ index in the control group (p = 0.008). CONCLUSION Caregivers of spastic CP children who were previously submitted to SDR presented less burden related to feeling of the amount of given care than those without previous surgery. The impression that they could do a better job with their kids was higher in the control group. The severity of CP and low economic status were related to more burden in both groups. After pairing groups by age, the control group had a significative higher BIQ index compared to the SDR group. CLINICAL TRIAL REGISTRATION Trial registration number: CAAE 73407317.6.0000.0068 (Ethical and Research Committee of University of Sao Paulo, Sao Paulo, Brazil, approved on 08/06/2021). All the subjects were freely given an informed consent to participate in the study that was obtained from all participants. Non-consented ones were excluded from the study.
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Affiliation(s)
- Bernardo Assumpcao de Monaco
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
- CDF-Clinica de Dor e Funcional, R. Mato Grosso 306, cj1306B, Sao Paulo, SP, Brazil.
| | | | - Manoel Jacobsen Teixeira
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo Joaquim Lopes Alho
- Neurosurgery Division, Neurology Department, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- CDF-Clinica de Dor e Funcional, R. Mato Grosso 306, cj1306B, Sao Paulo, SP, Brazil
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Corradin M, Schiavon R, Micaglio A, Pierantoni S, Luppi V, Canavese F. Simultaneous subtalar arthroeresis, midfoot soft tissue release, and talo-navicular arthrodesis in children with planovalgus neurologic foot. Eur J Orthop Surg Traumatol 2024; 34:2163-2170. [PMID: 38565784 DOI: 10.1007/s00590-024-03914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Planovalgus foot deformity (PVFD) is common in children with neuromuscular conditions and severe deformity may require surgical correction. This study aims to assess clinical and radiological outcomes of PVFD secondary to neuromuscular disease managed by subtalar arthroeresis (SuAE), midfoot soft tissue release and talo-navicular arthrodesis (TNA). METHODS A retrospective analysis of children with neuromuscular disease and nonreducible PVFD who underwent SuAE, midfoot soft tissue release, and TNA and with a minimum follow-up of 5 years was performed. A total of 60 patients with neuromuscular disease (108 feet) including cerebral palsy were reviewed. Mean age at surgery was 12.7 ± 4.6 years (6-17). Mean follow-up was 7 ± 2.9 years (5-10). Clinical outcomes and radiologic correction at final follow-up were compared with preoperative values. Statistical analysis was performed and significance was set at P < 0.01. RESULTS Statistically significant radiological improvements between pre- and postoperative values were found for all angle values. At final follow-up, there was a significant improvement in VAS score (4.8 vs. 2; P < 0.01). There was also a positive trend in the improvement of walking ability. No cases of pseudoarthrosis were reported at final follow-up. Screw removal was required in 5 out of 108 feet (4.6%) and 2 feet (3.3%) had delayed medial wound healing. CONCLUSIONS SuAE combined with TNA and midfoot soft tissue is a safe and feasible procedure that can provide good clinical and radiologic results in patients with neuromuscular disease and nonreducible PVFD; the procedure can improve foot stability, and has a limited number of complications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Marco Corradin
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy.
| | - Roberto Schiavon
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Andrea Micaglio
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Silvia Pierantoni
- Department of Paediatric Orthopaedic, Policlinic Abano Terme, 35031, Abano Terme, PD, Italy
| | - Valentina Luppi
- Department of Orthopaedics and Traumatology, Alto Vicentino Hospital, Via Garziere 42, 36014, Santorso, VI, Italy
| | - Federico Canavese
- Department of Pediatric Orthopedics, Faculty of Medicine, Jeanne de Flandre Hospital, Lille University Hospital, Rue Eugène Avinée, 59800, Lille, France
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Nabian MH, Zadegan SA, Mallet C, Neder Y, Ilharreborde B, Simon AL, Presedo A. Distal femoral osteotomy and patellar tendon advancement for the treatment of crouch gait in patients with bilateral spastic cerebral palsy. Gait Posture 2024; 110:53-58. [PMID: 38492261 DOI: 10.1016/j.gaitpost.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Crouch gait, or flexed knee gait, represents a common gait pattern in patients with spastic bilateral cerebral palsy (CP). Distal femoral extension and/or shortening osteotomy (DFEO/DFSO) and patellar tendon advancement (PTA) can be considered as viable options when knee flexion contractures are involved. Better outcomes have been reported after a combination of both, independently of the presence of knee extensor lag. In this study, we evaluated the clinical and kinematic outcomes of these procedures. PATIENTS AND METHODS We reviewed a cohort of 52 limbs (28 patients) who were treated for crouch gait by DFEO/DFSO alone (group 1, n = 15) or DFEO/DFSO + PTA (group 2, n = 37) as a part of single event multilevel surgery (SEMLS). The mean age at surgery was 14 years, and the mean follow-up time was 18 months. The physical examination data and three-dimensional standardized gait analysis were collected and analyzed before the surgery and postoperatively. RESULTS Overall knee range of motion improved in all limbs. The knee flexion decreased significantly in both groups at initial, mid, and terminal stance. Hip flexion significantly decreased in mid-stance for limbs in group 2. Both clinical and gait parameters were most improved in limbs who underwent DFEO/DFSO + PTA. Increased pelvic tilt was observed in both groups after surgery. CONCLUSION Although DFEO/DFSO alone was successful in correcting knee flexion contractures, PTA has helped to improve knee extensor lag and knee extension during gait. LEVEL OF EVIDENCE Therapeutic level IV.
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Affiliation(s)
- Mohammad Hossein Nabian
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Shayan Abdollah Zadegan
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Cindy Mallet
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Yamile Neder
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Brice Ilharreborde
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Anne Laure Simon
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France
| | - Ana Presedo
- Department of Pediatric Orthopedics, Robert Debré University Hospital, Paris, France.
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Schwartz MH, Ries AJ, Georgiadis AG, Kainz H. Demonstrating the utility of Instrumented Gait Analysis in the treatment of children with cerebral palsy. PLoS One 2024; 19:e0301230. [PMID: 38593122 PMCID: PMC11003627 DOI: 10.1371/journal.pone.0301230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Instrumented gait analysis (IGA) has been around for a long time but has never been shown to be useful for improving patient outcomes. In this study we demonstrate the potential utility of IGA by showing that machine learning models are better able to estimate treatment outcomes when they include both IGA and clinical (CLI) features compared to when they include CLI features alone. DESIGN We carried out a retrospective analysis of data from ambulatory children diagnosed with cerebral palsy who were seen at least twice at our gait analysis center. Individuals underwent a variety of treatments (including no treatment) between sequential gait analyses. We fit Bayesian Additive Regression Tree (BART) models that estimated outcomes for mean stance foot progression to demonstrate the approach. We built two models: one using CLI features only, and one using CLI and IGA features. We then compared the models' performance in detail. We performed similar, but less detailed, analyses for a number of other outcomes. All results were based on independent test data from a 70%/30% training/testing split. RESULTS The IGA model was more accurate than the CLI model for mean stance-phase foot progression outcomes (RMSEIGA = 11∘, RMSECLI = 13∘) and explained more than 1.5 × as much of the variance (R2IGA = .45, R2CLI = .28). The IGA model outperformed the CLI model for every level of treatment complexity, as measured by number of simultaneous surgeries. The IGA model also exhibited superior performance for estimating outcomes of mean stance-phase knee flexion, mean stance-phase ankle dorsiflexion, maximum swing-phase knee flexion, gait deviation index (GDI), and dimensionless speed. INTERPRETATION The results show that IGA has the potential to be useful in the treatment planning process for ambulatory children diagnosed with cerebral palsy. We propose that the results of machine learning outcome estimators-including estimates of uncertainty-become the primary IGA tool utilized in the clinical process, complementing the standard medical practice of conducting a through patient history and physical exam, eliciting patient goals, reviewing relevant imaging data, and so on.
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Affiliation(s)
- Michael H. Schwartz
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
- Center for Gait and Motion Analysis, Gillette Children’s Specialty Healthcare, St Paul, MN, United States of America
| | - Andrew J. Ries
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Andrew G. Georgiadis
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States of America
- Center for Gait and Motion Analysis, Gillette Children’s Specialty Healthcare, St Paul, MN, United States of America
| | - Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology, and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria
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Wu J, Bai C, Yan B, Mutalifu N, Guan Q, Li J, Luan X. Development and validation of a predictive model for poor prognosis of communication disorders in children with cerebral palsy after cervical perivascular sympathectomy. Neurosurg Rev 2024; 47:142. [PMID: 38587684 PMCID: PMC11001727 DOI: 10.1007/s10143-024-02380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/12/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024]
Abstract
Cervical perivascular sympathectomy (CPVS) can improve communication disorders in children with cerebral palsy (CP); however, there are no research reports on the factors affecting surgical efficacy. This study aimed to establish a nomogram for poor prognosis after CPVS. We collected data from 313 CP patients who underwent CPVS at the Neurosurgery Cerebral Palsy Center of the Second Affiliated Hospital of Xinjiang Medical University from January 2019 to January 2023. Among them, 70% (n = 216) formed the training cohort and 30% (n = 97) the validation cohort. The general data and laboratory examination data of both groups were analyzed. In training cohort, 82 (37.96%) showed improved postoperative communication function. Logistic analysis identified motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity as the prognostic factors. Using these four factors, a prediction model was constructed with an area under the curve (AUC) of 0.807 (95% confidence interval [CI], 0.743-0.870), indicating its ability to predict adverse outcomes after CPVS. The validation cohort results showed an AUC of 0.76 (95% CI, 0.650-0.869). The consistency curve and Hosmer-Lemeshow test (χ2 = 10.988 and p = 0.202, respectively) demonstrated good consistency between the model-predicted incidence and the actual incidence of poor prognosis. Motor function, serum alkaline phosphatase, serum albumin, and prothrombin activity are independent risk factors associated with the prognosis of communication disorders after CPVS. The combined prediction model has a good clinical prediction effect and has promising potential to be used for early prediction of prognosis of CPVS.
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Affiliation(s)
- Junjie Wu
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Chao Bai
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Baofeng Yan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Nurehemaiti Mutalifu
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Qi Guan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Jianglong Li
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China
| | - Xinping Luan
- Department of Cerebral Palsy Center in Neurosurgery, Second Affiliated Hospital of Xinjiang Medical University, Nanhu North Road, Shuimogou District, Urumqi, Xinjiang, 830063, China.
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Schwend RM, Nguyen BT, Noe MC, Anderson JT, Jiang S. Transiliac-Shortening Osteotomy to Treat Ischial Pressure Injury due to Fixed Pelvic Obliquity: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00031. [PMID: 38758928 DOI: 10.2106/jbjs.cc.23.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
CASE A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury. CONCLUSION This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity.
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Affiliation(s)
- Richard M Schwend
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Brandon T Nguyen
- Kansas City University Graduate Medical Education Consortium (KCU-GME Consortium)/HCA Healthcare Kansas City Program, Kansas City, Missouri
| | - McKenna C Noe
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - John T Anderson
- Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
| | - Shao Jiang
- Department of Plastic Surgery, Children's Mercy Kansas City, Kansas City, Missouri
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Müller F, Huber H. Anterior Proximal Tibial Screw Hemiepiphysiodesis Decreases Posterior Tibial Slope in Knee Flexion Contracture: A Case Report. JBJS Case Connect 2024; 14:01709767-202406000-00017. [PMID: 38669444 DOI: 10.2106/jbjs.cc.23.00680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
CASE A 13-year-old adolescent boy with hemiplegic cerebral palsy suffering from fixed knee flexion deformity of 10° despite extensive conservative treatment. Owing to a posterior tibial slope (PTS) of 16°, anterior hemiepiphysiodesis was applied to the proximal tibia. The 2 screws were removed after 9 months. Final follow-up at 16 months showed complete knee extension and a PTS of 4°. CONCLUSION The presented technique is a good alternative in knee flexion deformity with an increased PTS and has surprisingly not been described in the literature. This might be worth considering for other pathologies such as pediatric anterior cruciate ligament injury with an increased PTS.
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Affiliation(s)
- Fabio Müller
- Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Teles de Oliveira Filho I, Romero PC, Rezende AP, Costa BBS, Oliveira SD, Fontoura EAF, Botelho RV. Cervical dorsal rhizotomy for upper limbs spasticity. Case report. Acta Neurochir (Wien) 2024; 166:157. [PMID: 38546890 DOI: 10.1007/s00701-024-06041-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
Spasticity is a prevalent symptom of upper motor neuron syndrome, becoming debilitating when hindering voluntary movement and motor function and causing contractures and pain. Functional neurosurgery plays a crucial role in treating severe spasticity. Despite extensive literature on SDR for lower limb spasticity, there is a scarcity of papers regarding the procedure in the cervical region to alleviate upper limb spasticity. This case report details a cervical dorsal rhizotomy (CDR) performed for upper limb spasticity, resulting in significant improvement in spasticity with sustained outcomes and low complication rates. Neuroablative procedures like CDR become an option to treat spasticity.
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Affiliation(s)
- Italo Teles de Oliveira Filho
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil.
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, São Paulo, Brazil.
| | - Paulo Cesar Romero
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | | | - Bruno Braga Sisnando Costa
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | - Saul Dalla Oliveira
- Department of Neurosurgery, Hospital Sepaco, R. Vergueiro, 4210, Vila Mariana, São Paulo, 04102-900, Brazil
| | | | - Ricardo Vieira Botelho
- Health Sciences Post-Graduation Program, Instituto de Assistência Médica ao Servidor Público Estadual - IAMSPE, São Paulo, Brazil
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13
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Rethlefsen SA, Hanson A, Ciccodicola E, Hara R, Kay RM, Chambers H, Wren TAL. Update on the reliability of gait analysis interpretation in cerebral palsy: Inter-institution agreement. Gait Posture 2024; 109:109-114. [PMID: 38295485 DOI: 10.1016/j.gaitpost.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/26/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Studies have shown good reliability for gait analysis interpretation among surgeons from the same institution. However, reliability among surgeons from different institutions remains to be determined. RESEARCH QUESTION Is gait analysis interpretation by surgeons from different institutions as reliable as it is for surgeons from the same institution? METHODS Gait analysis data for 67 patients with cerebral palsy (CP) were reviewed prospectively by two orthopedic surgeons from different institutions in the same state, each with > 10 years' experience interpreting gait analysis data. The surgeons identified gait problems and made treatment recommendations for each patient using a rating form. Percent agreement between raters was calculated for each problem and treatment, and compared to expected agreement based on chance using Cohen's kappa. RESULTS For problem identification, the greatest agreement was seen for equinus (85% agreement), calcaneus (88%), in-toeing (89%), and out-toeing (90%). Agreement for the remaining problems ranged between 66-78%. Percent agreement was significantly higher than expected due to chance for all issues (p ≤ 0.01) with modest kappa values ranging from 0.12 to 0.51. Agreement between surgeons for treatment recommendations was highest for triceps surae lengthening (89% agreement), tibial derotation osteotomy (90%), and foot osteotomy (87%). Agreement for the remaining treatments ranged between 72-78%. Percent agreement for all treatments was significantly higher than the expected values (p ≤ 0.002) with modest kappa values ranging from 0.22 to 0.52. SIGNIFICANCE Previous research established that computerized gait analysis data interpretation is reliable for surgeons within a single institution. The current study demonstrates that gait analysis interpretation can also be reliable among surgeons from different institutions. Future research should examine reliability among physicians from more institutions to confirm these results.
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Affiliation(s)
- Susan A Rethlefsen
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA.
| | - Alison Hanson
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Eva Ciccodicola
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Reiko Hara
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA
| | - Robert M Kay
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
| | - Hank Chambers
- Rady Children's Hospital, 3030 Children's Way, San Diego, CA 92123, USA; University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA 92093, USA
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA 90033, USA
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Gelder CL, Sataite I, Chave-Cox RS, Goodden JR. Transcutaneous ultrasound level check for selective dorsal rhizotomy. Childs Nerv Syst 2024; 40:863-868. [PMID: 38135826 DOI: 10.1007/s00381-023-06253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023]
Abstract
AIM Single-level selective dorsal rhizotomy (SDR) surgery requires an intra-operative level check to identify the L1 vertebral level or the conus medullaris. Typically, this requires a pre-operative or intra-operative x-ray. We present our experience using initial transcutaneous ultrasound as an alternative to x-ray level check. METHODS A prospective SDR database was used to identify patients. The operation notes were reviewed to identify the level check method and any complications or wrong-level surgery. RESULTS Data are reported for the first 160 SDR surgeries performed within our centre, mean age 6.47 years (range 2.5-19 years). The first 11 patients had combined x-ray and transcutaneous ultrasound for pre-incision level check. This allowed the neurosurgeon to assess the accuracy and feasibility of using transcutaneous ultrasound instead of x-ray. The subsequent 149 patients had ultrasound alone for transcutaneous pre-incision level check. An intra-operative ultrasound level check was performed for all patients following skin incision and dissection down to the spinal lamina. In this way, the conus level was confirmed before dural opening. For all patients at all ages, the combination of initial transcutaneous ultrasound followed by intra-operative ultrasound allowed accurate identification of the conus. There were no instances of wrong-level surgery. Learning points are presented within this paper. CONCLUSION Combined use of transcutaneous ultrasound followed by intra-operative ultrasound can allow accurate identification of the conus, saving radiation exposure and potentially improving theatre efficiency. Appropriate training and experience are required for any neurosurgeon using these techniques.
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Affiliation(s)
- C L Gelder
- The Leeds Children's Hospital, Department of Paediatric Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
| | - I Sataite
- The Leeds Children's Hospital, Department of Paediatric Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - R S Chave-Cox
- The Leeds Children's Hospital, Department of Paediatric Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
| | - J R Goodden
- The Leeds Children's Hospital, Department of Paediatric Neurosurgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK.
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15
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Tonkin M. Tendon transfers in cerebral palsy: art or science? J Hand Surg Eur Vol 2024; 49:390-395. [PMID: 37917831 DOI: 10.1177/17531934231210380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Tendon transfers in cerebral palsy are commonly described as a method to improve function in the upper limb. The field can be considered by some to be more of an art than science due to the unique challenges involved, which include poor volitional control and spasticity. Surgical outcomes can be uncertain and, in certain circumstances, worsened. This presentation looks at the rationale behind tendon transfers for patients with cerebral palsy and the application of this rationale (science vs. art) to a philosophy of treatment.
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Affiliation(s)
- Michael Tonkin
- Emeritus Professor, University of Sydney Faculty of Medicine and Health, Sydney, Australia
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Jiang W, Zhang L, Wei M, Wang R, Xiao B, Wang J, Zhan Q. A preliminary study on the spasticity reduction of quadriceps after selective dorsal rhizotomy in pediatric cases of spastic cerebral palsy. Acta Neurochir (Wien) 2024; 166:108. [PMID: 38409557 DOI: 10.1007/s00701-024-06010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/18/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE This study aimed to evaluate the potential alleviation of quadriceps spasticity in children diagnosed with spastic cerebral palsy (CP) following selective dorsal rhizotomy (SDR). METHODS A retrospective study was conducted on children suffering from spastic CP who underwent SDR at the Department of Neurosurgery, Shanghai Children's Hospital, from July 2018 to September 2020. Inclusion criteria comprised children exhibiting quadriceps spasticity exceeding modified Ashworth Scale grade 2. Muscle tone and motor function were assessed before the operation, at short-term follow-up and at the last follow-up after SDR. Additionally, intraoperative neurophysiological monitoring data were reviewed. RESULTS The study comprised 20 eligible cases, where, prior to surgery, 35 quadriceps muscles exhibited spasticity exceeding modified Ashworth Scale grade 2. Following short-term and mid-term follow-up, specifically an average duration of 11 ± 2 days and 1511 ± 210 days after SDR, it was observed that muscle tension in adductors, hamstrings, gastrocnemius, and soleus decreased significantly. This reduction was accompanied by a decrease in quadriceps muscle tone in 24 out of 35 muscles (68.6%). Furthermore, the study found that intraoperative electrophysiological parameters can predict postoperative spasticity relief in the quadriceps. The triggered electromyographic (EMG) output of the transected sensory root/rootlets after single-pulse stimulation revealed that the higher the EMG amplitudes in quadriceps, the greater the likelihood of postoperative decrease in quadriceps muscle tension. CONCLUSIONS SDR demonstrates the potential to reduce muscle spasticity in lower extremities in children diagnosed with CP, including a notable impact on quadriceps spasticity even they are not targeted in SDR. The utilization of intraoperative neurophysiological monitoring data enhances the predictability of quadriceps spasticity reduction following SDR.
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Affiliation(s)
- Wenbin Jiang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Li Zhang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Min Wei
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Rui Wang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Bo Xiao
- Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
| | - Junlu Wang
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Qijia Zhan
- Department of Neurosurgery, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China.
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Combey A, Bard-Pondarré R, Erhard L, Chaléat-Valayer E. Retrospective study of functional benefits and satisfaction in multisite upper-limb surgery in children with unilateral cerebral palsy. Hand Surg Rehabil 2024; 43:101623. [PMID: 38000449 DOI: 10.1016/j.hansur.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To evaluate the functional impact of individualised multisite neuro-orthopedic upper-limb surgery in children with unilateral cerebral palsy, and to assess patient satisfaction. PATIENTS AND METHODS This retrospective study evaluated the impact of surgery on unilateral functional capacity on the Melbourne Assessment (MA2) and Box and Blocks test, on bimanual performance on the Assisting Hand Assessment, and on achievement of individualised goals. Satisfaction was assessed on a Likert scale between 6 and 14 months after surgery. RESULTS Twenty-three children were included (mean age, 13.2 ± 3 years). They underwent neuro-orthopedic surgery as part of their care pathway, with botulinum toxin, splints and functional training. After surgery, there was a significant 11.7-point improvement in the MA2 dexterity domain (p = 0.003) and 10.6 points in the MA2 range of motion domain (p = 0.005). Satisfaction was high in 81% of patients. CONCLUSION Neuro-orthopedic upper-limb surgery included in a global care pathway in children with unilateral cerebral palsy improved unilateral upper-limb function and patient satisfaction. The present cohort should be expanded to further explore the impact of surgery on bimanual performance, focusing on more homogeneous functional levels and surgical procedures.
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Affiliation(s)
- Audrey Combey
- Centre des Massues - Croix-Rouge Française, 92 rue Edmond Locard, 69322 Lyon Cedex 5, France
| | - Rachel Bard-Pondarré
- Centre des Massues - Croix-Rouge Française, 92 rue Edmond Locard, 69322 Lyon Cedex 5, France.
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Horsch A, Petzinger L, Deisenhofer J, Ghandour M, Klotz M, Renkawitz T, Putz C. The Impact of Operative Correction of Equinus in Cerebral Palsy on Gait Patterns. Foot Ankle Int 2024; 45:130-140. [PMID: 38156624 DOI: 10.1177/10711007231217273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND This study aimed to evaluate gait outcomes and strength following the surgical correction of equinus in cerebral palsy (CP) based on different surgical procedures. We included the Baumann and Strayer procedures, as well as the Achilles tendon lengthening (ATL). METHODS A retrospective analysis was performed in patients with infantile, bilateral CP who received instrumental 3D gait analysis before and after surgical correction (18.66 months postoperatively). Patients were divided into 3 groups: Strayer surgery, Baumann surgery, and ATL. Gait performance and muscle strengths were compared between studied surgeries. RESULTS A total population of 204 patients (15.43 years) with 341 operated lower limbs (LLs) was analyzed. Dorsiflexion in swing and stance phases significantly improved in all groups postoperatively. The Strayer and the ATL group showed higher postoperative dorsiflexion than the Baumann group. However, no loss of strength was observed with the Baumann method. Maximum power improved in this group postoperatively. An 8.2% loss in calf muscle strength was recorded in the Strayer group. CONCLUSION Operative pes equinus treatment successfully improved the gait of children and adults with CP postoperatively. There were differences in postoperative results between studied operative techniques regarding range of motion and power. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Axel Horsch
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Lara Petzinger
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Deisenhofer
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Maher Ghandour
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias Klotz
- Orthopedics and Trauma Surgery, Marienkrankenhaus Soest, Soest, Germany
| | - Tobias Renkawitz
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
| | - Cornelia Putz
- Department of Orthopedics, Heidelberg University Hospital, Heidelberg, Germany
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Ravera EP, Rozumalski A. Selective dorsal rhizotomy and its effect on muscle force during walking: A comprehensive study. J Biomech 2024; 164:111968. [PMID: 38325195 DOI: 10.1016/j.jbiomech.2024.111968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 01/03/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
Selective dorsal rhizotomy (SDR) is commonly used to permanently reduce spasticity in children with cerebral palsy (CP). However, studies have yielded varying results regarding muscle strength and activity after SDR. Some studies indicate weakness or no changes, while a recent study using NMSK simulations demonstrates improvements in muscle forces during walking. These findings suggest that SDR may alleviate spasticity, reducing dynamic muscle constraints and enhancing muscle force without altering muscle activity during walking in children with CP. In this study, we combined NMSK simulations with physical examinations to assess children with CP who underwent SDR, comparing them to well-matched peers who did not undergo the procedure. Each group (SDR and No-SDR) included 81 children, with pre- and post-SDR assessments. Both groups were well-matched in terms of demographics, clinical characteristics, and gait parameters. The results of the physical examination indicate that SDR significantly reduces spasticity without impacting muscle strength. Furthermore, our findings show no significant differences in gait deviation index improvements and walking speed between the two groups. Additionally, there were no statistically significant changes in muscle activity during walking before and after SDR for both groups. NMSK results demonstrate a significant increase in muscle force in the semimembranosus and calf muscles during walking, compared to children with CP who received other clinical treatments. Our findings confirm that although SDR does not significantly impact muscle strength compared to other treatments, it creates a more favorable dynamic environment for suboptimal muscle force production, which is essential for walking.
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Affiliation(s)
- Emiliano Pablo Ravera
- Group of Analysis, Modeling, Processing and Clinician Implementation of Biomechanical Signals and Systems, Bioengineering and Bioinformatics Institute, CONICET-UNER, Oro Verde, Argentina; Human Movement Research Laboratory, School of Engineering, National University of Entre Ríos (UNER), Oro Verde, Argentina.
| | - Adam Rozumalski
- The James R. Gage Center for Gait & Motion Analysis, Gillette Children's Specialty Healthcare, St. Paul, MN, United States of America.
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20
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Galloway G. Dorsal Rhizotomy in the Pediatric Patient. J Clin Neurophysiol 2024; 41:134-137. [PMID: 38306221 DOI: 10.1097/wnp.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024] Open
Abstract
SUMMARY The majority of cases of dorsal rhizotomy surgeries in children are done to improve the spasticity associated with cerebral palsy, and more recent techniques are selective in nature and referred to as selective dorsal rhizotomy (SDR). The techniques applied to selective dorsal rhizotomy surgery has changed since it was first described and continues to undergo modifications. Approaches to surgery and monitoring vary slightly among centers. This article provides a review of the rationale, variety of surgical approaches, and intraoperative neurophysiologic monitoring methods used along with discussion of the risks, complications and outcomes in these surgeries.
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Affiliation(s)
- Gloria Galloway
- Department of Neurology, Ohio State University, Columbus, Ohio, U.S.A
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Hanson AM, Wren TAL, Rethlefsen SA, Ciccodicola E, Rubel B, Kay RM. Anterior Distal Femoral Hemiepiphysiodesis Does Not Change Pelvic Tilt in Children With Cerebral Palsy. J Pediatr Orthop 2024; 44:76-81. [PMID: 37970741 DOI: 10.1097/bpo.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
BACKGROUND Anterior distal femoral hemiepiphysiodesis (ADFH) is a surgical treatment choice to correct flexed knee gait and fixed knee flexion deformities in children with cerebral palsy who are skeletally immature. Increased anterior pelvic tilt has been reported after surgeries that correct knee flexion deformities, including hamstring lengthening (HSL) and distal femoral extension osteotomies, but anterior pelvic tilt has not been studied after ADFH. We hypothesized that anterior pelvic tilt would increase after ADFH, especially when combined with HSL, and it would correlate with the change in minimum knee flexion in stance and dynamic hamstring lengths. METHODS Thirty-four eligible participants (age: 13.0, SD: 2.0) were included. Change in mean pelvic tilt across the gait cycle was compared as a function of clinical and gait parameters using linear mixed models. The relationship of change in pelvic tilt to change in other variables was examined using Pearson correlation. RESULTS Overall, anterior pelvic tilt increased significantly after ADFH by 4.4 degrees ( P = 0.02). Further, the analysis revealed anterior pelvic tilt only increased significantly in the group that had concurrent HSL (11.1 degrees, P < 0.001). Overall, minimum knee flexion significantly decreased (increase in knee extension) in stance (-19.1 degrees, P < 0.001) and there was an increase in maximum normalized dynamic hamstring lengths (0.03, P < 0.001). The anterior pelvic tilt increased significantly in Gross Motor Function Classification System levels III to IV (5.9 degrees, P = 0.02) but did not change significantly in Gross Motor Function Classification System I to II (2.5 degrees, P = 0.37). Change in pelvic tilt was correlated with change in maximum dynamic hamstring lengths ( r = 0.87, P < 0.0001) and change in minimum knee flexion in stance ( r = -0.71, P < 0.0001). CONCLUSIONS Anterior distal hemiepiphysiodesis without concurrent HSL for flexion knee deformities does not result in increased anterior pelvic tilt. Surgeons should consider anterior distal hemiepiphysiodesis in patients with cerebral palsy and flexed knee gait, who preoperatively have long dynamically modeled hamstrings, are skeletally immature, and when maintenance of pelvic tilt is desired. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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Affiliation(s)
- Alison M Hanson
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
| | - Tishya A L Wren
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
| | - Susan A Rethlefsen
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
| | - Eva Ciccodicola
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
| | - Boris Rubel
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
| | - Robert M Kay
- Jackie and Gene Autry Orthopaedic Center, Children's Hospital Los Angeles
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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Lynch ME, Daniels DJ, Brandenburg JE. Gabapentin as part of a multimodal pain protocol for selective dorsal rhizotomy does not impact percentage of rootlets transected. Childs Nerv Syst 2024; 40:487-494. [PMID: 37676296 DOI: 10.1007/s00381-023-06124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE We aim to determine whether preoperatively initiated gabapentin for pain control impacts the percentage of rootlets cut during monitored, limited laminectomy selective dorsal rhizotomy (SDR) procedure. METHODS This retrospective cohort study includes participants with cerebral palsy who had SDR for treatment of spasticity between 2010 and 2019 at a single-institution tertiary care center. One-level laminectomy SDR aimed to evaluate the cauda equina roots from levels L2-S1 with EMG monitoring. Gabapentin titration began 3 weeks prior to SDR. Data was analyzed using simple linear regression. Thirty-one individuals met inclusion criteria. Mean age was 7 years, 4 months. Eighteen participants (58%) identified as male, 12 (39%) female, and one (3%) non-binary. Thirty (97%) had bilateral CP. Sixteen (52%) were GMFCS II, four (13%) GMFCS III, five (16%) GMFCS IV, and six (19%) GMFCS V. RESULTS Mean percentage of rootlets transected was 50.75% (SD 6.00, range 36.36-60.87). There was no relationship between the dose of gabapentin at time of SDR and percentage of rootlets cut with a linear regression slope of - 0.090 and an R2 of 0.012 (P = 0.56). CONCLUSION Results indicate that preoperative initiation of gabapentin did not impact the percentage of rootlets transected. Thus, gabapentin can be initiated prior to SDR at moderate dosages without impacting SDR surgical outcomes.
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Affiliation(s)
- Mary E Lynch
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David J Daniels
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Joline E Brandenburg
- Department of Physical Medicine and Rehabilitation, Division of Pediatric Rehabilitation Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Barik S, Kumar V, Raj V. Letter Regarding: Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy. Foot Ankle Int 2024; 45:99. [PMID: 38279769 DOI: 10.1177/10711007231213366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
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Marowsky M, Jungesblut O, Strahl A, Stücker R, Rupprecht M. Medium-term Results After Femoral Head Resection and Subtrochanteric Valgus Osteotomy in Children and Adolescents With Neuromuscular Disorders. J Pediatr Orthop 2024; 44:49-54. [PMID: 37899529 DOI: 10.1097/bpo.0000000000002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND Various salvage surgical procedures for painful hip dislocation in adolescent patients with cerebral palsy exist. To date, no significant differences among these surgical techniques have been described. In our institution the McHale procedure is the standard of care for painful chronically dislocated hips with or without deformity of the femoral head in patients with cerebral palsy. This study focuses on mid-term results after surgical treatment. METHODS Surgical reports and patient charts were analyzed retrospectively. All x-rays were evaluated and migration of the proximal femur and heterotopic ossification according to Brooker were recorded. In addition, we conducted a telephone interview with the caretakers with special reference to pain preoperatively and postoperatively and after implant removal, sitting tolerance, range of motion, mobility, quality of life, and personal hygiene. RESULTS Fifty-two patients (65 hips) with a mean age of 13.5 ± 3.6 years (range: 4 to -20 y) were included. Mean surgery time was 178.4 ± 63.4 minutes (range: 45 to 380 min) and mean follow-up was 45.17 ± 30.6 months (range: 12 to 204 mo). A significant difference between preoperative and postoperative pain levels was found, P <0.001. Personal hygiene ( P =0.02) and quality of life ( P =0.013) improved significantly. Eighty-five percent of the caregivers would have the surgery performed on their child again and 81% of the caregivers would recommend the surgery to others. The removal of implants leads to a significant improvement in pain ( P =0.011). A total of 22 complications in 65 McHale procedures (33.9%) were related to the procedures. CONCLUSIONS A significant reduction in pain and a significant improvement of hygiene as well as quality of life can be achieved with the McHale procedure in painful chronically dislocated hips in patients with cerebral palsy. Overall, the procedure is predominantly experienced as helpful by the caregivers and recommended to others. The removal of the implants improves pain significantly, but complications may occur in one third of the patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Madeleine Marowsky
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona
| | - Oliver Jungesblut
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr, Hamburg, Germany
| | - André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr, Hamburg, Germany
| | - Ralf Stücker
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr, Hamburg, Germany
| | - Martin Rupprecht
- Department of Pediatric Orthopaedic Surgery, Children's Hospital Hamburg-Altona
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistr, Hamburg, Germany
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Bortnick EM, Logvinenko T, Wang HHS, Fogelman DJ, Shore BJ, Nelson CP, Kurtz MP. Association between lower limb spasticity and cryptorchidism in males with cerebral palsy. Dev Med Child Neurol 2024; 66:82-86. [PMID: 37282840 DOI: 10.1111/dmcn.15644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 06/08/2023]
Abstract
AIM To explore the association between presence and severity of lower limb spasticity (LLS) and risk of orchidopexy for cryptorchidism among people with cerebral palsy (CP) and to further define the cremasteric muscle spasticity theory. METHOD We queried the Pediatric Health Information System database for male patients with CP, stratified patients into those with/without LLS, and compared groups for orchidopexy occurrence. Comparative statistics were performed using χ2 and Mann-Whitney U tests for categorical and continuous variables respectively. The association between orchidopexy and spasticity type was investigated using logistic regression. RESULTS In total, 44 561 males with CP were identified. Of these, 1.6% underwent orchidopexy (median age: 7 years 8 months [interquartile range: 4 years 6 months-11 years 4 months]). LLS presence was significantly associated with higher orchidopexy rate compared to spasticity absence (odds ratio [OR] = 1.33 [1.10-1.59], p = 0.003). Among 7134 patients with LLS, intervention was significantly associated with higher orchidopexy rate (injection procedures: OR = 2.47 [2.27-6.39], p = 0.034; surgical procedure: OR = 2.60 [1.22-6.76], p = 0.026). LLS groin proximity was significantly associated with higher orchidopexy rate (OR = 2.52 [1.42-4.96], p = 0.003). INTERPRETATION A strong association exists between LLS presence and severity and orchidopexy risk among people with CP. These findings support a cremasteric spasticity hypothesis as an important factor of cryptorchidism in CP. Providers should continue to examine for cryptorchidism in males with CP as they age. WHAT THIS PAPER ADDS Lower limb spasticity (LLS) is associated with higher orchidopexy rate in cerebral palsy. Orchidopexy rate was higher in more severe LLS. Orchidopexy rate was higher in more proximal LLS.
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Affiliation(s)
- Eric M Bortnick
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Tanya Logvinenko
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - David J Fogelman
- Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Benjamin J Shore
- Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts, USA
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Gillespie CS, Hall BJ, George AM, Hennigan D, Sneade C, Cawker S, Silva AHD, Vloeberghs M, Aquilina K, Pettorini B. Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study. Childs Nerv Syst 2024; 40:171-180. [PMID: 37439914 PMCID: PMC10761507 DOI: 10.1007/s00381-023-06062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). METHODS This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. RESULTS Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients. CONCLUSIONS SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.
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Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Neurology, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
| | - Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Alan M George
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Christine Sneade
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Stephanie Cawker
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michael Vloeberghs
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
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Merckx L, Poncelet F, De Houwer H, Laumen A, Peeters L, Nuttin B, Pauwels P, Van Campenhout A, Ortibus E, De Vloo P. Upper-extremity spasticity and functionality after selective dorsal rhizotomy for cerebral palsy: a systematic review. J Neurosurg Pediatr 2023; 32:673-685. [PMID: 37877954 DOI: 10.3171/2023.7.peds22526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/21/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Lumbosacral selective dorsal rhizotomy is a neurosurgical treatment option to reduce spasticity in the lower extremities in children with cerebral palsy. Surprisingly, concomitant improvement of spasticity in the upper extremities and functionality of the hands has been sporadically reported postoperatively. In this systematic review, the authors aimed to quantify the postoperative improvement in upper-extremity spasticity and functionality, identify predictors, and discuss underlying mechanisms. METHODS The authors searched the MEDLINE and Embase databases for studies reporting upper-extremity outcomes in cerebral palsy patients after selective dorsal rhizotomy that reported one or more of the following clinical scales: the Ashworth Scale (AS), the Modified AS (MAS), the fine motor skills domain of the Peabody Developmental Motor Scales (PDMS), the Quality of Upper Extremity Skills Test (QUEST), the self-care domain of the Functional Independence Measure for Children (WeeFIM), or the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI). The authors arbitrarily divided postoperative follow-up into short-term (< 6 months), medium-term (6-24 months), and long-term (> 24 months) follow-up. A 1-point change in MAS score has been reported as clinically significant. To assess bias, the Cochrane Collaboration's tool and ROBINS-I tool were used. RESULTS The authors included 24 articles describing 752 patients. Spasticity reduction of the upper extremities ranged from 0.30 to 0.55 (AS) and between 0 and 2.9 (MAS) at medium-term follow-up. This large variability may partially be attributed to a floor effect since patients with normal upper-extremity function would not be expected to have further improvement. QUEST improvement ranged from 2.7% to 4.5% at medium-term follow-up. The mean improvements in functional skills of the self-care domain of the PEDI were 4.3 at short-term and 7 at medium-term follow-ups and ranged from 10.8 to 34.7 at long-term follow-up. There are insufficient data to draw meaningful conclusions regarding the PDMS fine motor skills and the WeeFIM self-care domains. CONCLUSIONS The literature suggests that a pronounced postoperative spasticity reduction in the lower extremities and a moderately severe preoperative upper-extremity spasticity may positively predict postoperative reduction in upper-extremity spasticity. There are at least 5 hypotheses that may explain the postoperative reduction in upper-extremity spasticity and functionality: 1) a somatosensory cortex reorganization favoring the hand region over the leg region, 2) a decrease in abnormal electrical transmission throughout the spinal cord, 3) an indirect result of improved posture due to improved truncal and leg stability, 4) an indirect consequence of occupational/physical therapy intensification, and 5) a maturation effect. However, all remain unproven to date.
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Affiliation(s)
| | | | - Hannah De Houwer
- 2Orthopedic Surgery
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
| | - Armand Laumen
- 2Orthopedic Surgery
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
| | - Leen Peeters
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
- 4Rehabilitation Medicine, and
| | - Bart Nuttin
- Departments of1Neurosurgery
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
- 5Department of Neuroscience, Laboratory for Experimental Neurosurgery and Neuroanatomy, KU Leuven Brain Institute, Leuven, Belgium
| | - Petra Pauwels
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
- 4Rehabilitation Medicine, and
| | | | - Els Ortibus
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
- 6Pediatrics, University Hospitals Leuven
| | - Philippe De Vloo
- Departments of1Neurosurgery
- 3Cerebral Palsy Clinic, University Hospitals Leuven; and
- 5Department of Neuroscience, Laboratory for Experimental Neurosurgery and Neuroanatomy, KU Leuven Brain Institute, Leuven, Belgium
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28
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Vallim FCDM, Nogueira-Barbosa MH, da Cruz HA, Viana VM, Ferzeli MV, Guimarães JAM. Conventional versus locked plates for hip dislocation in cerebral palsy: a matched cohort analysis. Eur J Orthop Surg Traumatol 2023; 33:3429-3434. [PMID: 37147534 DOI: 10.1007/s00590-023-03568-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Bone quality of non-ambulatory patients with cerebral palsy (CP) is a matter of concern for proximal femoral varus derotational osteotomies (VDRO). Locking plates (LCP) have been designed to compensate this biological downfall. Little data exist comparing the LCP with the conventional femoral blade plate. METHODS We retrospectively studied 32 patients submitted to VDRO (40 hips), operated with blade plates or LCP. Groups were matched, and the minimal follow-up was 36 months. Clinical (age at surgery, sex, GMFCS class, CP patterns) and radiological characteristics (neck shaft angle [NSA], acetabular index [AI], Reimers migration index [MP] and time until bone healing), as well as postoperative complications and the cost of treatment, were evaluated. RESULTS Preoperative clinical characteristics and radiographic measurements were comparable, except for a higher AI in the BP group (p < 0.01). Mean follow-up was longer in the LCP group (57.35 vs 34.6 months). Mean NSA, AI and MP had comparable correction with surgery (p < 0.01). At final follow-up, dislocation recurrence speed was higher in BP group although not statistically significant (0.56% vs 0.35%/month; p = 0.29). The complication rate was similar in both groups (p > 0.05). Finally, the cost of the treatment was 62% higher in the LCP group (p = 0.01). CONCLUSION Our cohorts showed LCP or BP equivalence clinically and radiographically in mid-term follow-up, with the former increasing the cost of treatment by a mean of 62%. This may raise a question on the real necessity of locked implants for these operations. LEVEL OF EVIDENCE Level III-Retrospective comparative study.
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Affiliation(s)
- Frederico Coutinho de Moura Vallim
- Hospital Estadual da Criança - SES/RJ, Rio de Janeiro, Brazil
- National Institute of Traumatology and Orthopaedics INTO / MS - RJ, Rio de Janeiro, Brazil
| | - Marcello Henrique Nogueira-Barbosa
- Medical Imaging Department, Faculdade de Medicina de Ribeirão Preto from Universidade de São Paulo - FMRP USP, São Paulo, Brazil
- Faculdade de Medicina de Ribeirão Preto from Universidade de São Paulo - FMRP USP, São Paulo, Brazil
- Universidade de São Paulo - USP, São Paulo, Brazil
| | | | - Vitor Moreira Viana
- Hospital Estadual da Criança - SES/RJ, Rio de Janeiro, Brazil.
- , Volta Redonda, Brasil.
| | | | - João Antonio Matheus Guimarães
- National Institute of Traumatology and Orthopaedics INTO / MS - RJ, Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro - UFRJ, Rio de Janeiro, Brazil
- Universidade Federal Fluminense - UFF RJ, Rio de Janeiro, Brazil
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Miskiewicz M, Hidalgo Perea S, Magruder M, Abdelgawad A. Risk Factors of Infectious Complications in Pediatric Patients With Cerebral Palsy After Spinal Arthrodesis. Clin Spine Surg 2023; 36:E397-E401. [PMID: 37348066 DOI: 10.1097/bsd.0000000000001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVE The main objective of this study was to investigate (1) whether pediatric patients with cerebral palsy (CP) have higher rates of postoperative infectious complications after spinal fusion and (2) risk factors for postoperative infections. SUMMARY OF BACKGROUND DATA Prior studies have shown that patients with CP undergo corrective spine surgery more often than the general population, yet typically have worse postoperative outcomes. Further investigation is needed to improve our understanding of the perioperative factors that place children with CP at greater risk of postoperative infectious complications. PATIENTS AND METHODS The 2019 "American College of Surgeons National Surgical Quality Improvement Program" Pediatric database was used for patient data. The univariable analysis compared the prevalence of preoperative comorbidities and perioperative factors between children with and without CP. Multivariable logistic regression modeling was used to ascertain independent risk factors for postoperative infectious complications. RESULTS A total of 4445 patients were included in the study; 606 (13.63%) patients had CP and 3839 (86.37%) did not. Patients with CP were more likely to have several notable preoperative comorbidities, and the rate of developing any infectious complication was more than 7 times greater in the CP cohort than in the control cohort (14.36% vs 1.88%; P <0.001). Multivariable analysis revealed CP [odds ratio (OR): 3.55, CI: 2.25-5.60; P <0.001], American Society of Anesthesiologists class 3 or higher (OR: 2.10, CI: 1.29-3.42; P = 0.003), and hematologic disorders (OR: 2.01, CI: 1.06-3.83; P = 0.033) to be independent risk factors for increased postoperative infectious complications. CONCLUSIONS CP is an independent risk factor for the development of 30-day postoperative infectious complications in pediatric patients. In addition, the American Society of Anesthesiologists class 3 or higher and hematologic disorders were risk factors for postoperative infections after spinal fusion surgery.
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Affiliation(s)
- Michael Miskiewicz
- Renaissance School of Medicine, Stony Brook University Hospital Stony Brook, NY
| | - Sofia Hidalgo Perea
- Renaissance School of Medicine, Stony Brook University Hospital Stony Brook, NY
| | - Matthew Magruder
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Amr Abdelgawad
- Department of Orthopedic Surgery, Maimonides Medical Center, Brooklyn, NY
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30
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Fong MM, Gibson N, Williams SA, Jensen L. Clinical functional outcome measures for children with cerebral palsy after gait corrective orthopaedic surgery: A scoping review. Dev Med Child Neurol 2023; 65:1573-1586. [PMID: 37147852 DOI: 10.1111/dmcn.15622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 05/07/2023]
Abstract
AIM To identify the most frequently reported non-instrumented measures of gait, activity, and participation in children with cerebral palsy (CP) after undergoing gait corrective orthopaedic surgery. METHOD Four databases were searched from database inception to the 9th December 2021 for studies that evaluated functional outcomes for children with CP under 18 years undergoing gait corrective orthopaedic surgery. RESULTS Of 547 citations, 44 publications (n = 3535 participants, n = 1789 males, mean age 10 years 5 months [SD = 3 years 3 months], Gross Motor Function Classification System levels I-III at the time of surgery) were eligible for inclusion. Fourteen different outcome measures were used: one measure of gait, 10 measures of activity, and three measures of participation. Gait was measured with the Edinburgh Visual Gait Scale (EVGS; 4 out of 44). The most common activity and participation measures were the Functional Mobility Scale (FMS; 15 out of 44) and Pediatric Outcomes Data Collection Instrument (11 out of 44) respectively. No studies reported a combination of gait, activity, and participation measures. INTERPRETATION The EVGS and FMS should be considered as core outcome measures in gait corrective orthopaedic surgery, while a measure of participation is unclear. Additional considerations for developing a comprehensive suite of outcomes include identifying a combination of clinical measures and performance-reflective questionnaires that are standardized for children with CP undergoing surgery and meaningful to clinicians and families.
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Affiliation(s)
- Maxine M Fong
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Noula Gibson
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
- Kids Rehab WA, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Sian A Williams
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Lynn Jensen
- Department of Physiotherapy, Perth Children's Hospital, Nedlands, Western Australia, Australia
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Lau D, Samdani AF, Pahys JM, Miyanji F, Shah SA, Lonner BS, Sponseller PD, Yaszay B, Hwang SW. Surgical Outcomes of Cerebral Palsy Patients With Scoliosis and Lumbar Hyperlordosis: A Comparative Analysis With 2-year Minimum Follow-up. Spine (Phila Pa 1976) 2023; 48:E374-E381. [PMID: 37000681 DOI: 10.1097/brs.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 04/01/2023]
Abstract
STUDY DESIGN Retrospective review of a prospectively collected multicenter database. OBJECTIVE To compare outcomes of patients with cerebral palsy (CP) who undergo surgery for scoliosis with normal lordosis (NL) versus hyperlordosis. SUMMARY OF BACKGROUND DATA Surgical correction of scoliosis with lumbar hyperlordosis is challenging. Hyperlordosis may confer higher perioperative morbidity, but this is not well understood. MATERIALS AND METHODS A multicenter database was queried for CP patients who underwent surgery from 2008 to 2017. The minimum follow-up was 2 years. Two groups were identified: lumbar lordosis <75° (NL) versus ≥ 75° hyperlordosis (HL). Perioperative, radiographic, and clinical outcomes were compared. RESULTS Two hundred seventy-five patients were studied: 236 NL and 39 HL (-75 to -125°). The mean age was 14.1 years, and 52.4% were male. Patients with hyperlordosis had less cognitive impairment (76.9% vs. 94.0%, P =0.008) and higher CPCHILD scores (59.4 vs. 51.0, P =0.003). Other demographics were similar between the groups. Patients with hyperlordosis had greater lumbar lordosis (-90.5 vs. -31.5°, P <0.001) and smaller sagittal vertical axis (-4.0 vs. 2.6 cm, P <0.001). Patients with hyperlordosis had greater estimated blood loss (2222.0 vs. 1460.7 mL, P <0.001) but a similar perioperative complication rate (20.5% vs. 22.5%, P =0.787). Significant correction of all radiographic parameters was achieved in both groups. The HL group had postoperative lumbar lordosis of -68.2° and sagittal vertical axis of -1.0 cm. At a 2-year follow-up, patients with hyperlordosis continued to have higher CPCHILD scores and gained the greatest benefit in overall quality of life measures (20.0 vs. 6.1, P =0.008). The reoperation rate was 10.2%: implant failure (3.6%), pseudarthrosis (0.7%), and wound complications (7.3%). There were no differences in the reoperation rate between the groups. CONCLUSION Surgical correction of scoliosis with hyperlordosis is associated with greater estimated blood loss but similar radiographic results, perioperative morbidity, and reoperation rate as normal lordosis. Patients with hyperlordosis gained greater overall health benefits. Correction of ≥25% of hyperlordosis seems satisfactory. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Darryl Lau
- Department of Neurosurgery, NYU Langone Medical Center, New York, NY
| | | | | | - Firoz Miyanji
- Department of Orthopaedics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Baron S Lonner
- Department of Orthopaedic Surgery, Mount Sinai Beth Israel Medical Center, New York, NY
| | - Paul D Sponseller
- Department of Orthopaedics, Johns Hopkins Children's Center, Baltimore, MD
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32
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Green-Petersen I, Magnano L, Charalampidis A, Gerdhem P. Distal fusion level, complications, and reoperations in individuals with cerebral palsy undergoing surgery for scoliosis. Eur Spine J 2023; 32:4037-4044. [PMID: 37656234 DOI: 10.1007/s00586-023-07907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To compare radiological outcome, complications and reoperations in individuals with cerebral palsy and scoliosis fused to the fifth lumbar vertebra (L5), the sacrum, or the ilia. METHODS 208 individuals were identified in the national quality registry Swespine. Lowest level of fusion was L5 in 58, the sacrum in 92, and the ilia in 58 individuals. A subanalysis on 58 matched pairs operated to L5 or the pelvis (sacrum = 42, ilia = 16) with similar pelvic obliquity (± 5°) was performed. RESULTS The median (interquartile range) follow-up for the last radiograph was 1.7 (1.7) years and for reoperations 6.0 (5.9) years. Preoperatively, median Cobb angle of the major curve was 65° (23°) in the L5 group, 68° (28°) in the sacrum group, and 78° (25°) in the ilia group (p = 0.006). Preoperative median pelvic obliquity according to Maloney was 16° (19°), 21° (13°), and 27° (28°), respectively (p = 0.004). Immediate postoperative Cobb angles were 28° (18°), 28° (16°), and 32° (25°), respectively (p = 0.11). Immediate postoperative pelvic obliquity was 7° (10°), 7° (8°), and 8° (10°), respectively (p = 0.28). The median change in pelvic obliquity from the first to the last postoperative radiograph was - 5° (7°), - 3° (6°), - 3° (6°), respectively (p = 0.55). 7 (12%), 11 (12%), and 7 (12%) patients required at least one reoperation (p = 1.0), respectively. In the matched analysis, no significant differences in the radiological outcomes were found (all p ≥ 0.38). CONCLUSIONS Maintained curve and pelvic obliquity correction with no significant difference in complication and reoperation rates were found irrespective of distal fusion level.
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Affiliation(s)
- I Green-Petersen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - L Magnano
- Department of Trauma and Orthopaedics, Enna Hospital, Sicily, Italy
| | - A Charalampidis
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - P Gerdhem
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
- Department of Orthopedics and Hand Surgery, Uppsala University Hospital, Uppsala, Sweden.
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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Ahonen M, Helenius I, Gissler M, Jeglinsky-Kankainen I. Mortality and Causes of Death in Children With Cerebral Palsy With Scoliosis Treated With and Without Surgery. Neurology 2023; 101:e1787-e1792. [PMID: 37679048 PMCID: PMC10634643 DOI: 10.1212/wnl.0000000000207796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/06/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To compare mortality and causes of death in scoliotic children with cerebral palsy (CP) with and without scoliosis surgery. METHODS National population-based registries were searched for children with CP and scoliosis with and without surgery for scoliosis and were analyzed for comorbidities, mortality, and causes of death. RESULTS Two hundred thirty-six had not been operated and 238 had been operated on for scoliosis during the median follow-up of 17.8 (interquartile range [IQR] 11.7-25.7) and 23.0 (IQR 18.4-28.2) years, respectively. Both groups had similar comorbidities. During the follow-up, mortality was higher in the nonsurgically treated group than in the surgically treated group (n = 38/236, 16% and 8.7 per 1,000 follow-up years vs n = 29/238, 12% and 5.3 per 1,000 follow-up years, p = 0.047). In patients with nonsurgical treatment, the cause of death was respiratory in 76.3% (29/38) and 37.9% (11/29) in patients with surgical treatment of scoliosis (6.6 and 2.0 per 1,000 follow-up years, p = 0.002). Neurologic causes of death were more common in surgically treated patients than in nonsurgically treated patients, 44.8% (13/29) and 15.8% (6/38), respectively (3.0 and 1.1 per 1,000 follow-up years, p = 0.009). DISCUSSION Surgical treatment of scoliosis associates to reduced mortality because of respiratory causes in children with CP and scoliosis. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence of the effects of spinal fusion on mortality of children with severe scoliosis due to CP.
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Affiliation(s)
- Matti Ahonen
- From the Helsinki University Hospital (M.A.); Department of Orthopaedics and Traumatology (I.H.), University of Helsinki and Helsinki University Hospital; THL Finnish Institute for Health and Welfare (M.G.); and Department of Health and Welfare (I.J.-K.), Arcada University of Applied Sciences, Helsinki, Finland.
| | - Ilkka Helenius
- From the Helsinki University Hospital (M.A.); Department of Orthopaedics and Traumatology (I.H.), University of Helsinki and Helsinki University Hospital; THL Finnish Institute for Health and Welfare (M.G.); and Department of Health and Welfare (I.J.-K.), Arcada University of Applied Sciences, Helsinki, Finland
| | - Mika Gissler
- From the Helsinki University Hospital (M.A.); Department of Orthopaedics and Traumatology (I.H.), University of Helsinki and Helsinki University Hospital; THL Finnish Institute for Health and Welfare (M.G.); and Department of Health and Welfare (I.J.-K.), Arcada University of Applied Sciences, Helsinki, Finland
| | - Ira Jeglinsky-Kankainen
- From the Helsinki University Hospital (M.A.); Department of Orthopaedics and Traumatology (I.H.), University of Helsinki and Helsinki University Hospital; THL Finnish Institute for Health and Welfare (M.G.); and Department of Health and Welfare (I.J.-K.), Arcada University of Applied Sciences, Helsinki, Finland
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Ma N, Gould D, Camathias C, Graham K, Rutz E. Single-Event Multi-Level Surgery in Cerebral Palsy: A Bibliometric Analysis. Medicina (Kaunas) 2023; 59:1922. [PMID: 38003972 PMCID: PMC10672936 DOI: 10.3390/medicina59111922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Single-Event Multi-Level Surgery (SEMLS) is a complex surgical programme in which soft tissue contractures and bony torsional deformities at the ankle, knee and hip, in both lower limbs are surgically corrected during a single operative session, requiring one hospital admission and one period of rehabilitation. The aim of SEMLS is to improve gait and function in ambulant children with cerebral palsy. Utilisation of the SEMLS concept can reduce the number of surgical events, hospital inpatient stays and reduce rehabilitation requirements to a single intensive episode. Three-dimensional gait analysis is a pre-requisite to plan intervention at multiple anatomic levels to correct fixed deformities and to improve gait and function. Materials and Methods: This study was a bibliometric analysis of SEMLS in cerebral palsy using the Clarivate Web of Science Core Collection database from 1900 to 29 May 2023. Results: A total of 84 studies met the inclusion criteria. The most highly cited article was "Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery" by Rodda et al. (2006) with 141 citations. The most productive institutions by number of articles were the Royal Children's Hospital Melbourne (Australia), Murdoch Children's Research Institute (Australia) and University of Melbourne (Australia). The most productive author by number of citations was HK Graham (Australia). Conclusions: The literature base for SEMLS consists largely of retrospective cohort studies. The aforementioned three institutes in Melbourne, Australia, which frequently collaborate together, have contributed the greatest number of studies in this field.
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Affiliation(s)
- Norine Ma
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Daniel Gould
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Carlo Camathias
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Praxis Zeppelin, Brauerstrasse 95, 9016 St. Gallen, Switzerland
| | - Kerr Graham
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia
- Paediatric Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Hugh Williamson Gait Analysis Laboratory, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Erich Rutz
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC 3010, Australia
- Medical Faculty, University of Basel, 4001 Basel, Switzerland
- Paediatric Orthopaedic Department, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Hugh Williamson Gait Analysis Laboratory, The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
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Gather KS, Hagmann S, Gantz S, Renkawitz T. [Solidarity with children and people with disabilities? : An economic analysis of reconstructive hip interventions in pediatric orthopedics]. Orthopadie (Heidelb) 2023; 52:824-833. [PMID: 37195420 PMCID: PMC10539185 DOI: 10.1007/s00132-023-04381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Brain damage in childhood can be caused cerebral palsy (CP) or be due to other diseases. Disturbance of muscle tone results in consecutive development of hip subluxation. Hip reconstructive surgery can significantly improve the mobility and quality of care of children. However, the DRG for surgical care of these conditions has been increasingly devalued. In Germany, this has already led to a reduction of pediatric orthopedics departments, accompanied by an important risk of insufficient treatment options for children and people with disabilities. METHOD The aim of this retrospective study was an economic analysis of pediatric orthopedic interventions using the example of neurogenic hip decentration. For this purpose, the revenue-cost situation in patients with CP or other causes of brain damage was evaluated at a maximum care hospital in the period of 2019-2021. RESULTS The entire analysis period showed a deficit. The non-CP-group showed the most important deficit. In CP-patients, however, the plus decreased each year and resulted in a deficit in 2021. CONCLUSION While the distinction between cerebral palsy and other forms of brain damage in children is usually not relevant for treatment, it is evident that the non-CP group is massively underfinanced. Overall, the negative economic balance of pediatric orthopedics in the field of neurogenic hip reconstruction is clearly revealed. In the current interpretation of the DRG system, children with disabilities cannot be offered cost-effective care at a maximum-care university center.
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Affiliation(s)
- Katharina Susanne Gather
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
| | - Sébastien Hagmann
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Simone Gantz
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
| | - Tobias Renkawitz
- Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland
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Miller SD, Juricic M, Bone JN, Steinbok P, Mulpuri K. The Effect of Selective Dorsal Rhizotomy on Hip Displacement in Children With Cerebral Palsy: A Long-term Follow-up Study. J Pediatr Orthop 2023; 43:e701-e706. [PMID: 37493022 PMCID: PMC10481910 DOI: 10.1097/bpo.0000000000002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
BACKGROUND Hip displacement is common in children with cerebral palsy (CP). Spasticity in the hip adductor muscles, hip flexors, and medial hamstrings has been identified as a possible cause of progressive hip displacement. Selective dorsal rhizotomy (SDR) aims to reduce lower extremity spasticity in children with CP. Here, we investigate the influence of SDR on hip displacement in children with CP at long-term follow-up, a minimum of 5 years post-SDR. METHODS A retrospective review of children undergoing SDR at a Canadian pediatric hospital was completed. Migration percentage (MP) was measured on pelvis radiographs taken in the 6 months before SDR and minimum 5 years post-SDR or before hip surgery. The number of hips with displacement, defined as MP >30%, and the number of children with at least 1 hip displaced were determined. A linear mixed-effects model was used to assess potential risk factors for poor outcome post-SDR, defined as having MP >40% or surgical intervention for hip displacement. RESULTS Ninety children [50 males, 40 females, Gross Motor Function Classification System (GMFCS) levels I to V: 1/13/24/43/9] with a mean follow-up of 8.5 years (SD 5.1) were included. The mean age at SDR was 4.9 years (SD 1.5); more than half of children (52%) had hip displacement at the time of SDR. Post-SDR, MP exceeded 30% in 0 (0%) of children at GMFCS level I, 1 (8%) at II, 11 (46%) at III, 31 (72%) at IV, and 7 (78%) at V. A poor outcome was associated with preoperative MP, age, and GMFCS level. CONCLUSIONS The incidence of hip displacement post-SDR was consistent with population-based studies when evaluated by GMFCS. Our findings suggest that SDR has neither a positive nor negative effect on hip displacement when assessed at least 5 years postintervention. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Stacey D. Miller
- Department of Physical Therapy, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Maria Juricic
- Department of Physical Therapy, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey N. Bone
- Biostatistics, BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Paul Steinbok
- Division of Pediatric Neurosurgery, Department of Surgery, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
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Shah MM, Raibagkar S, Bansal S, Jain M, Ponugoti G. Patellar Tendon Rupture During Postoperative Physiotherapy for Crouch Gait: A Case Report. JBJS Case Connect 2023; 13:01709767-202312000-00047. [PMID: 38096336 DOI: 10.2106/jbjs.cc.23.00157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
INTRODUCTION A 14-year-old adolescent girl with spastic diplegic cerebral palsy underwent bilateral distal femur extension osteotomy and patellar tendon plication. Two and a half months after surgery, during physiotherapy, she sustained mid-substance tear of the left patellar tendon. The girl was successfully managed with patellar tendon repair and augmentation with tensor fascia lata autograft. CONCLUSION Patellar tendon rupture during rehabilitative physiotherapy after patellar tendon plication surgery is rare. Postoperative protocols in patients with cerebral palsy are crucial and should progress gradually to improve knee range of motion. This report highlights that patellar tendon repair with fascia lata augmentation yields good outcome.
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Pan X, Zhao G, Yang X, Hua Y, Wang J, Ying Q, Mi J. Contralateral C7 nerve transfer via the prespinal route in treatment of spastic paralysis of upper limb after cerebral palsy. Br J Neurosurg 2023; 37:1292-1296. [PMID: 33325256 DOI: 10.1080/02688697.2020.1859091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Upper limb spasticity leads to different degrees of disabilities in cerebral palsy, which seriously affects the life of patients. Contralateral C7 nerve transfer has been shown to improve function and reduce spasticity in the affected upper limb with post-stroke hemiplegia. However, reports about the efficacy of this procedure in treating upper limb spasticity caused by hemiplegic cerebral palsy were limited. CASE DESCRIPTION We reported two cases (a 23-year-old male and a 18-year-old female) who suffered from hemiplegic cerebral palsy with unilateral sustained upper limb spasticity and underwent contralateral C7 nerve transfer in adulthood. The scores of Fugel-Meyer and ROM of the affected upper limbs were observed before and after surgery. Compared with the preoperative, scores of the latest follow-up both were significantly improved. The muscle tension of the upper limbs decreased, and the symptoms of spasm were alleviated. CONCLUSIONS Considering contralateral C7 nerve transfer could effectively relieve spasticity and improve upper limb activity, it can be recommended as one of the reliable methods to manage spasticity and dystonia of upper limbs in patients with hemiplegic cerebral palsy.
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Affiliation(s)
- Xiaoyun Pan
- Orthopaedic Institute, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Gang Zhao
- Department of Sport Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Xiaojiao Yang
- Department of Rehabilitation Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Yong Hua
- Department of Sport Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Jun Wang
- Department of Rehabilitation Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Qiuwen Ying
- Department of Sport Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
| | - Jingyi Mi
- Department of Sport Medicine, The Ninth People's Hospital affiliated to Soochow University, Wuxi, China
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Lumsden DE. Neurosurgical management of elevated tone in childhood: interventions, indications and uncertainties. Arch Dis Child 2023; 108:703-708. [PMID: 36690424 DOI: 10.1136/archdischild-2020-320907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023]
Abstract
Elevated tone (hypertonia) is a common problem in children with physical disabilities. Medications intended to reduce tone often have limited efficacy, with use further limited by a significant side effect profile. Consequently, there has been growing interest in the application of Neurosurgical Interventions for the Management of Posture and Tone (NIMPTs). Three main procedures are now commonly used: selective dorsal rhizotomy (SDR), intrathecal baclofen (ITB) and deep brain stimulation (DBS). This review compares these interventions, along with discussion on the potential role of lesioning surgery. These interventions variably target spasticity and dystonia, acting at different points in the distributed motor network. SDR, an intervention for reducing spasticity, is most widely used in carefully selected ambulant children with cerebral palsy. ITB is more commonly used for children with more severe disability, typically non-ambulant, and can improve both dystonia and spasticity. DBS is an intervention which may improve dystonia. In children with certain forms of genetic dystonia DBS may dramatically improve dystonia. For other causes of dystonia, and in particular dystonia due to acquired brain injury, improvements following surgery are more modest and variable. These three interventions vary in terms of their side-effect profile and reversibility. There are currently populations of children for who it is unclear which intervention should be considered (SDR vs ITB, or ITB vs DBS). Concerns have been raised as to the equity of access to NIMPTs for children across the UK, and whether the number of surgeries performed each year meets the clinical need.
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Affiliation(s)
- Daniel E Lumsden
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
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McGrath M, Wood J, Walsh J, Window P. The impact of Three-Dimensional Gait Analysis in adults with pathological gait on management recommendations. Gait Posture 2023; 105:75-80. [PMID: 37490826 DOI: 10.1016/j.gaitpost.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/07/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Three-Dimensional Gait Analysis (3DGA) is a gold standard tool that can help identify pathological components of walking patterns. It has been well established that this tool influences the treatment decision making of clinicians treating paediatric patients with Cerebral Palsy, but it has not been established whether this tool changes decision making of clinicians treating adults with complex pathological gait. RESEARCH QUESTION To investigate the impact of pre-treatment 3DGA on treatment plans and management of adults with complex pathological gait. METHOD This retrospective audit examined the medical records of 87 patients undergoing pre-treatment 3DGA between 2014 and 2019. The review collected treatment plans from the initial referral, the post-gait analysis multidisciplinary report, and post-intervention progress notes with consistencies and differences noted throughout the care pathway. RESULTS Treatment plans of patients were altered in 80 % (N = 32) of patients following 3DGA assessment and recommendations. These treatment plan alterations included a change in surgery or avoidance of surgery, changes in orthosis prescriptions, casting or rehabilitation; and administration or changes in administration of Botulinum Neurotoxin (BoNT-A). In 47 % (N = 15) of cases the change in plans represented a de-escalation in intervention requirements (e.g. BoNT-A in lieu of surgical intervention), and in 31 % (N = 10) the change in plans represented an escalation in intervention requirements (e.g. requirement for surgery). These changes in treatment plans were either fully or partly enacted by the referring consultant in 86 % of cases. SIGNIFICANCE Pre-treatment 3DGA impacts the management of adult patients with complex pathological gait and facilitates patients potentially avoiding unnecessary interventions. Further investigation is needed to determine the cost effectiveness of 3DGA in this population and the impact of pre-treatment 3DGA on management outcomes.
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Affiliation(s)
- Michelle McGrath
- Queensland Motion Analysis Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - James Wood
- Queensland Motion Analysis Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - John Walsh
- The Menzies institute, Griffith university Gold Coast. Australia
| | - Peter Window
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service, Metro North Health and University of Queensland, Brisbane, Queensland, Australia; Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
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McMulkin ML, MacWilliams BA, Nelson EA, Munger ME, Chen BPJ, Novacheck TF, Carroll KL, Stotts AK, Carter LH, Mader SL, Hayes B, Baird GO, Schwartz MH. The long-term effects of aggressive spasticity reducing treatment, including selective dorsal rhizotomy, on joint kinematic outcomes of persons with cerebral palsy. Gait Posture 2023; 105:139-148. [PMID: 37572544 DOI: 10.1016/j.gaitpost.2023.07.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/13/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Selective dorsal rhizotomy (SDR) creates a large and permanent reduction of spasticity for children with cerebral palsy (CP). Previous SDR outcomes studies have generally lacked appropriate control groups, had limited sample sizes, or reported short-term follow-up, limiting evidence for improvement in long-term gait function. RESEARCH QUESTION Does aggressive spasticity management for individuals with CP improve long-term gait kinematics (discrete joint kinematics) compared to a control group of individuals with CP with minimal spasticity management? METHODS This study was a secondary analysis - focused on joint-level kinematics - of a previous study evaluating the long-term outcomes of SDR. Two groups of participants were recruited based on a retrospectively completed baseline clinical gait study. One group received aggressive spasticity treatment including a selective dorsal rhizotomy (Yes-SDR group), while the other group had minimal spasticity management (No-SDR group). Both groups had orthopedic surgery treatment. Groups were matched on baseline spasticity. All participants prospectively returned for a follow-up gait study in young adulthood (greater than 21 years of age and at least 10 years after baseline). Change scores in discrete kinematic variables from baseline to follow-up were assessed using a linear model that included treatment arm (Yes-SDR, No-SDR), baseline age, and baseline kinematic value. For treatment arm, 5° and 5 Gait Deviation Index points were selected as thresholds to be considered a meaningful difference between treatment groups. RESULTS At follow-up, there were no meaningful differences in pelvis, hip, knee, or ankle kinematic variable changes between treatment arms. Max knee flexion - swing showed a moderate treatment effect for Yes-SDR, although it did not reach the defined threshold. SIGNIFICANCE Aggressive spasticity treatment does not result in meaningful differences in gait kinematics for persons with cerebral palsy in young adulthood compared to minimal spasticity management with both groups having orthopedic surgery.
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Affiliation(s)
- Mark L McMulkin
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA.
| | - Bruce A MacWilliams
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | | | | | - Brian Po-Jung Chen
- Gillette Children's, USA; Motion Analysis Laboratory, Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan City, Taiwan; Department of Pediatric Orthopedics, Chang Gung Memorial Hospital - Linkou Branch, Taoyuan City, Taiwan
| | - Tom F Novacheck
- Gillette Children's, USA; University of Minnesota, Department of Orthopedic Surgery, USA
| | - Kristen L Carroll
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | - Alan K Stotts
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA; University of Utah, Department of Orthopedic Surgery, USA
| | - Lisa H Carter
- Motion Analysis Center, Shriners Children's - Salt Lake City, USA
| | - Shelley L Mader
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Brianna Hayes
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Glen O Baird
- Walter E. and Agnes M. Griffin Motion Analysis Center, Shriners Children's - Spokane, USA
| | - Michael H Schwartz
- Gillette Children's, USA; University of Minnesota, Department of Orthopedic Surgery, USA
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Westberry DE, Carson L, Shull ER, Hyer LC. Hip reconstruction in children with cerebral palsy: does magnitude of surgery influence complications and outcomes? J Pediatr Orthop B 2023; 32:461-469. [PMID: 37129017 DOI: 10.1097/bpb.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Children with cerebral palsy (CP) and neuromuscular hip dysplasia (NMHD) frequently require hip reconstruction including femoral and pelvic osteotomies. Outcomes and complications in CP patients with NMHD who underwent varying degrees of hip reconstruction surgeries were examined. Ninety-nine patients with a diagnosis of CP who underwent surgical management of NMHD over a 15-year period (2005-2020) were reviewed. Three patient cohorts with varying degrees of surgery were analyzed including: (1) unilateral femoral osteotomy with pelvic osteotomy; (2) bilateral femoral osteotomy with unilateral pelvic osteotomy; and (3) simultaneous bilateral femoral osteotomy and bilateral pelvic osteotomy. Data points included operative (OR) time, length of stay (LOS), estimated blood loss (EBL), and transfusion requirement. Complications during the perioperative and postoperative periods were identified and graded by severity. Increased EBL, need for transfusion, OR time, and LOS were observed more frequently in patients undergoing bilateral reconstruction. Complication rates were high for all three cohorts, with 87% of cases in the bilateral pelvic osteotomy cohort experiencing ≥1 complication. However, 90% of these were considered grade I or II and required no or minimal intervention. The average postoperative migration index at final follow-up for treated hips was significantly less in bilateral pelvic osteotomy cases. Patients with CP and bilateral NMHD can be safely managed with bilateral simultaneous comprehensive reconstruction. The data presented in this study can help both surgeons and families anticipate a more accurate postoperative course. Level of evidence: III.
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Affiliation(s)
- David E Westberry
- Shriners Hospitals for Children® - Greenville, Greenville, South Carolina, USA
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Asma A, Ulusaloglu AC, Howard JJ, Rogers KJ, McManus M, Miller F, Shrader MW. Does intrathecal baclofen therapy decrease the progression of hip displacement in young patients with cerebral palsy? Dev Med Child Neurol 2023; 65:1112-1117. [PMID: 36649172 DOI: 10.1111/dmcn.15509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/11/2022] [Accepted: 12/10/2022] [Indexed: 01/18/2023]
Abstract
AIM To evaluate the effects of intrathecal baclofen pump (ITBP) therapy on hip dysplasia in young patients with cerebral palsy (CP). METHOD This was a retrospective cohort series of prospectively collected data. Inclusion criteria were all patients with CP in Gross Motor Function Classification System (GMFCS) levels IV or V who underwent ITBP placement under 8 years old with at least 5 years of follow-up. Thirty-four patients were matched to a control group of 71 patients based on GMFCS level, motor type, medical comorbidities, worst hip migration percentage at ITBP placement, age, and Modified Ashworth scale scores. Patients were followed for at least 5 years or until they had hip reconstructive surgery. The primary outcome was the development of hip displacement as measured by the migration percentage at the latest follow-up or the preoperative migration percentage before hip reconstruction. RESULTS The migration percentage at last follow-up was not statistically different between groups (ITBP: 36.2%, non-ITBP: 44.4%, p = 0.14). The rates of future preventative, reconstructive, and recurrent hip surgery were not different between groups. INTERPRETATION The use of ITBP as an early treatment of spasticity did not alter the natural history of progressive hip displacement in non-ambulatory patients with CP and hip displacement is likely multifactorial, not solely due to spasticity.
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Affiliation(s)
- Ali Asma
- Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA
| | | | - Jason J Howard
- Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA
| | - Kenneth J Rogers
- Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA
| | - Maura McManus
- Division of Physical Medicine and Rehabilitation, Nemours Children's Health, Delaware, USA
| | - Freeman Miller
- Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA
| | - M Wade Shrader
- Department of Orthopedic Surgery, Nemours Children's Health, Delaware, USA
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Bacaksız T, Akan İ, Kazimoglu C. Split Transfer of the Tibialis Anterior Tendon Combined With Calcaneocuboid Fusion vs Split Transfer of the Tibialis Anterior Tendon Alone to Treat Equinovarus Foot Deformity in Children With Cerebral Palsy. Foot Ankle Int 2023; 44:528-538. [PMID: 37086001 DOI: 10.1177/10711007231165308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND The study aimed to compare the outcomes of combined calcaneocuboid arthrodesis and split anterior tibialis tendon transfer (SPLATT) procedure to isolated SPLATT surgery for the treatment of the spastic equinovarus deformity in children with cerebral palsy (CCP). METHODS Forty-one ambulatory CCP with 56 equinovarus feet, with positive flexor withdrawal reflex test results, were studied. The average age was 9.1 ± 3.2 years (range 3-22). Patients were assigned into 2 groups based on the surgical procedures. Patients in group 1 underwent isolated SPLATT surgery, whereas patients in group 2 underwent the SPLATT procedure combined with calcaneocuboid arthrodesis. All feet were followed for at least 12 months after surgery. Patients were evaluated preoperatively and at the most recent follow-up visit. The hindfoot positions were assessed using Chang's criteria, the functional outcomes were assessed using Kling's criteria, and the ambulatory levels were assessed using the Gross Motor Function Classification System (GMFCS). RESULTS Patients were followed for an average of 30.4 ± 14 (range 14-84) months. We found no difference between the groups in Chang's scoring (P = .550), better clinical outcomes (P = .034) according to the Kling criteria in SPLATT with calcaneocuboid fusion group, and postoperative GMFCS levels better in the SPLATT with calcaneocuboid fusion group (P = .025). CONCLUSION In this retrospective comparative study to treat children with spastic equinovarus feet, patients who had the SPLATT procedure combined with calcaneocuboid arthrodesis generally resulted in better functional outcomes compared to isolated SPLATT surgery in spastic equinovarus foot. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Tayfun Bacaksız
- İzmir Katip Celebi Üniversity, Department of Orthopeadics and Traumatology, İzmir, Turkey
| | - İhsan Akan
- İzmir Katip Celebi Üniversity, Department of Orthopeadics and Traumatology, İzmir, Turkey
| | - Cemal Kazimoglu
- İzmir Katip Celebi Üniversity, Department of Orthopeadics and Traumatology, İzmir, Turkey
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DE Lepeleere B, Forward M, Martens M, Plasschaert F. Surgical approach to forearm pronation deformity in patients with cerebral palsy: a systematic review. Acta Orthop Belg 2023; 89:183-194. [PMID: 37924533 DOI: 10.52628/89.2.11048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023]
Abstract
Background Pronation deformity in patients with cerebral palsy can have a major impact on upper limb functionality. There is lack of consensus in the literature about the preferred surgical technique to address this deformity. Study aim To evaluate and synthesize the outcome of different surgical techniques for pronation deformity in patients with cerebral palsy. Methodology The databases MEDLINE and Embase were searched for publications up to December 2021. Articles were considered eligible for inclusion when the included patients had a pronation deformity caused by cerebral palsy and results of surgical intervention for pronation deformity were examined. Evaluation of the quality of the retrieved study was conducted using the MINORS tool. Meta-analysis was not possible due to the heterogeneity of interventions and reported outcomes. Results Nineteen studies, involving 475 patients and eight different techniques were included. All studies reported gain of active supination in most patients. The effect of surgery on functional gain was less clear and there was a large heterogeneity of reported functional outcome measures. There were 46 reported complications. Overall quality of study design was poor, illustrated by the average MINOR score of 6.9/16. Overall, there is a high risk of bias due to poor internal and external validity of the studies. Conclusion Despite positive reports on gain in supination and functionality after most procedures addressing pronation deformity in CP patients, no conclusions can be drawn concerning the preferred technique due to the low quality of the evidence.
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Pruszczyński B, Synder M, Drobniewski M, Borowski A. More than 20 years of experience with Dega transiliac osteotomy in the treatment of dislocated hip joints in children with cerebral palsy. J Pediatr Orthop B 2023; 32:221-226. [PMID: 34028381 DOI: 10.1097/bpb.0000000000000872] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cerebral palsy in children, which is the result of a nonprogressing damage to the central nervous system, causes motor and posture disorders that change with age. The level of child activity correlates with the hip dislocation risk. It most often affects nonwalking patients and those with tetraparesis or oblique pelvis. The aim of the study was to assess the effectiveness and clinical value of Dega pelvic osteotomy with accompanying directional femoral bone osteotomy after minimum of 20 years from surgery of patients with cerebral palsy. The conducted research was retrospective and concerned the children operated at our Hospital. The assessment was carried out in 346 children with spastic hip during the years 1993-2000. The inclusion criteria were applied: unilateral dislocation of the hip, the observation period of at least 20 years, pelvic osteotomy by Dega method and combined with varus derotation femur osteotomy. The analysis involved fifteen patients. The follow-up period was minimum 20 years (20-27 years). The average migration percentage decreased from 88% down to 25%, and an improved range of mobility was observed in the operated joint after surgery. However, the range of mobility was again significantly reduced during the last control examination after a minimum of 20 years. In all hips, the degenerative joint disease was present. Pelvic transiliac osteotomy, according to Dega, with VDRO, ensures very effective correction of the deficit in femoral head coverage by the acetabulum in the upper, lateral and posterior parts. However, it does not prevent the development of the early degenerative disease of the joint.
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Affiliation(s)
- Błażej Pruszczyński
- Clinic of Orthopedics, Pediatric Orthopedics Medical University of Lodz, Lodz, Poland
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Josse A, Pons C, Printemps C, Chan-Waï-Nam J, Affes H, Brochard S, Thépaut M. Rectus femoris surgery for the correction of stiff knee gait in cerebral palsy: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109:103022. [PMID: 34314902 DOI: 10.1016/j.otsr.2021.103022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rectus femoris (RF) transfer was long the gold-standard treatment for stiff knee gait (SKG), but efficacy now seems less than that of distal RF release. The aim of the present study was to compare efficacy between the two. The study hypothesis was that both significantly improve 4 knee kinematic parameters at 1 year. PATIENTS AND METHOD A meta-analysis was performed, using PRISMA criteria, on the Medline, Science Direct, Cochrane Registry, Scopus and Pascal databases. Search was conducted up to March 1, 2020 by two authors (A.J & M.T). Study methodology was assessed on MINORS index. Inclusion criteria comprised patients with SKG, treated by RF transfer or distal release. Endpoints comprised: Peak Knee Flexion in swing phase (PKFSW), Knee Range of Motion (KROM), time to Peak Knee Flexion (t-PKFGC), and Maximum Knee Extension in stance phase (MKEST). Effect size was assessed on Standard Mean Deviation (SMD). RESULTS A total of 695 studies were identified, 16 of which were included: 14 transfer, 5 release. Data were analyzed for 1,079 limbs in 768 patients. Only transfer improved PKFSW, with small effect size (SMD=0.29). The other three parameters were improved by both techniques, with moderate effect size. DISCUSSION Results showed improved knee kinematics after RF transfer, but with small or moderate effect size. The effect of distal release on PKF could not be assessed, due to publication bias. The heterogeneity of studies and low levels of evidence call for caution in interpreting the present results. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Antoine Josse
- Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France.
| | - Christelle Pons
- Service de Rééducation Fonctionnelle, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
| | - Camille Printemps
- Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
| | - Julie Chan-Waï-Nam
- Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
| | - Hassene Affes
- Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
| | - Sylvain Brochard
- Service de Rééducation Fonctionnelle, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
| | - Matthias Thépaut
- Service de Chirurgie Pédiatrique, CHRU de Brest, 2, Avenue Foch, 29200 Brest, France
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Rasadurai A, Frank NA, Greuter LA, Licci M, Weber P, Jünemann S, Guzman R, Soleman J. Patient- and Caregiver-Reported Outcome Measures after Single-Level Selective Dorsal Rhizotomy in Pediatric and Young Adult Patients with Spastic Cerebral Palsy. Pediatr Neurosurg 2023; 58:128-135. [PMID: 37075708 PMCID: PMC10614523 DOI: 10.1159/000530748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/11/2023] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The aim of this cohort study was to assess the outcome of single-level selective dorsal rhizotomy (SDR) in children and young adults with spastic cerebral palsy (CP) treated at our institution, focusing on patient-reported outcome measures (PROMs) and quality of life (QoL) of patients and their caregivers. METHODS We included consecutive patients undergoing SDR from 2018 to 2020 at our institution. Subjective outcome was measured through PROMs, while functional outcome was measured through baseline characteristics, operative outcome, as well as short- and long-term follow-up. Furthermore, the effect of age at the time of surgery on patient/caregiver satisfaction was analyzed. RESULTS Seven patients (3 female, 43%) with a median age at surgery of 11.9 years (IQR 8.7-15.5) were included. All patients had a Gross Motor Function Classification (GMFCS) score of at least IV before surgery. Five surgeries were palliative and two non-palliative. Based on PROMs, SDR showed very good QoL and health-related outcome measures for both palliative and non-palliative patients. Patient/caregiver satisfaction was higher for the early subgroup (age ≤11) than the late subgroup (age >11). Functional outcome showed reduced spasticity in both groups. Blood transfusions were never needed, while no cerebrospinal fluid leak, infection, or permanent morbidity was seen. CONCLUSION Based on PROMs, SDR leads to high satisfaction and improved QoL, especially if done at an early age. Further studies with larger cohorts are necessary to underline and confirm our observations.
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Affiliation(s)
- Abeelan Rasadurai
- Faculty of Medicine, University of Basel, Basel, Switzerland,
- Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland,
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland,
| | - Nicole Alexandra Frank
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Ladina Aurea Greuter
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Maria Licci
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Peter Weber
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Stephanie Jünemann
- Department of Neuropediatrics, University Children's Hospital of Basel (UKBB), Basel, Switzerland
| | - Raphael Guzman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland
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A core outcome set for lower limb orthopaedic surgery for children with cerebral palsy: An international multi-stakeholder consensus study. Dev Med Child Neurol 2023; 65:e48-55. [PMID: 36807905 DOI: 10.1111/dmcn.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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50
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Pharmacological and neurosurgical interventions for individuals with cerebral palsy and dystonia: a systematic review update and meta-analysis. Dev Med Child Neurol 2023. [PMID: 36929103 DOI: 10.1111/dmcn.15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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