Impact of Age on Gait Deviations and Function After Single Event Multilevel Surgery in Children With Cerebral Palsy.

Abstract

Single event multi-level surgery (SEMLS) is the standard of orthopaedic care for children with cerebral palsy (CP). The optimal age to perform SEMLS is unclear, with studies showing positive results from childhood to adulthood. Few studies have combined clinical gait analysis with participation and activity outcome measures. The purpose of this study was to examine the effect of age on changes in gait parameters, activity, and participation in children with CP who underwent SEMLS with a follow-up time of 8 to 48 months. One hundred twenty-eight participants met the inclusion criteria. Ninety-one participants (71%) were aged under 11 years and 37 participants (29%) were 11 years or older. Changes in gait deviation index (GDI), walking velocity, stride length, functional mobility scale (FMS), and pediatric outcomes data collection instrument (PODCI) scores were calculated. The impact of age on outcomes was analyzed in age groups (<11 vs. ≥11 y) using linear and ordered logistic regression. The Gross Motor Function Classification System level was included as a covariate in all analyses. There was no difference between age groups for preoperative to postoperative change in GDI, walking velocity, or FMS. The younger group significantly improved GDI, stride length, and global and upper extremity PODCI scores after SEMLS, while the older group significantly improved GDI only. The PODCI upper extremity subscale was the only variable impacted by age group ( P =0.02). Children with CP who undergo SEMLS at any age are likely to see improvements in the GDI. Those under 11 years at the time of SEMLS also show improvements in stride length and global and upper extremity PODCI scores, while those older than 11 years are likely to maintain but not improve their levels of activity and participation. Level III-retrospective comparative study.