Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit

Background: Spastic cerebral palsy (CP) remains the most common type of CP and may be managed surgically or non-surgically depending upon its severity. Recent advances have replaced single-level surgery by the concept of multilevel surgery where multiple levels of musculoskeletal pathology, in one/both lower limbs, are addressed during one operative procedure, requiring only one hospital admission and one period of rehabilitation. This study assessed the outcome of lower limb soft tissue surgery in children with spastic CP in a government rehabilitation unit and measured its feasibility with limited infrastructure facilities and patient compliance.Methods: The study comprised of 26 patients aged between 2-12 years. Physical examination and GMFCS scores were recorded and evaluation of sitting balance, standing balance and gait were done. Musculotendinous soft tissue lower limb surgery was performed at one or more levels unilaterally or bilaterally and the results were interpreted.Results: Complete or near complete correction of deformities were attained by all children postoperatively. Significant improvements were noted in the gross motor functional classification system (GMFCS) scores. All parents and children were satisfied with the surgical outcome and reported improvement in functional abilities and locomotion in the follow-up along with better quality of life and mobility. Conclusions: Lower limb soft tissue surgery is a valuable aid in improving functional abilities and locomotion in children with spastic CP. Surgery should be undertaken depending upon clinical indications and can be successfully carried out in government hospitals with ordinary infrastructure in developing countries as well.

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Soft tissue surgery as an initial treatment for hip displacement in spastic cerebral palsy

SICOT-J ◽

10.1051/sicotj/2020036 ◽

2020 ◽

Vol 6 ◽

pp. 38

Author(s):

Luiz Antônio Angelo da Silva ◽

Patricia Maria de Moraes Barros Fucs

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Small Sample ◽

Acetabular Index ◽

Soft Tissue Release ◽

Spastic Cerebral Palsy ◽

Hip Displacement ◽

Migration Percentage ◽

Soft Tissue Surgery

Objective: To use the measurement of migration percentage (MP) to evaluate the long-term radiographic results of soft tissue surgery as the first treatment for hip displacement in spastic bilateral cerebral palsy. A secondary objective was to identify predictive factors of stability (i.e., less than 30% of MP in the long term), after surgical correction. Methods: In this longitudinal cohort study, we reviewed the electronic medical records and radiographs of all consecutive patients with cerebral palsy operated for the correction of hip displacement between 1984 and 2013 in a referral orthopedic public hospital in Brazil. Patients were included if they had received, as the first surgical procedure, soft-tissue release. All surgeries were bilateral and symmetrical. We used the available radiographs to evaluate the migration percentage (MP), acetabular index (AI), pelvic obliquity (PO) angle, head-shaft angle (HSA), congruence and femoral head sphericity, and function using the GMFCS (Gross Motor Function Classification System). Results: we included 93 patients, all operated before being 12 years old, with follow-up of 10 years in average, 73 (78%) of them with good results (MP < 30%). We found association between preoperative MP ≤ 40%, AI ≤ 25°, and postoperative symmetry with good results, with a cut-off value of 38% of MP and 27° of acetabular index being predictive. Discussion: The role of soft tissue releases remains controversial owing to small sample sizes, heterogeneity, variety range of ages, definitions used for outcome, and lack of statistical quality. Our results were better in combined tenotomies, in diparetic patients aged more than six years, and in patients with lower initial values of MP and AI. Radiographic variables had good correlation with each other and association with results, with cut-off values for MP and AI PRE.

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Short-term Gait Parameters Change in Mild Spastic Cerebral Palsy after Selective Dorsal Rhizotomy Guided by Our Newly-Modified Protocol

10.21203/rs.3.rs-278334/v1 ◽

2021 ◽

Author(s):

wenbin jiang ◽

Shuyun Jiang ◽

Yan Yu ◽

Qijia Zhan ◽

Min Wei ◽

...

Keyword(s):

Cerebral Palsy ◽

Lower Limbs ◽

Spastic Cerebral Palsy ◽

Selective Dorsal Rhizotomy ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Dorsal Rhizotomy ◽

Gait Parameters

Abstract Background Selective Dorsal Rhizotomy (SDR) guided by our modified protocol can decrease spasticity in certain muscles. This study aimed to investigate gait parameters changes in cerebral palsy (CP) with focal spasticity after SDR in short-term follow-up. Methods CP classified as Gross Motor Function Classification System (GMFCS) level Ⅰ and Ⅱ who underwent SDR were included. Changes of spasticity, gait parameters and gait deviation index (GDI) were retrospectively reviewed. Results This study contained 26 individuals with 44 affected and 8 intact lower limbs (4 monoplegia, 4 hemiplegia and 18 diplegia). Mean age was 5.7 ± 1.9 years-old and follow-up duration was 9.9 ± 6.6 months. After SDR, average spasticity of 108 target muscles decreased from 2.9 ± 0.8 to 1.8 ± 0.6 in Modified Ashworth Scale (MAS). Kinematic curves changed after the surgery in sagittal and transverse plane in affected sides, further investigation showed improvements in ankle and knee. No changes were found in temporal-spatial parameters except decrease in cadence in affected sides. GDI improved significantly in affected limbs. Conclusion In short-term follow up, the new-protocol-guiding SDR can lower focal spasticity, GA showed improvements in kinematic parameters and GDI. Longer follow-up duration is needed to clarify the long-term outcome.

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Clinical and physiological consideration of the influence of soft tissue contractures on walking ability in spastic cerebral palsy

Journal of Biomechanics ◽

10.1016/0021-9290(92)90399-l ◽

1992 ◽

Vol 25 (7) ◽

pp. 732

Author(s):

N. Suzukil ◽

M. Watakabe ◽

K. Mita ◽

Y. Takemitsu

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Spastic Cerebral Palsy ◽

Walking Ability

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Soft Tissue Release for Subluxation of the Hip in Children with Spastic Cerebral Palsy.

Orthopedics & Traumatology ◽

10.5035/nishiseisai.46.152 ◽

1997 ◽

Vol 46 (1) ◽

pp. 152-154

Author(s):

Yuichiro Yazaki ◽

Masaru Higo ◽

Ken-ichi Nishimura

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Soft Tissue Release ◽

Spastic Cerebral Palsy

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The Hip in Children With Cerebral Palsy: Predicting the Outcome of Soft Tissue Surgery

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199707000-00021 ◽

1997 ◽

Vol 340 ◽

pp. 165-171 ◽

Cited By ~ 55

Author(s):

Mark S. Cornell ◽

N. Cameron Hatrick ◽

Roslyn Boyd ◽

Gillian Baird ◽

John D. Spencer

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Children With Cerebral Palsy ◽

Soft Tissue Surgery

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Soft Tissue Surgery for Equinus Deformity in Spastic Hemiplegic Cerebral Palsy: Effects on Kinematic and Kinetic Parameters

Yonsei Medical Journal ◽

10.3349/ymj.2006.47.5.657 ◽

2006 ◽

Vol 47 (5) ◽

pp. 657 ◽

Cited By ~ 14

Author(s):

Chang Il Park ◽

Eun Sook Park ◽

Hyun Woo Kim ◽

Dong-wook Rha

Keyword(s):

Cerebral Palsy ◽

Soft Tissue ◽

Kinetic Parameters ◽

Hemiplegic Cerebral Palsy ◽

Equinus Deformity ◽

Soft Tissue Surgery

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Evaluation of autonomic nervous system in children with spastic cerebral palsy: clinical and electophysiological study

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-021-00092-z ◽

2021 ◽

Vol 48 (1) ◽

Author(s):

Hanan G. Azouz ◽

Ali M. AbdelMohsen ◽

Hayam M. Abdel Ghany ◽

Rana M. Mohamed

Keyword(s):

Cerebral Palsy ◽

Autonomic Dysfunction ◽

Postural Hypotension ◽

Head Tilt ◽

Sympathetic Skin Response ◽

Lower Limbs ◽

Tilt Test ◽

Spastic Cerebral Palsy ◽

Healthy Children ◽

Skin Response

Abstract Background Cerebral palsy (CP) is the most prevalent severe motor disability among children. The aim of this work was to assess autonomic dysfunction in children with cerebral palsy clinically and electrophysiologically. Results Age of the studied children ranged from 4 to 12 years. Quadriplegic type of spastic cerebral palsy constituted 82.5% of CP children while diplegic type constituted 17.5%. Based on Gross Motor Function Classification System (GMFCS), the majority of children were in levels 4 and 5. The prevalence of autonomic dysfunction symptoms were 80% for thermoregulatory abnormalities (cold extremities), 65% for chronic constipation, 52.5% for sleep disturbance, 47.5% for loss of appetite, 40% for sweating abnormalities, 25% for recurrent nausea and/or vomiting, 22.5% for increased sensitivity to light or dark and 15% for bloating. As regards sympathetic skin response, 19 CP children had unobtainable response in both upper and lower limbs while 5 children had unobtainable response in lower limbs only. All of them were in levels 4 and 5 of GMFCS. Postural hypotension was present in 20% of CP children. Mean Heart rate of CP children was significantly increased more than healthy children upon head tilt test. Conclusions Autonomic dysfunction has been objectively proven in CP children through absent sympathetic skin response, presence of orthostatic tachycardia and postural hypotension.

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