Evaluation of the condition of adolescent patients with spastic types of cerebral palsy admitted for orthopedic surgery: a cross-sectional study

Introduction Cerebral palsy (CP) is the most common neurological disorder in children, associated with movement disorders. The maximum age for reconstructive surgery is twelve years, but the optimal age for maintaining the results of multi-level orthopedic interventions is considered to be the second half of the adolescence period. Analysis of established orthopedic impairments and their impact on gait, as well as their characteristics depending on previous interventions, is of interest for determining the optimal conditions for reconstructive surgery on the lower extremities in adolescents.

The purpose of this study was to evaluate the kinematic and kinetic gait parameters of adolescents with cerebral palsy (GMFCS I–III) before orthopedic surgery using a cross-sectional comparative analysis. The null hypothesis was the absence of differences in gait parameters between patients with previous orthopedic surgery and those who did not undergo it.

Materials and methods This retrospective study included 102 adolescents aged 13–17 years with cerebral palsy, divided into two groups: Group A (GMFCS I–II, n = 63) and Group B (GMFCS III, n = 39). Three subgroups were identified in each group based on surgical history. All patients underwent computer video gait analysis. The gait analysis presents the parameters as medians with a percentile distribution level of 25 %–75 %. The unpaired Wilcoxon test (p ≤ 0.05) was used for comparison. The relationship between the parameters was assessed using Spearman's rank correlation. The chi-square test for binary samples was used to compare the incidence of the crouch gait pattern.

Results Gait characteristics revealed a predominance of horizontal movement disorders (due to torsional deformities) in previously unoperated GMFCS I–II patients, while the prevalence of crouch gait increased in the remaining subgroups. An increase in decompensated crouch gait patterns was observed in the subgroups of patients who underwent early triceps surae interventions. A significant difference was found between groups 1A and 2A in the incidence of decompensated crouch gait (chi-square test, p = 0.002). No significant differences were found between the other subgroups.

Discussion The systemic nature of motor impairments in children with cerebral palsy and the resulting orthopedic disorders, necessitate not only the assessment and monitoring of individual orthopedic impairments of the lower extremity locomotor chains but also the consideration of integrated movement indices (GPS), as well as kinematic and kinetic data in their interrelationships.

Conclusion In patients with GMFCS levels I–II and no previous orthopedic interventions, indications for surgical treatment are determined by joint contractures and torsional deformities of the lower extremity segments. In patients with GMFCS level III, the crouch gait pattern, which remains compensated, predominates in adolescence. In the group of patients with triceps surae lengthening performed at an early age, the development of compensated and decompensated types of crouch gait with high-energy movements was observed. This should be taken into account both when choosing a surgical treatment strategy and during subsequent rehabilitation measures and orthotics. In adolescents with previous multilevel interventions, torsional deformities, recurrent contractures, and the development of knee flexion remained indications for surgical treatment. However, the spatiotemporal and strength characteristics of movements remained relatively high.

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