Long-term development of gait after multilevel surgery in children with cerebral palsy: a multicentre cohort study

AimWe investigated the long-term efficacy and safety of multilevel surgery (MLS) in ambulatory children with bilateral spastic cerebral palsy (CP). MethodTwo hundred and thirty-one children were evaluated at short term (1.1y, SD 0.4) and long term (9.1y, SD 3.0) follow-up using clinical examination and gait analysis. MLS was investigated by studying changes in the Gait Profile Score (GPS) referenced to the minimally important clinical difference. ResultsAmbulatory children aged 10 years and 7 months (SD 2y 11mo) at MLS in Gross Motor Function Classification System levels I (19), II (144), and III (68) showed a decrease (improvement) in preoperative GPS from 16.3 degrees (SD 4.8) to 11.3 degrees (SD 3.2) at short-term follow-up, an improvement of 5 degrees. At long-term follow-up, GPS was maintained at 11.4 degrees (SD 3.1). Overall, 177 (76.6%) children maintained their improvement in GPS after 9 years. InterpretationMultilevel surgery is a safe and effective surgical intervention, which leads to a significant improvement in gait kinematics in children with bilateral spastic CP. This study improves our understanding of MLS in the long term and will help to inform families and children when planning for MLS.