Work

Biomechanical and functional outcomes of high‐burden and low‐burden multilevel surgery in young people with cerebral palsy

Year: 2026

Type: article

Abstract: AIM: To compare changes in gait biomechanics and mobility function in ambulatory young people with cerebral palsy undergoing low-burden or high-burden multilevel orthopedic surgery (MLS). METHOD: This retrospective cohort study examined young people with cerebral palsy (classified in Gross Motor Function Classification System [GMFCS] levels I-III) using preoperative and postoperative gait analysis data, including Gait Deviation Index (GDI), Gross Motor Function Measure-Dimension D (GMFM-D), gait velocity, Pediatric Outcomes Data Collection Instrument (PODCI), and walking activity. The impact of surgical burden and preoperative factors on outcomes was evaluated with paired t-tests and linear regression. RESULTS: A total of 287 young people (GMFCS level I = 13.9%, II = 58.9%, III = 27.2%; mean age 12 years 4 months [SD 3 years 10 months]) were included. Both low-burden (67.0 [SD 16.0] to 73.2 [SD 14.9]) and high-burden (67.0 [SD 14.3] to 70.7 [SD 12.9]; p < 0.001) groups exhibited improved GDI. GMFCS level (p < 0.01) and baseline GDI (p < 0.001) were significant factors for a change in GDI. The low-burden group exhibited functional improvements in GMFM-D (29.2 [SD 8.4] to 30.7 [SD 6.9]; p < 0.001), gait velocity (83.4 [SD 27.2] to 87.9 [SD 27.5]; p < 0.01), and PODCI (68.5 [SD 16.0] to 72.4 [SD 15.2]; p < 0.001); the high-burden group exhibited worse or lower gait velocity (76.2 [SD 27.5] to 71.1 [SD 31.4]; p < 0.01) and improvements in PODCI (65.1 [SD 15.9] to 67.4 [SD 16.2]; p < 0.05). GMFCS level and baseline measures were significant for changes in GMFM-D (p < 0.01) and gait velocity (p < 0.05) as worse baseline functioning was associated with greater improvements postoperatively. INTERPRETATION: While gait pattern improved in both groups, young people undergoing low-burden MLS had greater functional improvements. These findings provide evidence to help clinicians make surgical decisions, set expectations, and implement resources after MLS.

Source: Developmental Medicine & Child Neurology

DOI: 10.1111/dmcn.70264