Surgical orthopaedic management of cerebral palsy in adults: literature review and preliminary analysis of our treatment experience

Introduction Improving the quality of care has led to an increase in the life expectancy of patients with cerebral palsy and in the number of adult patients suffering from cerebral palsy. However, functional motor limitations aggravate after their physiological growth completion and the risk of pain increases. The aim of this work was to study the literature on the problem of surgical orthopedic treatment in adolescents and adults with cerebral palsy belonging to GMFCS levels I-IV of motor disorders as well as to make a preliminary analysis of the surgical orthopedic treatment performed in this category of patients at our institution. Materials and methods The results of multi-level single-event interventions were studied in 165 patients older than 16 years. The sample for analysis included cases that met the following criteria: age of 16 years and older, spastic types of cerebral palsy, GMFCS levels I–IV. In addition, some patients underwent botulinum therapy during the stages of surgical treatment. Results The maximum functional effect was manifested 12–24 months after the surgery if proper early and subsequent rehabilitation was provided. According to the Gillette Functional Assessment Questionaire, motor abilities improved in 81.3 %. Multilevel interventions included 2.3–3.5 elements on average during one surgical session. Current literature postulates the implementation of multi-level single-event interventions and indications for surgery and follow-up control are studied at a motion analysis laboratory. Conclusion Multi-level orthopedic interventions are indicated for patients who have completed physiological growth. Techniques of such interventions should provide early functional activity. Surgical orthopedic treatment in adult patients with cerebral palsy should be performed by the staff and at an institution that specialize in neuro-orthopedic

Assessment of the state of patients with spastic cerebral palsy at transition to adult medical institutions: a cross-sectional study

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years. Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17‑18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied. Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012). Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders