Orthopedic Surgery to Improve Gait in Cerebral Palsy

Cerebral palsy (CP) is the most common cause of childhood-onset, lifelong physical disability, and of motor dysfunction affecting children with an estimated prevalence of 17 million people worldwide. Gait abnormailities associated with CP range from mild impairments such as walking on their toes to more severe gait dysfunction such as crouched and in-toed gait. These gait problems can lead to pain, deterioration in ambulant function, skeletal deformity and joint instability. Therefore the term „CP“ refers to a group of disorders of the development of movement and posture rather than to an aetiological diagnosis. There are many identified contributors to this disorder. However the cause remains unkown in about 15% of the cases. Clinical management of children with CP is directed towards maximizing the function of the body, activities and participation and in contrast minimizing the effects of the factors that implement further deterioration of gait. Treatment strategies can consist of a variety of options such as: orthotics, physical therapy or orthopedic surgery. In an interdisciplinary team other options such as pharmaco-therapeutic treatment (e.g. Botulinum toxin type A or Intra-thecal Baclofen) and neurosurgical procedures (Selective Dorsal Rhizotomy, SDR, or Deep Brain stimulation) should be considered as well as treatment options. For orthopedic surgical treatment there are many possibilities, but generally it includes corrections of bony deformities and soft tissue procedures. Often several surgical interventions are performed in one session, i.e. Single-event Multilevel Surgery approach (SEMLS). Therefore, SEMLS is defined as at least four surgical procedures, performed on two different anatomic levels (hip, knee, or foot and ankle) and on both sides of the body. The surgical procedure does not need to be symmetrical, but individually customised to the child’s needs. If the orthopedic problem is at one level, only, so called single level surgery might be sufficient as a less complex treatment option to fix the problem in one surgical session.