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Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study
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DOI：10.23736/S1973-9087.25.08924-5.png)
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Abstract
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BACKGROUND: Single-event multilevel surgery is a widely used intervention for improving gait in children with cerebral palsy. While its effects on kinematics and spatiotemporal parameters are well documented, its impact on gait efficiency remains underexplored. AIM: To evaluate the impact of single-event multilevel surgery on gait efficiency and quality in children with cerebral palsy. DESIGN: Retrospective study. SETTING: Pediatric Rehabilitation Unit at AUSL-IRCCS, Reggio Emilia, Italy, using pre-and post-surgical gait analysis data collected from 2011 to 2022. POPULATION: The study included 109 children with cerebral palsy, categorized into a surgical group (81 patients) who underwent single-event multilevel surgery anda non-surgical group (28 patients). METHODS: Single-event multilevel surgery targeted lower limb pathologies using soft tissue and skeletal corrections. Gait efficiency was assessed through maximum knee and hip extension, and push-off power and energy. Gait quality was evaluated using the Gait Profile Score and Gait Variable Scores. Spatiotemporal parameters were also measured. RESULTS: In the surgical group, maximum knee extension improved by 6.1 degrees (P<0.001) and hip extension by 1.6 degrees (P=0.023). Ankle push-off power (+24.1%) and energy (+19.8%) increased significantly, while knee energy production decreased (-14%). Gait Profile Score improved by-2.8 degrees (P<0.001). Significant gait variable score reductions included knee flexion-extension (-4.0 degrees), ankle plantarflexion-extension (-3 .8 degrees), and foot progression angle (-4.0 degrees). Spatiotemporal metrics remained largely unchanged. Correlations revealed a modest inverse relationship between age and push-offpower (rho=-0.28, P=0.012) and an association between Gross Motor Function Classification System levels and push-off power (P=0.018). The non-surgical group showed no significant changes in any efficiency or quality metrics. CONCLUSIONS: Single-event multilevel surgery significantly improves gait efficiency and quality in children with cerebral palsy by enhancing joint kinematics and dynamics. CLINICAL REHABILITATION IMPACT: these findings highlight single-event multilevel surgery's capacity to optimize gait mechanics, prioritizing efficiency and quality improvements over maximal walking performance. This supports its use as a key intervention for improving functional mobility in rehabilitation settings.
Keywords:
Cerebral palsy
Gait analysis
Biomechanical phenomena
Orthopedic procedures
Rehabilitation
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