Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study.

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 and a 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° (P<0.001) and hip extension by 1.6° (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° (P<0.001). Significant gait variable score reductions included knee flexion-extension (-4.0°), ankle plantarflexion-extension (-3.8°), and foot progression angle (-4.0°). Spatiotemporal metrics remained largely unchanged. Correlations revealed a modest inverse relationship between age and push-off power (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.