The results of orthopedic correction of neurogenic deformities of limbs and spine in children with cerebral palsy

Long-term tonic disorders in children with cerebral palsy can cause serious deformities of the limbs and spine, causing pain, limiting motor activity and maintenance of patients who are unable to move independently. The purpose of this study was to improve the results of orthopedic surgical treatment of neurogenic deformities of limbs and spine in children with cerebral palsy by performing orthopedic surgical interventions on the musculoskeletal system.

Materials and methods. The results of orthopedic and surgical treatment of 89 patients with cerebral palsy aged 4 to 18 years who were undergoing inpatient treatment at the V.F. Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children in 2022–2024 were analyzed. The effectiveness of the treatment was assessed based on the results of a survey of the patients’ parents using the Gillette questionnaire.

Results. The surgical treatment made it possible to eliminate contractures of the hip, knee, and ankle joints, restore congruence in the hip joints, and correct foot deformities. As a result of the treatment, the average correction of scoliotic deformity was 63%, and the correction of pelvic misalignment reached 55%. In the period from 12 to 24 months after the surgical intervention, according to the questionnaire, an increase in the volume of movements in the joints, an improvement in the balance of the trunk, appearance, easier transportation, improved self-care, improved respiratory function, and a decrease in pain were revealed.

Conclusion. The results of treatment are manifested by improvements in the social adaptation of patients, the emergence of opportunities forself-care, verticalization and mobility of patients in a wheelchair, as well as easier care for patients who are unable to move independently.

1. Persson-Bunke M., Hägglund G., Lauge-Pedersen H., Wagner P., Westbom L. Scoliosis in a total population of children with cerebral palsy. Spine 2012; 37:E708–E713. DOI:10.1097/BRS.0b013e318246a962

2. Graham H.K., Rosenbaum P., Paneth N., Dan B., Lin J.P., Damiano D.L., et. al. Cerebral palsy. Nat. Rev. Dis. Primers. 2016; (2): 15082. DOI: 10.1038/nrdp.2015.82

3. Ryabykh S.O., Gubin A.V., Savin D.M., Filatov E.Yu., Ochirova P.V., Ryabykh T.V., Sergeenko O.M. Spinal deformities in children with cerebral palsy: natural course and methods of correction. Genij ortopedii. 2021; 27 (4): 468–474. (in Russ.). DOI: 10.18019/1028–4427–2021–27–4–468–474

4. Buyukavcı R., Buyukavcı M.A. Effects of ultrasound-guided botulinum toxin type-A injections with a specific approach in spastic cerebral palsy. Acta Neurol. Belg. 2018; 118 (3): 429–433. DOI: 10.1007/s13760-018-0929-5

5. Palisano R., Rosenbaum P., Walter S., Russell D., Wood E., Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology. 1997; 39 (4): 214–223. DOI: 10.1111/j.1469-8749.1997.tb07414.x

6. Sandström K., Alinder J., Oberg B. Descriptions of functioning and health and relations to a gross motor classification in adults with cerebral palsy. Disabil Rehabil 2004; 26: 1023– 1031. DOI: 10.1080/09638280410001703503

7. Baranov A.A., Namazova-Baranova L.S., Kurenkov A.L., Klochkova O.A., Karimova X.M., Mamedyarov A.M., et. al. Comprehensive assessment of motor functions in patients with cerebral palsy. M.: Pediatr; 2014; 84 (in Russ.).

8. Zherdev K.V., Pak L.A., Volkova M.O., Zubkov P.A., Chelpachenko O.B. Current directions of optimization of surgical treatment of musculoskeletal disorders in spastic forms of cerebral palsy. Rossijskij pediatricheskij zhurnal. 2018; 21 (3): 175–181. (in Russ.). DOI: 10.18821/1560–9561–2018–21–3–175–181

9. Elmeshneb M.A., Hassanin M.A., Elnady B., Sleem A., Le G.T., Patel M.S., Quraishi N.A. Surgical complications in neuromuscular scoliosis surgery: systematic review and meta-analysis of the last ten years. Eur Spine J. 2024; 33 (7): 2666–2676. DOI: 10.1007/s00586-024-08338-y

10. Gorton G.E. 3rd, Stout J.L., Bagley A.M., Bevans K., Novacheck T.F., Tucker C.A. Gillette Functional Assessment Questionnaire 22-item skill set: factor and Rasch analyses. Dev Med Child Neurol. 2011; 53 (3): 250–255. DOI: 10.1111/j.1469-8749.2010.03832.x