Timing of single-event multilevel surgical interventions on long-term motor outcomes in children and adolescents with cerebral palsy: A systematic review and meta-analysis

Background

The aim of this meta-analysis was to evaluate the impact of the timing of single-event multilevel surgery (SEMLS) on long-term motor outcomes in children and adolescents with cerebral palsy (CP).

Methods

A systematic review and meta-analysis were conducted by searching PubMed, Cochrane Library, Embase, and Web of Science databases for studies up to April 2024. Twelve eligible studies were included, from which we examined patients’ gait, stride length, walking speed, and the gross motor function measure (GMFM66).

Results

Gait analysis showed significant improvements in CP patients after SEMLS, which included an increased gait deviation index (p < 0.001), reduced Gillette gait index (p < 0.001), and reduced gait profile score (p < 0.001). Subgroup analysis showed that age at surgery (<12 years old vs. 12−18 years old) was not a factor affecting patients’ gait. Spatial and temporal parameters such as stride length (p < 0.001) and walking velocity (p = 0.02) also improved significantly after surgery. However, there were only trends towards broader motor function gains measured by the GMFM66 (p = 0.39).

Conclusions

SEMLS effectively improved key gait and mobility parameters in children and adolescents with CP, and was not affected by younger or older surgical ages (<12 years old or 12−18 years old). However, these gait improvements do not uniformly translate into broader motor function gains.