Predictors affecting outcome after single-event multilevel surgery in children with cerebral palsy: a systematic review

Abstract

Aim: To review the potential predictors of outcome after single-event multilevel surgery (SEMLS) in children with cerebral palsy (CP). Method: A literature search using the following criteria was performed in six electronic databases: (1) children with cerebral palsy; (2) analysed potential predictors of outcome after SEMLS; (3) minimum 12 months follow-up. The potential predictors were predefined: sex; topographical distribution; socio-economic status; Gross Motor Function Classification System (GMFCS) level; preoperative kinematic summary statistic; age at surgery. Study quality was appraised with the methodological index for non-randomized studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. Results: Of the seven studies identified, the MINORS scores ranged from 9 to 11 and all were graded 2b on the Oxford Centre for Evidence-Based Medicine scale. There was little or no evidence to support sex, topographical distribution, or socio-economic status as predictive factors after SEMLS. Preoperative Gait Profile Score (GPS) was the best measure of expected improvement in gait kinematics. Parent-reported satisfaction and GPS were best after SEMLS in children graded GMFCS II. The best long-term results were seen in those aged between 10 years and 12 years of age. Interpretation: The candidate who might expect to realize the most improvement from SEMLS is aged between 10 years and 12 years, is in GMFCS level II, and has a poor preoperative GPS. What this paper adds: Children aged 10 to 12 years, in Gross Motor Function Classification System level II, with a poor preoperative Gait Profile Score might expect to realize the most improvement after single-event multilevel surgery.