J Korean Med Assoc.  2008 May;51(5):475-482. 10.5124/jkma.2008.51.5.475.

Musculoskeletal Surgeries for Optimization of Ambulation Ability in Patients with Spastic Cerebral Palsy

• Kim HW
• Kwak YH

• KMID: 2185878
• DOI: http://doi.org/10.5124/jkma.2008.51.5.475

Abstract

Cerebral palsy is a disorder of movement and posture that arises from a congenital or acquired lesion of the immature brain. While the underlying cause is static, the musculoskeletal manifestations are progressive overtime. A variety of gait abnormalities are common, and orthopedic surgery typically is indicated when contractures or deformities decrease functions, cause pain, or interfere with activities of daily life. Surgical procedures should be scheduled to minimize the number of hospitalizations and interference with school and social activities. They can be divided into several groups of procedures; (1) to correct static or dynamic deformity, (2) balance muscle power across a joint, (3) reduce spasticity, and (4) stabilize uncontrollable joints. The clinical decision-making paradigm, consisting of clinical history, physical examination, diagnostic imaging, quantitative gait analysis, and examination under anesthesia makes it possible for single stage multi-level surgeries to reduce the long-term morbidity.

Keyword

Cerebral palsy; Gait; Musculoskeletal Surgeries

MeSH Terms

Anesthesia
Brain
Cerebral Palsy
Congenital Abnormalities
Contracture
Diagnostic Imaging
Gait
Hospitalization
Humans
Joints
Muscle Spasticity
Muscles
Orthopedics
Paralysis
Physical Examination
Posture
Walking

Figure

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  Figure 1 Lever-arm dysfunctions at the hip, knee, and the foot produce hip dislocation, patellar alta, and pathologic flatfoot, respectively.

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  Figure 2 Findings of gait analysis include temporospatial, kinematic, kinetic, and electromyographic parameters.

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  Figure 3 Younger child with spastic diplegia. He walks on his toes in equinus with extended hips and knees.

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  Figure 4 Calcaneal deformity caused by excessive lengthening of the Achilles tendon.

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  Figure 5 Genu recurvatum gait is generally secondary to pes equinus and incompetent ankle plantarflexion-knee extension couple.

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  Figure 6 A child showing jumping gait pattern with hips, knees, and ankles in flexion. The patient needs to hold hands or use a walker, and rarely they can balance themselves.

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  Figure 7 Crouch gait is characterized by increased knee and hip flexion with ankle dorsiflexion.

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  Figure 8 Malalignment syndrome consisting of increased femoral anteversion and external tibial torsion forcing the feet into valgus.

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  Figure 9 Planovalgus foot deformity.

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