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This study compares the initial outcomes of minimally invasive techniques for single-event multi-level surgery with conventional single-event multi-level surgery. The minimally invasive techniques included derotation osteotomies using closed corticotomy and fixation with titanium elastic nails and percutaneous lengthening of muscles where possible. A prospective cohort study of two matched groups was undertaken. Ten children with diplegic cerebral palsy with a mean age of ten years six months (7.11 to 13.9) had multi-level minimally invasive surgery and were matched for ambulatory level and compared with ten children with a mean age of 11 years four months (7.9 to 14.4) who had conventional single-event multi-level surgery. Gait kinematics, the Gillette Gait Index, isometric muscle strength and gross motor function were assessed before and 12 months after operation. The minimally invasive group had significantly reduced operation time and blood loss with a significantly improved time to mobilisation. There were no complications intra-operatively or during hospitalisation in either group. There was significant improvement in gait kinematics and the Gillette Gait Index in both groups with no difference between them. There was a trend to improved muscle strength in the multi-level group. There was no significant difference in gross motor function between the groups. We consider that minimally invasive single-event multi-level surgery can be achieved safely and effectively with significant advantages over conventional techniques in children with diplegic cerebral palsy.

Original publication

DOI

10.1302/0301-620x.92b10.24307

Type

Journal article

Journal

The Journal of bone and joint surgery. British volume

Publication Date

10/2010

Volume

92

Pages

1442 - 1448

Addresses

Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK. nicky.thompson@noc.nhs.uk

Keywords

Femur, Hip Joint, Knee Joint, Humans, Cerebral Palsy, Blood Loss, Surgical, Gait, Treatment Outcome, Early Ambulation, Intraoperative Period, Surgical Procedures, Minimally Invasive, Prospective Studies, Pilot Projects, Adolescent, Child, Female, Male, Muscle Strength