ArticleDevelopmental medicine and child neurology2026
Biomechanical and functional outcomes of high-burden and low-burden multilevel surgery in young people with cerebral palsy.
Article in Developmental medicine and child neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimTo compare changes in gait biomechanics and mobility function in ambulatory young people with cerebral palsy undergoing low-burden or high-burden multilevel orthopedic surgery (MLS).
methodThis retrospective cohort study examined young people with cerebral palsy (classified in Gross Motor Function Classification System [GMFCS] levels I-III) using preoperative and postoperative gait analysis data, including Gait Deviation Index (GDI), Gross Motor Function Measure-Dimension D (GMFM-D), gait velocity, Pediatric Outcomes Data Collection Instrument (PODCI), and walking activity. The impact of surgical burden and preoperative factors on outcomes was evaluated with paired t-tests and linear regression.
resultsA total of 287 young people (GMFCS level I = 13.9%, II = 58.9%, III = 27.2%; mean age 12 years 4 months [SD 3 years 10 months]) were included. Both low-burden (67.0 [SD 16.0] to 73.2 [SD 14.9]) and high-burden (67.0 [SD 14.3] to 70.7 [SD 12.9]; p < 0.001) groups exhibited improved GDI. GMFCS level (p < 0.01) and baseline GDI (p < 0.001) were significant factors for a change in GDI. The low-burden group exhibited functional improvements in GMFM-D (29.2 [SD 8.4] to 30.7 [SD 6.9]; p < 0.001), gait velocity (83.4 [SD 27.2] to 87.9 [SD 27.5]; p < 0.01), and PODCI (68.5 [SD 16.0] to 72.4 [SD 15.2]; p < 0.001); the high-burden group exhibited worse or lower gait velocity (76.2 [SD 27.5] to 71.1 [SD 31.4]; p < 0.01) and improvements in PODCI (65.1 [SD 15.9] to 67.4 [SD 16.2]; p < 0.05). GMFCS level and baseline measures were significant for changes in GMFM-D (p < 0.01) and gait velocity (p < 0.05) as worse baseline functioning was associated with greater improvements postoperatively.
interpretationWhile gait pattern improved in both groups, young people undergoing low-burden MLS had greater functional improvements. These findings provide evidence to help clinicians make surgical decisions, set expectations, and implement resources after MLS.
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