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Functional and radiographic outcomes of adductor myotomy in patients with spastic cerebral palsy
Author(s) -
A MARQUEZ-LARA,
V SWAROOP,
L DIAS,
S TAYLOR,
J VALENTINE,
L CAREY,
C ELLIOTT
Publication year - 2015
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.41_12886
Subject(s) - cerebral palsy , spastic , myotomy , medicine , spastic quadriplegia , physical medicine and rehabilitation , spastic cerebral palsy , radiography , surgery , achalasia , esophagus
Background/Objectives: Hip displacement is the second most common musculoskeletal deformity in children with spastic cerebral palsy (SCP). Adductor myotomy (AM) can delay or prevent worsening hip subluxation and may obviate further procedures. However, considerable debate remains over the success of this preventive intervention in management of SCP. The purpose of this study was to analyze functional and radiographic outcomes of AM and assess risk factors associated with subsequent interventions. Study Design: Retrospective cohort study. Study Participants and Setting: Consecutive series at a tertiary referral center of all patients with SCP who underwent AM by a single surgeon between 1977–2007 (Table 1). Exclusion criteria were < 5 year postoperative follow-up, < 12 years old at final follow-up, and concomitant bony procedure at index surgery. Materials/Methods: Charts/radiographs were reviewed for demographics, function (GMFCS), type of AM, hip range of motion (ROM), and Reimer Index (RI). Subgroup analysis comparing GMFC level 1–3 versus level 4–5 was performed. Multivariate regression, with a 95% confidence interval, was performed to assess the risks associated with subsequent AM and hip osteotomy. Statistical analysis utilized independent Ttest for continuous and v-test for categorical variables. Alpha of p < 0.05 denoted statistical significance. Results: 134 patients had sufficient data for inclusion. After average follow-up of 8.6 years, 82 (61.2%) did not require further surgical intervention. 17 patients (12.7%) required two or more AM, 12 (8.9%) underwent a bony procedure, and 23 (17.2%) required both an additional AM and an osteotomy. 75% of the GMFCS 1–3 group required only a single AM, compared to 56% in the GMFCS 4–5 group (p<0.05). Patients with lower functional capacity (GMFCS 4–5) more often required revision AM than higher functioning patients (38.0% vs. 14.6%, p < 0.05). However, the rate of bony surgery did not significantly differ based upon GMFCS (28.0% vs. 18.8%, p=0.28). After controlling for demographics, subsequent AM was associated with increased risk of osteotomy (p<0.05). At final follow up, average bilateral RI was < 30 in both groups. Conclusions/Significance: AM is a successful procedure to address hip displacement in ~60% patients with SCP. Need for revision surgery is higher in patients with higher GMFCS. However, need for bony surgery did not correlate with GMFCS level. Our results suggest patients who require >1 AM are at increased risk for bony surgery. This study affirms that AM continues to have an important role in the treatment of hip displacement in patients with SCP. This data helps to counsel patients and their families on risk of further surgery based on functional level.