Team Approach: Single-Event Multilevel Surgery in Ambulatory Patients with Cerebral Palsy

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A 10-year old girl with spastic diplegic cerebral palsy (CP) is evaluated for difficulty with walking and tripping. Medical history includes prematurity, low birth weight, neonatal intensive care unit stay, ventilator support, and developmental delay. Surgical history includes selective dorsal rhizotomy at the age of 7 years with improvement in gait and energy expenditure (Video 1 and Video 2). The patient has weekly physical therapy for lower-extremity motion and strengthening and has follow-up with orthopaedic surgery and physiatry services for serial examinations and hip surveillance. She functions at Gross Motor Function Classification System (GMFCS) Level I 1 .
{ "href" : "Single Video Player" , "role" : "media-player-id" , "content-type" : "play-in-place" , "position" : "float" , "orientation" : "portrait" ,"label" : "Video 1" ,"caption" : "Video showing the gait of a 7-year-old girl with cerebral palsy (GMFCS Level I) before selective dorsal rhizotomy." ,"object-id" : [ { "pub-id-type" : "doi" ,"id" : "10.2106/JBJS.RVW.16.00101.vid1" }, { "pub-id-type" : "other" , "content-type" : "media-stream-id" ,"id" : "JBJSRVW1600101V1" } ] }
{ "href" : "Single Video Player" , "role" : "media-player-id" , "content-type" : "play-in-place" , "position" : "float" , "orientation" : "portrait" ,"label" : "Video 2" ,"caption" : "Video showing the gait of the same patient at the age of 9 years, 2 years after rhizotomy. The patient has improvement in spasticity and decreased energy expenditure but continues to have lever-arm dysfunction (internal femoral torsion, dynamic internal hip rotation, external tibial torsion)." ,"object-id" : [ { "pub-id-type" : "doi" ,"id" : "10.2106/JBJS.RVW.16.00101.vid2" }, { "pub-id-type" : "other" , "content-type" : "media-stream-id" ,"id" : "JBJSRVW1600101V2" } ] }
Examination reveals no fixed contractures, excessive internal hip rotation, increased femoral anteversion, and increased external transmalleolar axes, suggesting external tibial torsion. Left and right popliteal angles are 40° and 50°, respectively.
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