Outcomes of Selective Percutaneous Myofascial Lengthening Surgery (SPML) In Children with Lower Extremity Spasticity

Abstract

Cerebral palsy (CP) is a neurodevelopmental condition defined as a disorder of posture and movement that is caused by a nonprogressive abnormality of an immature brain which can result in spasticity (Paneth, 2006; Pelligrino, 2002). Children with spastic CP usually present with muscle stiffness which eventually leads to decreased range of motion (ROM) in the knee and ankle joints interfering with gait and functional mobility (Graham, 2003). The purpose of this study was to assess changes in dynamic ROM of the knee and ankle and functional mobility following Selective Percutaneous Myofascial Lengthening Surgery (SPML) in a group of children with spastic CP. SPML is a minimally invasive surgical procedure designed to lengthen tight muscles of the lower extremity. Subjective and objective measures were obtained from medical records and video tapes of gait. Pre-operative and follow–up videos of gait for 31 children with CP who underwent SPML surgery from 2006 to 2008 were evaluated retrospectively. The outcome measures considered for this study included sagittal plane kinematic parameters of the knee and ankle joint, gait speed, and functional mobility. Mixed model for repeated measures for the knee and ankle joint parameters were used to estimate the change in ROM. Statistically significant differences in ROM were found for most joint measurements at p<0.05 in pre and post-operative comparisons, except for plantarflexion at toe-off. There was no difference in gait speed. FMS ratings improved by 1 level at 5 m, 50 m, and 500 m distances. The results of this study indicate that the SPML surgery, can positively affect dynamic ROM of the knee and ankle during gait, as well as improve functional mobility at 5 m, 50 m, and 500 m. This study provides information regarding a minimally invasive surgical option for children with spastic CP.