DOI: 10.12688/f1000research.166735.1 ISSN: 2046-1402

Early Surgical Interventions for Pediatric Cerebral Palsy: A Systematic Review and Meta-Analysis of Effects on Mobility, Independence, Developmental Outcomes, and Deformity Prevention.

Yazan Jumah Alalwani, Muath A. Alhasson, Mohammed A. Alahmari, Nouf Abdullah Alyabis, Mohammed Yousef Alhammrani, Ibtisam Heji Hussein AlBader, Sadeem Naeem Alshehri, Elyas Abdullah Saad Alashwan, Abeer Saud Alrasheed, Fatimah Abdulrahman Altakrouni, Ahmed Y. Azzam, Ammar K. Alomran
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Introduction Determining the optimal timing and type of surgical interventions for children with cerebral palsy (CP) remains challenging. This systematic review and meta-analysis aimed to investigate and evaluate the effects of early surgical interventions on functional mobility, independence, developmental trajectories, and deformity prevention in pediatric CP. Methods Following PRISMA 2020 guidelines, we searched multiple literature databases from inception up to May 18, 2025. Randomized and non-randomized studies evaluating surgical interventions (selective dorsal rhizotomy, single-event multilevel surgery, hip reconstruction, spinal fusion, intrathecal baclofen) in children with CP were included. Primary outcomes were changes in gross motor function, gait parameters, functional mobility, and independence measures. Results Thirty-two studies met our defined inclusion criteria. Children undergoing Selective Dorsal Rhizotomy (SDR) between ages four to seven-years showed sustained improvements in GMFM-66 scores (+9.5 points at five-years). Single-Event Multilevel Surgery (SEMLS) demonstrated optimal outcomes when performed at ages ten to 12-years, with Gross Motor Function Classification System (GMFCS) III patients being "benchmark responders" (Gait Deviation Index [GDI] improvement +12.1 points at one-year, maintained at +10.3 points after ten-years). Risk-benefit profiles varied significantly by GMFCS level, with interventions for GMFCS IV-V patients showing higher complication rates (20.5% for spinal fusion) but still providing good improvements in comfort and care. Conclusions Surgical interventions show age-specific and GMFCS-specific effectiveness. SDR demonstrates greatest benefit when performed earlier at four to seven-year old, while SEMLS shows optimal results in the ten to 12-year old range, especially for GMFCS III patients. Strategic timing of interventions based on functional classification can maximize developmental outcomes and deformity prevention.

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