A 10.5-year follow-up of walking with unilateral spastic cerebral palsy.

Purpose: The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years. Methods: Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t-tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed. Results: Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, p < 0.001) were negatively correlated. Conclusions: SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group. Level of evidence: This was a retrospective comparative therapeutic study (level III).

Simultaneous multisegmental and multifocal corrections of complex lower limb deformities with a hexapod external fixator.

INTRODUCTION: External fixators are a part of the therapeutic arsenal used in the correction of complex pediatric lower limb deformities. These long iterative procedures, which are commonly performed over several months, strongly impact the lives of these children and their families. To reduce these drawbacks, we perform, whenever possible, a simultaneous multisegmental and/or multifocal correction of these deformities. HYPOTHESIS: Simultaneous multilevel correction of complex pediatric deformities using external fixators does not result in more complications than sequential corrections. MATERIALS AND METHODS: Sixteen patients were treated with this hexapod external fixator correction procedure. The mean age was 13.9 years. The corrections involved 12 femurs and 20 tibias, representing 53 osteotomies on 23 limbs. The quality of the correction was assessed by measuring the mechanical axis deviation (MAD), residual limb length discrepancy (RLLD) and a new, specifically defined, criterion called the "angular healing index" (AHI). Complications were assessed according to Lascombes' classification. RESULTS: The mean MAD went from 30 to 13.5 mm (P<.05) and the mean RLLD from 33.2 to 6.9 mm (P<.05). The mean AHI was 74.1 days/cm (16.7 to 319). The overall complication rate was 13/23 operated limbs or 56.5% (4.3% grade 1, 43.3% grade 2, 9.3% grade 3, and no grade 4). DISCUSSION: One-stage multilevel corrections of complex pediatric lower limb deformities represent a difficult technical challenge, and any reduction in treatment time must not adversely impact the quality of the results. The rate and severity of complications compared to monofocal/segmental procedures were no higher than that reported in the literature. This study demonstrated the feasibility of multisegmental and multifocal corrections, which reduced the total treatment duration compared to successive corrections, without adversely affecting the result or increasing the complication rate. LEVEL OF EVIDENCE: IV; retrospective study.

Cardiopulmonary function in adolescent patients with pectus excavatum or carinatum.

BACKGROUND: Pectus excavatum (PE) and pectus carinatum (PC) have generally been considered an aesthetic issue, although there is growing evidence of associated cardiopulmonary function (CPF) impairment, especially in PE patients. The study goal was to determine any correlation between pectus malformations and cardiopulmonary symptoms and function based on systematic assessment of CPF and thoracic measurements, such as Haller Index (HI) and sternal torsion angle (STA). METHODS: Data from 76 adolescent patients with PE (n=30) or PC (n=46) were retrospectively collected referred between January 2015 and April 2018. CPF measurements and thoracic imaging were performed in all patients. HI and STA correction indexes were measured in all patients. FINDINGS: Medical records from 76 patients (PE n=30; PC n=46) were analysed. Patients were predominantly male (>93.3%), and aged between 13 and 14½ old. PE was associated with airway obstruction, with a forced expiratory volume in 1 s value under the lower limit of normal in 13% of cases (p<0.001). Restrictive syndrome was observed in 23% of cases (p<0.001), with a Z score for total lung capacity under the lower limit of normal. In PC, pulmonary function was not affected. All patients showed slightly decreased values of left and right ejection fraction and cardiac index at rest, although values were within normal range. There were no significant correlations between pulmonary and cardiac functions or between low CPF and thoracic measurements. INTERPRETATION: Our results confirm the modest impact of pectus malformations on CPF at rest, without correlation with anamnestic dyspnoea on exertion, nor with chest pain or anatomical measurements. Validation of new correction indexes could be helping characterise these malformations and choose optimal therapeutic management.

Irradiation level related to intraoperative imaging device in paediatric elastic stable intramedullary nailing: preliminary prospective study on 51 patients using PCXMC software.

PURPOSE: Radiation-induced cancers due to imaging devices concern above all the growing child, however, to date, intraoperative irradiation doses are not well-documented in children. The goal of the study was to evaluate the intraoperative doses received by patients operated with the use of a C-arm in traumatology, as well as the lifetime attributable risk of cancer death (LAR) related to the irradiation of the imaging device. METHODS: From 1 April 2017 to 31 March 2019, we started a multicentre study and prospectively recruited all consecutive children who needed elastic stable intramedullary nailing (ESIN) for long-bone fracture. We collected demographic and operative data, with dose reports including duration and doses. The main outcome was the effective dose (ED) in millisievert (mSv), calculated with PCXMC software, and the secondary outcome was the LAR expressed as a percentage. RESULTS: In all, 51 patients operated on using 2D C-arm imaging were included in this study. The mean ED was 0.085 mSv (sd 0.10; 0.002 to 0.649). Overall LAR was 6.5 x 10-4% (sd 6.7 x 10-4%; 0.1 x 10-4% to 28.3x10-4%). Univariate linear regression showed a significant association between ED and irradiation time (p < 0.001). There was no significant association between ED and other outcomes (p > 0.05). CONCLUSION: Treatment of long-bone fractures by ESIN found a low level of effective doses with utilization of the C-arm device in current practice. Further studies on a larger sample are needed to confirm these results. LEVEL OF EVIDENCE: II.

Lower limb lengthening and deformity correction in polyostotic fibrous dysplasia using external fixation and flexible intramedullary nailing.

The study describes preliminary experience of the use of external fixators for limb lengthening and deformity correction in combination with flexible intramedullary nailing in management of polyostotic fibrous dysplasia. PATIENTS AND METHODS: The retrospective study included 8 patients (mean age 11.6 ± 3.38 years; range 7-17 years) with polyostotic fibrous dysplasia operated on using external circular frame and flexible intramedullary nailing. Mean follow-up was 2.6 years. Surgical technique consisted of percutaneous osteotomy of a segment and application of circular external frame. The intramedullary nailing was done using two bent nails. Hydroxyapatite-coated nails were applied in three patients; five patients had titanium nails. Amount of lengthening (cm and %), amount of deformity correction, duration of external fixator use, index of external fixation, "nail/medullary canal at narrowest site" ratio, "nail-medullary canal at osteotomy site" ratio were analyzed. Results and complications were assessed according to Lascombes's classification. RESULTS: The mean amount of lengthening was 4.5 cm (or 13.7 ± 6.0% per segment). This gave a mean external fixation index of 32.5 ± 13.97 days/cm. The mean ratio of IM nail diameter/medullary canal diameter at the narrowest site was 0.22 ± 0.07 (range, 0.125-0.3 mm). No migration of IM nails into medullary canal were noticed. But in one case there was external migration of Ti-nail. In a year after frame removal, the results of treatment were classified as grade I in 7 cases and IIb in one case.At the latest follow-up control, mechanical axis deviation was found within normal limits in six patients. Two patients had excessive MAD of 11 and 28 mm. In the first case a partial varus deformity recurrence occurred at middle shaft site where a large dysplastic zone was presented. In the second case, a specific shepherd's crook deformity developed and caused excessive MAD. Mean lower limb length discrepancy varied from 1 to 15 mm. CONCLUSION: There are advantages of using elastic intramedullary nailing and external fixation in the treatment of limb length discrepancy and deformity of long bones in patients with PFD. This strategy ensures reduced external fixation time and high accuracy of alignment. Intramedullary nails left in situ, especially nails with HA-coating, seem to prevent deformity recurrence and stimulate remodeling in dysplastic fibrous zones.

Follow-up of walking quality after end of growth in 28 children with bilateral cerebral palsy.

PURPOSE: Assessment of surgical treatments on gait in patients with bilateral cerebral palsy (CP) is often performed in short-term studies. The purpose of this study was to analyze the influence of single-event multilevel surgery (SEMLS) on long-term evolution of gait using gait deviation index (GDI) and walking speed. METHODS: In all, 28 patients with bilateral CP (Gross Motor Function Classification System I to III) with two clinical gait analyses (CGA) were included (mean age: 9.0 years (sd 2.9) at the first CGA, 19.6 years (sd 4.1) at the last, all of them at skeletal maturity). GDI, walking speed and their changes were calculated. Statistical analysis was performed to observe differences between baseline and follow-up CGA. Pearson's correlations were conducted to evaluate the associations between GDI and walking speed changes with: GDI at baseline and walking speed at baseline. GDI and walking speed evolution have been analyzed for two groups of patients: with and without SEMLS. RESULTS: Regardless of the treatment, GDI was significantly higher at follow-up CGA (baseline: 73.1 (sd 13.1) versus follow-up: 80.1 (sd 13.2); p = 0.014). Significant negative correlations were found between GDI change and GDI at baseline (r = -0.52; p = 0.004) and between walking speed change and walking speed at the baseline (r = -0.70; p < 0.001). Regarding the group of patients with or without SEMLS, only significant improvement of GDI was found for patients with SEMLS (at baseline: 69.0 (sd 12.1) versus follow-up: 77.8 (sd 11.2); p < 0.05). CONCLUSION: Analysis at skeletal maturity showed a gait quality maintained for patients without SEMLS and an improvement for patients with SEMLS. LEVEL OF EVIDENCE: Level III.

Combined technique with hydroxyapatite coated intramedullary nails in treatment of anterolateral bowing of congenital pseudarthrosis of tibia.

PURPOSE: The goal of this study is to evaluate the treatment outcomes of anterolateral bowing and residual deformities of distal tibia in patients with CPT using circular external fixation and hydroxyapatite coated flexible intramedullary nailing without excision of affected part of tibia. PATIENTS AND METHODS: Six patients (4 boys and 2 girls, mean age 12.4 ±â€¯4.1 years) were included in the study. Mean follow-up is 2.1 years. In 4 patients with early onset of disease initial surgical treatment (at age of 5-8 years) was dysplastic zone or pseudarthrosis resection with proximal metaphyseal osteotomy for bone transport. Children with unbroken bowed tibia (2 cases of type II according to Crawford classification) had no previous surgery. Neurofibromatosis type I was diagnosed in 4 cases. Surgical technique for residual deformity correction consisted of percutaneous osteotomy, application of circular external frame and composite hydroxyapatite-coated intramedullary nailing. RESULTS: Mean external fixation time was 95.3 ±â€¯17.5 days. All patients never get fractured after frame removal. At the present time, they are considered to be healed, in 2.1 years, in average, without fractures or deformity recurrence. Mean lower limb length discrepancy varied from 2 to 10 mm at the latest follow-up control. After realignment procedure, patients didn't require additional surgery but one. Intramedullary nails were removed in two years after deformity correction for individual reason. CONCLUSION: Correction of anterolateral bowing or residual deformity in children with CPT is indicated. Association of external fixation with intramedullary nailing/rodding left in situ after frame removal ensure stability and accuracy of deformity correction. Biological methods of stimulation of bone formation in dysplastic zone are obligatory to ensure bone union. Intramedullary nailing with composite hydroxyapatite-coated surface provides mechanical and biological advantages in patients with CPT.

IDH1 immunohistochemistry reactivity and mosaic IDH1 or IDH2 somatic mutations in pediatric sporadic enchondroma and enchondromatosis.

Mosaic somatic mutations in the isocitrate dehydrogenase 1/2 (IDH1/2) genes have been identified in most enchondromas by targeted mutation analysis. Next-generation sequencing (NGS), that may detect even low-level mosaic mutation rates, has not previously been applied to enchondromas. Immunohistochemistry using the H09 clone is routinely used as a surrogate for the common R132H IDH1 mutation in gliomas. We compared immunohistochemistry and NGS results in a series of 13 enchondromas from 8 pediatric patients. NGS identified a heterozygous IDH mutation in all enchondromas, showing identical mutation status in patients with multiple tumors assessed, thereby confirming somatic mosaicism. A majority of the tumors harbored an IDH1 mutation (p.R132H in 3 tumors; p.R132C in 4 tumors from 2 patients; p.R132L and p.R132G in one tumor each). A p.R172S IDH2 mutation was identified in 4 enchondromas, but not in the ependymoma from one patient with Ollier disease, who further displayed a heterozygous STK11 missense mutation. IDH mutation rates varied between 14% (indicative of mutations in 28% of the cells and of intratumoral mosaicism) and 45% (tumor content was close to 100%). Cytoplasmic H09 reactivity was observed as expected in tumors with an IDH1 p.R132H mutation; cross-reactivity was seen with the p.R132L variant. This first NGS study of pediatric enchondromas confirms that IDH mutations may occur in a mosaic fashion. STK11 gene mutations may provide insights in the development of multiple cartilaginous tumors in enchondromatosis, this tumor suppressor gene having been shown in animal models to regulate both chondrocyte maturation and growth plate organization during development.

Intra-medullary osteosclerosis of the tibia in children.

BACKGROUND: Intra-medullary osteosclerosis of the tibia is a rare condition characterised by chronic pain due to diaphyseal hyperostosis with no detectable triggering factor. The main differential diagnoses are stress fracture and osteoid osteoma. Of the few cases reported to date, most were in adults. The objective of this study was to assess paediatric patients with intra-medullary osteosclerosis to determine whether the first visit provides sufficient information to establish the diagnosis and rule out both osteoid osteoma and stress fracture, whether a biopsy is required, and which treatment is optimal. HYPOTHESIS: The diagnosis of intra-medullary osteosclerosis of the tibia can be made at the first visit. PATIENTS AND METHODS: Seven paediatric patients, 4 males and 3 females, with a mean age of 11 years, were included in this retrospective study. We evaluated the clinical features, findings from imaging studies (standard radiographs, computed tomography, magnetic resonance imaging, and bone scintigraphy), and treatment outcomes. RESULTS: At the first visit, all patients had a painful swelling at the middle of the shin and imaging study evidence of antero-lateral tibial cortical thickening extending into the medullary cavity; in 5 patients, a linear lucency was visible. No other bone abnormalities were seen. Treatments included non-operative measures, pinning, and nailing. None of these treatments provided permanent bone healing or pain relief, although transitory freedom from pain with or without radiological bone healing was achieved. DISCUSSION: Intra-medullary osteosclerosis of the tibia is rarely reported and therefore probably underdiagnosed. Distinctive characteristics of the cortical and endosteal thickening include location at the antero-lateral mid-diaphysis and, in some cases, the concomitant presence of a linear lucency that can provide the early diagnosis. The distinctive radiological features allow differentiation from a stress fracture. The management is challenging. LEVEL OF EVIDENCE: IV, retrospective observational study.

Limb lengthening and deformity correction in children with abnormal bone.

Flexible intramedullary nailing (FIN) provides multiple advantages in limb lengthening and progressive deformity correction in combination with external fixation. The article presents brief literature review and authors' experience in limb lengthening of abnormal bone (Ollier's disease, fibrous dysplasia, osteogenesis imperfecta). Titanium and, especially, hydroxyapatite-coated bent elastic nails in combination with external fixator are appropriate in limb lengthening of abnormal bone in children. FIN left in situ after lengthening procedure and external frame removal should be applied for long-term reinforcement of lengthened bone in patients with abnormal bone (metabolic bone disorders, skeletal dysplasias with compromised bone tissue development). The FIN respects bone biology, which is mandatory for good bone consolidation. Osteoactive properties of intramedullary elastic implants are favorable for bone formation and as well as for stable position of nails without risks of migration in long-term follow-up.

[Pectus excavatumn and carinatum in children and adolescents : what to say, what to do ?] / Pectus excavatum et carinatum chez l'enfant et l'adolescent : que dire, que faire ?

In children presenting with a pectus excavatum (PE) or pectus carinatum (PC) an underlying syndrome including Marfan's syndrome needs to be excluded. In adolescents, severe chest wall deformities may cause cardiac or respiratory problems but most commonly they have a psychological impact. The conservative treatment is a Vacuum Bell for PE, and a Dynamic Compression System for PC ; they play an increasing role in young patients. These devices need to be worn multiple hours per day for several months for an optimal result. Surgery is usually reserved for adolescents. The Nuss procedure for PE, also known as minimal invasive repair of PE offers excellent results. Sterno-chondro-plasty with stabilisation of the sternum with struts clipped to the ribs offers the same good results for PC. In our opinion, a multidisciplinary approach is preferable.

En présence d'un thorax en entonnoir (pectus excavatum, PE) ou en carène (pectus carinatum, PC), une affection syndromique, dont la maladie de Marfan, doit être recherchée. La déformation, avant tout disgracieuse, peut générer des troubles psychologiques chez l'adolescent, et des désordres cardiorespiratoires dans les formes sévères. Les traitements conservateurs sont très utiles chez le jeune : cloche aspirante pour PE ou corset dynamique de compression pour PC. Ils sont portés quelques heures par jour pendant plusieurs mois selon un « contrat moral ¼ établi avec l'enfant. La chirurgie peut être négociée chez l'adolescent. La technique mini-invasive par thoracoscopie de Nuss offre des résultats satisfaisants dans les PE. Il en est de même des sternochondroplasties fixées par des attelles-agrafes pour les PC. Un avis pluridisciplinaire est utile.

Validity and Reliability of Spine Rasterstereography in Patients With Adolescent Idiopathic Scoliosis.

STUDY DESIGN: Test-retest study. OBJECTIVE: This study aimed to evaluate the validity and reliability of rasterstereography in patients with adolescent idiopathic scoliosis (AIS) with a major curve Cobb angle (CA) between 10° and 40° for frontal, sagittal, and transverse parameters. SUMMARY OF BACKGROUND DATA: Previous studies evaluating the validity and reliability of rasterstereography concluded that this technique had good accuracy compared with radiographs and a high intra- and interday reliability in healthy volunteers. To the best of our knowledge, the validity and reliability have not been assessed in AIS patients. MATERIALS: Thirty-five adolescents with AIS (male = 13) aged 13.1 ±â€Š2.0 years were included. To evaluate the validity of the scoliosis angle (SA) provided by rasterstereography, a comparison (t test, Pearson correlation) was performed with the CA obtained using 2D EOS® radiography (XR). Three rasterstereographic repeated measurements were independently performed by two operators on the same day (interrater reliability) and again by the first operator 1 week later (intrarater reliability). The variables of interest were the SA, lumbar lordosis, and thoracic kyphosis angle, trunk length, pelvic obliquity, and maximum, root mean square and amplitude of vertebral rotations. The data analyses used intraclass correlation coefficients (ICCs). RESULTS: The CA and SA were strongly correlated (R = 0.70) and were nonsignificantly different (P = 0.60). The intrarater reliability (same day: ICC [1, 1], n = 35; 1 week later: ICC [1, 3], n = 28) and interrater reliability (ICC [3, 3], n = 16) were globally excellent (ICC > 0.75) except for the assessment of pelvic obliquity. CONCLUSION: This study showed that the rasterstereographic system allows for the evaluation of AIS patients with a good validity compared with XR with an overall excellent intra- and interrater reliability. Based on these results, this automatic, fast, and noninvasive system can be used for monitoring the evolution of AIS in growing patients instead of repetitive radiographs, thereby reducing radiation exposure and decreasing costs. LEVEL OF EVIDENCE: 4.

Current approaches to flexible intramedullary nailing for bone lengthening in children.

Limb-length discrepancies and extremity deformities are among the most common non-traumatic orthopaedic conditions for which children are hospitalised. There is a need to develop new treatment options for lower-limb length discrepancy in order to ameliorate treatment outcomes, avoid or reduce rates of complication and provide early rehabilitation. The authors report on the basic principles, experimental and clinical data, advantages, problems and complications of a combined technique associating the Ilizarov method and flexible intramedullary nailing (FIN) in limb lengthening and deformity correction in children. They describe features of the use of hydroxyapatite-coated intramedullary nails in patients with certain metabolic bone disorders and in cases where bone consolidation has been compromised. The advantages of bone lengthening using a combined technique (circular fixator plus FIN) are a lower healing index, quicker distraction-consolidation, a reduced rate of septic and bone complications, the ability to correct deformities gradually and the increased stability of bone fragments during the external fixation period and after frame removal.

Residual bone growth after lengthening procedures.

The prognosis of limb length discrepancy is a major subject in paediatric orthopaedic surgery. The strategy depends on the prognosis and must be adapted to each patient. The residual growth of the lengthened segment often remains unknown, but is dependent on age, the percentage of lengthening and other factors. Using a large cohort of 150 children who had undergone bone lengthening procedures, we describe five patterns of post-intervention growth and identify factors that are favourable for normal residual growth. The criteria for bone lengthening which should maintain good residual growth are-bone age at lengthening should be before the pubertal growth spurt; the interval between two lengthening procedures should be over three years; the percentage of lengthening should be <30% of the initial segment; and no more than two lengthening procedures should be carried out during infancy.

Are clinical parameters sufficient to model gait patterns in patients with cerebral palsy using a multilinear approach?

The aim of this study was to evaluate whether clinical parameters are sufficient using, a multilinear regression model, to reproduce the sagittal plane joint angles (hip, knee, and ankle) in cerebral palsy gait. A total of 154 patients were included. The two legs were considered (308 observations). Thirty-six clinical parameters were used as regressors (range of motion, muscle strength, and spasticity of the lower). From the clinical gait analysis, the joint angles of the sagittal plane were selected. Results showed that clinical parameter does not provide sufficient information to recover joint angles and/or that the multilinear regression model is not an appropriate solution.

Transient synovitis of the hip: which investigations are truly useful?

QUESTIONS UNDER STUDY/PRINCIPLES: To assess the usefulness of several laboratory and radiological investigations for the limping child with suspected transient synovitis of the hip. METHODS: The medical records of children admitted at our children's hospital for nontraumatic hip pain between 1999 and 2007 were retrospectively reviewed. During the study period, all children without a definite diagnosis after routine investigations in the emergency department were admitted and a specific work-up including antinuclear antibodies titre, rheumatoid factor, antistreptolysin O titre, Lyme disease serology and hip ultrasonography were obtained. Children were systematically re-evaluated 6 weeks after hospital discharge, with a clinical examination and radiological hip views. Patients were diagnosed with transient synovitis of the hip if an ultrasound-confirmed hip effusion was present at time of admission, complete resolution of symptoms occurred without any specific treatment, and no other pathology of the hip was identified during follow-up. RESULTS: A total of 417 cases without definite diagnosis were admitted and were submitted to a specific work-up. Transient synovitis of the hip was subsequently diagnosed in 383 patients, septic arthritis in 1 patient, and Lyme arthritis in 1 patient. Thirty-two patients remained without diagnosis. No rheumatological condition was found. CONCLUSION: Our results suggest that most investigations performed during the initial work-up in patients suspected transient synovitis of the hip are unnecessary and should routinely include only white blood cell count, C-reactive protein, erythrocyte sedimentation rate, and hip radiography and ultrasonography. No further investigations are necessary during follow-up for transient synovitis of the hip in asymptomatic children.

Trunk movements during gait in cerebral palsy.

BACKGROUND: Lower limb deficits have been widely studied during gait in cerebral palsy, deficits in upper body have received little attention. The purpose of this research was to describe the characteristics of trunk movement of cerebral palsy children in terms of type of deficits (diplegia/hemiplegia) and gross motor function classification system (1, 2 or 3). METHODS: Data from 92 cerebral palsy children, which corresponds to 141 clinical gait analysis, were retrospectively selected. Kinematic parameters of trunk were extracted from thorax and spine angles in the sagittal, transverse and coronal planes. The range of motion and the mean positions over the gait cycle were analysed. Intra-group differences between the children with diplegia or hemiplegia, gross motor function classification systems 1 to 3 and typically developing participants were analysed with Kruskal-Wallis tests and post hoc tests. Pearson correlation coefficients between the gait profile score normalised walking speed and kinematic parameters of the thorax were assessed. FINDINGS: The results revealed: 1) the range of motion of the thorax and spine exhibited more significant differences between groups than the mean positions; 2) greater levels of impairment were associated with higher thorax range of motion, and 3) the children with diplegia and gross motor function classification system 3 exhibited a greater range of motion for all planes with the exception of spine rotation. INTERPRETATION: This study confirmed that greater levels of impairment in cerebral palsy are associated with greater thorax range of motion during gait. The thorax plays an important role during gait in cerebral palsy.