Single-event multilevel surgery in children with spastic diplegia: a pilot randomized controlled trial

Area of Science:

• Pediatric Orthopedics
• Rehabilitation Medicine
• Cerebral Palsy Research

Background:

• Single-event multilevel surgery (SEMS) is standard for improving gait in children with spastic diplegic cerebral palsy (SDCP).
• Evidence supporting SEMS efficacy is limited.
• This pilot study represents the first randomized controlled trial (RCT) investigating SEMS for SDCP.

Purpose of the Study:

• To evaluate the efficacy of SEMS in improving gait and functional outcomes in children with SDCP.
• To compare SEMS to a progressive resistance strength training program.

Main Methods:

• Nineteen children with SDCP were randomized into a surgical group (n=11) or a control group (n=8).
• The control group received strength training, then surgery; the surgical group continued follow-up.
• Primary outcomes included Gait Profile Score (GPS) and Gillette Gait Index (GGI); secondary outcomes included GMFM-66, FMS, upright time, and CHQ.

Main Results:

• The surgical group showed significant improvements in GPS (34%) and GGI (57%) at 12 months; the control group showed non-significant deterioration.
• Between-group differences in GPS and GGI changes were highly significant.
• Secondary outcomes did not differ significantly at 12 months, but improvements in GMFM-66, FMS, upright time, and CHQ physical functioning were noted by 24 months post-surgery.

Conclusions:

• SEMS provides Level-II evidence for improving gait in children with SDCP at 12 months post-surgery.
• Enhanced gross motor function and quality of life become evident by 24 months after SEMS.