Impact of single-event multilevel surgery on gait efficiency in children with cerebral palsy: a retrospective study

Corrado Borghi ¹, Daniela Pandarese ², Debora Formisano ³

⁰Pediatric Rehabilitation Unit, Azienda USL IRCCS di Reggio Emilia, Reggio Emilia, Italy - corrado.borghi@gmail.com.

European Journal of Physical and Rehabilitation Medicine +

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December 9, 2025

View abstract on PubMed

Summary

Single-event multilevel surgery significantly enhances gait efficiency and quality in children with cerebral palsy. This intervention optimizes joint mechanics for improved functional mobility.

Area Of Science

Pediatric Orthopedics
Rehabilitation Medicine
Biomechanical Engineering

Background

Single-event multilevel surgery (SEMS) is a common intervention for children with cerebral palsy (CP).
While SEMS effects on kinematics and spatiotemporal parameters are known, its impact on gait efficiency is less understood.
This study addresses the underexplored area of SEMS's effect on gait efficiency in pediatric CP.

Purpose Of The Study

To evaluate the impact of single-event multilevel surgery (SEMS) on gait efficiency and quality in children with cerebral palsy (CP).
To compare outcomes between surgically treated and non-surgically managed children with CP.
To identify specific improvements in joint kinematics and dynamics post-SEMS.

Main Methods

Retrospective analysis of gait data from 109 children with CP (2011-2022).
Comparison between a surgical group (81 patients undergoing SEMS) and a non-surgical group (28 patients).
Assessment of gait efficiency (joint extension, push-off power/energy) and quality (Gait Profile Score, Gait Variable Scores).

Main Results

SEMS group showed significant improvements in knee (6.1°) and hip (1.6°) extension.
Ankle push-off power (+24.1%) and energy (+19.8%) increased, while knee energy production decreased (-14%).
Gait Profile Score improved significantly (-2.8°), with notable reductions in knee, ankle, and foot progression angle deviations. Non-surgical group showed no significant changes.

Conclusions

Single-event multilevel surgery (SEMS) significantly enhances gait efficiency and quality in children with cerebral palsy (CP).
SEMS optimizes joint kinematics and dynamics, leading to improved gait mechanics.
The findings support SEMS as a crucial intervention for enhancing functional mobility in pediatric rehabilitation.