Single Event Multilevel Surgery in children with bilateral spastic cerebral palsy: A 5 year prospective cohort study

BackgroundSingle Event Multilevel Surgery (SEMLS) is considered the standard of care to improve gait and function in children with bilateral spastic cerebral palsy (BSCP). We have demonstrated in a randomized controlled trial (RCT) of SEMLS, that gait was improved at 12 months after surgery and gross motor function at 24 months after surgery. The question addressed in this study, was to determine if improvements in gait and function, would be maintained at 5 year follow-up.MethodsNineteen children with BSCP, GMFCS levels II (14 children) and III (5 children), mean age 9.7 years (range 7.7–12.2 years) participated in a prospective cohort study following participation in a RCT, with follow-up to 5 years. Outcome measures were Gait Profile Score (GPS), Gillette Gait Index (GGI), Gait Deviation Index (GDI), Gross Motor Function Measure (GMFM66) and Functional Mobility Scale (FMS).ResultsEighteen children have completed follow-up, with interval analysis at 1, 2 and 5 years post SEMLS. One child was excluded because of neurological deterioration and his diagnosis was revised to Hereditary Spastic Paraparesis (HSP). GPS improved by 5.29° and GMFM66 by 3.3% at 5 years post SEMLS. Differences between outcome measures at 1 versus 5 years and 2 versus 5 years (except GMFM66) were not significant, indicating that improvements in gait and gross motor function were stable over time.ConclusionsSEMLS results in clinically and statistically significant improvements in gait and function, in children with BSCP, which were maintained at 5 years after surgery.

► A five year prospective follow up of children with CP following SEMLS.
► Outcomes in Gait, gross motor function and activity were measured.
► Gait improvement (GGI, GPS) maintained 5 yrs post SEMLS (GGI 60% better, GPS 5.3°).
► Functional improvement (GMFM 66) maintained 5 years post SEMLS, GMFM66 3.3% better.
► Functional mobility (FMS) same or better at 5 yrs post SEMLS.
► Longer term follow up required.