Evaluating the effectiveness of the technology of single-event multi level surgery in children with cerebral palsy

O.I. Korolkov, P.M. Rakhman


Background. Cerebral palsy is a non-progressive lesion of the developing brain in children, but the associated pathology of the musculoskeletal system often progresses in the growing body of the child. The interrelated combination of disorders such as contractures and joint instability, muscle dysfunction, bone deformities at different levels affect the quality and effectiveness of gait in children with cerebral palsy. Treatment of orthopedic pathology in children with cerebral palsy requires understanding of the biomechanical mechanisms of formation of these disorders and the features of neurological deficits during the development of the child’s body and plays a major role in reducing the functional limitations associated with musculoskeletal disorder. Single-event multilevel surgery (SEMLS) is the gold standard for the treatment of orthopedic pathology in children with cerebral palsy to avoid repeated surgical interventions. The goal of SEMLS is to correct all deformities of the musculoskeletal system that affect the quality of support and walking in one surgical session. The surgical procedure includes the correction of rigid muscle contractures by lengthening the tendons, eliminating muscle imbalance with tendon transplants, correction of bone deformities, and measures aimed at stabilizing the joints. Materials and methods. A retrospective study of treatment from 2006 to 2016 was conducted, it included 270 children (145 boys and 125 girls) aged 3 to 18 years. All children were divided into 2 groups: in the first group, multistage interventions (227 interventions on 340 segments) were performed on one segment; in the second group — SEMLS (120 interventions on 602 segments) were used. Results. A comparative analysis of the remote results of treatment was performed in both groups of patients according to the following criteria: the total duration of the bed-day for the next year from the beginning of treatment; the total duration of immobilization; the duration of rehabilitation before the start of walk. In accordance with the obtained results it was revealed that in children in the study group, the total duration of bed days was by an average of 25 ± 4 days less than in the control group; the total duration of immobilization, if necessary, was also by an average of 25 ± 4 days less than in the control group; the duration of rehabilitation before the start of walking is 3.5 months, in contrast to the control group, in which this period is 6.5 months. Conclusions. Treatment of children with cerebral palsy is a complex problem and should be built on the principles of stages. In the absence of the effect of conservative treatment for contractures of the lower extremities at the age of 2–3 years and older, there is a need to perform surgeries on soft tissues, from the proximal extremities to the distal ones, followed by the continuation of combination treatment. When carrying out treatment by this method, it is easier to adhere to the stage and sequence of therapy (conservative — surgical — rehabilitation). The time of children’s stay in hospital and rehabilitation centers is significantly lower, which significantly reduces the cost of treatment and makes it possible to receive secondary special education.


cerebral palsy; single-event multilevel surgery; children


Дитячі церебральні паралічі / В.І. Козявкін, М.О. Бабадагли, С.К. Ткаченко, О.О. Качмар. — Львів: Медицина світу, 1999. — 312 с.

Gorton III G.E., Abel M.F., Oeffinger D.J. et al. A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy // J. Pediatr Orthop. — 2009. — 29. — Р. 903-909.

Корольков О.І., Рахман П.М. Результати застосування технології одномоментних багаторівневих втручань у дітей з ДЦП // Соціальна педіатрія та реабілітологія. — 2017. — Т. 18, № 5. — С. 101-106.

Seniorouc M., Thompsona N., Harringtona M., Theo-logis T. Recovery of muscle strength following multi-level orthopaedic surgery in diplegic cerebral palsy // Gait Posture. — 2007. — 26. — Р. 475-481.

Nene A.V., Evans G.A., Patrick J.H. Simultaneous multiple operations for spastic diplegia. Outcome and functional assessment of walking in 18 patients // J. Bone Joint Surg. — 1993. — 75. — Р. 488-494.

Rang M. Cerebral palsy / Morrissy R. // Lovell and Winter’s Pediatric Orthopaedics. 3rd ed. — Philadelphia: JB Lippincott Co., 1990. — Р. 465-506.

Norlin R., Tkaczuk H. One-session surgery for correction of lower extremity deformities in children with cerebral palsy // J. Pediatr. Orthop. — 1985. — 5. — Р. 208-11.

Graham H.K. Classifying cerebral palsy // J. Pediatr. Orthop — 2005. — 25. — Р. 127-8.

Russell D., Rosenbaum P., Avery L., Lane M. Gross Motor Function Measure (GMFM-66 & GMFM-88) User’s Ma­nual // Clinics in Developmental Medicine No. 159. — London: Mac Keith Press, 2002.

Schwartz M.H., Viehweger E., Stout J., Novacheck T.F., Gage J.R. Comprehensive treatment of ambulatory children with cerebral palsy: an outcome assessment // J. Pediatr Orthop. — 2004. — 24. — Р. 45-53.

Saraph V., Zwick E.B., Zwick G. et al. Multilevel surgery in spastic diplegia: evaluation by physical examination and gait analysis in 25 children // J. Pediatr. Orthop. — 2002. — 22. — Р. 150-157.

Gage J.R. The treatment of gait problems in cerebral palsy. — London: Mac Keith Press, 2004. — 448 р.

Gage J.R., Novacheck T.F. An update on the treatment of gait problems in cerebral palsy // J. Pediatr. Orthop. — 2001. — 10. — Р. 265-274.

Akbaş A.N. Assessments and outcome measures of cerebral palsy / Gunel M.K. // Cerebral Palsy: Current Steps. — Croatia: InTech. — 2016. — Р. 23-48.

Harvey A., Graham H.K., Morris M.E., Baker R., Wolfe R. The Functional Mobility Scale: Ability to detect change following single event multilevel surgery // Dev. Med. Child Neurol. — 2007. — 49. — Р. 603-7.

Evine D.F., Richards J., Whittle M. Whittle’s Gait Ana­lysis Whittle’s Gai Analysis Elsevier Health Sciences. — 2012.

Maathuis K.G., van der Schans C.P., van Iperen A., Rietman H.S., Geertzen J.H. Gait in children with cerebral palsy: Observer reliability of Physician Rating Scale and Edinburgh visual gait analysis interval testing scale // J. Pediatr. Orthop. — 2005. — 25. — Р. 268-72.

Read H.S., Hazlewood M.E., Hillman S.J., Prescott R.J., Robb J.E. Edinburgh visual gait score for use in cerebral palsy // J. Pediatr. Orthop. — 2003. — 23. — Р. 296-301.

Copyright (c) 2018 TRAUMA

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.


© Publishing House Zaslavsky, 1997-2020


   Seo анализ сайта