title: Are results after single-event multilevel surgery in cerebral palsy durable?
abstract: BACKGROUND
  Gait and function may deteriorate with time in patients with spastic diplegia. Single-event multilevel surgery often is performed to either improve gait or prevent deterioration. However it is unclear whether the presumed gait improvements are durable.
  
  
  OBJECTIVE
  We therefore determined whether (1) single-event multilevel surgery improves gait in patients with spastic diplegia and (2) whether the improved function is durable.
  
  
  METHODS
  We retrospectively reviewed the data of 14 patients with spastic diplegia. At the time of surgery, one patient had gross motor Level I function, 10 patients had Level II function, and three patients had Level III function. There were four females and 10 males with a mean age of 13 years (range, 7-18 years). The mean number of orthopaedic procedures per single-event multilevel surgery session was 7.4 ± 2.8 (median, 6.5; range, 4-15). We used instrumented gait analysis to determine joint ROM, movement analysis profiles, and the gait profile score. The minimum followup was 1 year (mean, 2 years; range, 1-3 years).
  
  
  RESULTS
  At last followup, movement analysis profiles for knee flexion, for ankle dorsiflexion, and for foot progression improved as did the gait profile score. Additional surgery after the index procedure was performed in nine of the 14 patients because of relapse of the original or new gait problems. Major surgical adverse events occurred in one of the 14 patients.
  
  
  CONCLUSIONS
  Severe gait dysfunction in patients with spastic diplegia can be improved short-term in one operative session by single-event multilevel surgery, but to preserve the early improvements many patients require additional surgery. It is unknown whether the improvements will last for decades.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Murdoch Childrens Research Institute, The Royal Children's Hospital, Victoria, Australia. erich_rutz@hotmail.com
authors.forename: Erich
authors.initials: E
authors.lastname: Rutz
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
authors.forename: Oren
authors.initials: O
authors.lastname: Tirosh
authors.forename: Reinald
authors.initials: R
authors.lastname: Brunner
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007596:Joints / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009043:Motor Activity; D019637:Orthopedic Procedures / Q000009:adverse effects; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome