title: Multilevel surgery in adults with cerebral palsy.
abstract: OBJECTIVE
  Single-event multilevel surgery (SEMLS) has been used as an effective intervention in children with bilateral spastic cerebral palsy (BSCP) for 30 years. To date there is no evidence for SEMLS in adults with BSCP and the intervention remains focus of debate.
  
  
  METHODS
  This study analysed the short-term outcome (mean 1.7 years, standard deviation 0.9) of 97 ambulatory adults with BSCP who performed three-dimensional gait analysis before and after SEMLS at one institution.
  
  
  RESULTS
  Two objective gait variables were calculated pre- and post-operatively; the Gillette Gait Index (GGI) and the Gait Profile Score (GPS). The results were analysed in three groups according to their childhood surgical history (group 1 = no surgery, group 2 = surgery other than SEMLS, group 3 = SEMLS). Improvements in gait were shown by a significant decrease of GPS (p = 0.001). Similar results were obtained for both legs (GGI right side and left side p = 0.01). Furthermore, significant improvements were found in all subgroups although this was less marked in group 3, where patients had undergone previous SEMLS.
  
  
  CONCLUSIONS
  SEMLS is an effective and safe procedure to improve gait in adults with cerebral palsy. However, a longer rehabilitation period is to be expected than found in children. SEMLS is still effective in adult patients who have undergone previous SEMLS in childhood.
  
  
  CONCLUSIONS
  Single-event multilevel surgery is a safe and effective procedure to improve gait disorders in adults with bilateral spastic cerebral palsy.
authors: Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors: C
authors: C
authors: Putz
authors: Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauerstrasse 18, 83229 Aschau i. Chiemgau, Germany.
authors: L
authors: L
authors: Döderlein
authors: Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors: E M
authors: EM
authors: Mertens
authors: Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors: S I
authors: SI
authors: Wolf
authors: Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors: S
authors: S
authors: Gantz
authors: Private University of Applied Sciences Göttingen, Robert Koch Strasse 40, 37075 Göttingen, Germany.
authors: F
authors: F
authors: Braatz
authors: Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany.
authors: T
authors: T
authors: Dreher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000534:rehabilitation / Q000601:surgery*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000209:etiology; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult
keywords: multilevel surgery; cerebral palsy; gait analysis; adults; outcome; gait