Commentary on an article by Pamela Thomason, BPhty, MPT, et al.: “Single-Event Multilevel Surgery in Children with Spastic Diplegia. A Pilot Randomized Controlled Trial”

Abstract

The management of cerebral palsy has evolved substantially over the last seventy years. Motion analysis laboratories have played a pivotal role in this evolution by providing a means with which to study the interrelationship of limb segments for the purpose of devising treatment plans and evaluating results after treatment1-3. Advances in tone management including selective dorsal rhizotomy and medications such as baclofen and botulinum toxin4,5, and the advent of functionally based physical therapies replacing traditional neurodevelopmental approaches6 were other important contributions. The World Health Organization (WHO) framework, the International Classification of Functioning, Disability and Health (ICF), and the concurrent validation of outcome instruments for classifying and assessing children with chronic motor disabilities such as cerebral palsy were indispensable to the design of clinically relevant and more objective outcome studies7. The widespread adoption of single-event multilevel surgery as the mainstay orthopaedic surgical approach for gait abnormalities in patients with cerebral palsy was also a part of this evolution. However, single-event multilevel surgery is only one component of the multifaceted management approach for patients with cerebral palsy. Nevertheless, Thomason et al. are to be congratulated for providing the first published randomized controlled trial to evaluate the outcome of single-event multilevel surgery with use of outcome measures that assess several domains within the ICF framework, including impairments of body structure and functional capabilities. The study confirms what other prospective cohort studies of the lower extremity have shown—i.e., that single-event multilevel surgery results in short-term (twelve-month) improvement in gait alignment while its impact on functional capacity is negligible or …