Abstract
Background: Although single event multilevel surgery (SEMLS) is well supported in the literature for walking children with cerebral palsy (CP) there is little evidence to show the outcomes in developing countries with limited resources. Further there is no literature reporting on the use of SEMLS in walking children with HIV encephalopathy (HIVE). The primary aim of this study was to investigate whether SEMLS can have good short-term outcomes in a South African setting, and the secondary aim was to compare the outcomes of SEMLS in children with diplegia secondary to CP and HIVE. Methods: A prospective cohort study of ten children with spastic diplegia was enrolled (six with CP, four with HIVE) and followed up for 12 months. All children underwent SEMLS and received peri-operative therapy at a local clinic, hospital or a special-needs school. The primary outcome measures were the Edinburgh Visual Gait Score (EVGS), Gross Motor Function Measure-66 (GMFM-66) and the Functional Mobility Scale (FMS) measured pre-operatively (T1), at six months (T2) and at one year (T3). Results: There was an overall mean improvement of 6.4 in the EVGS and 3.2% in the GMFM-66 at the one-year follow-up assessment. The FMS revealed an initial deterioration in function at six months, with return to pre-operative function at the one-year assessment. Improvements in the GMFM-66 were found to be clinically significant. When comparing children with CP to those with HIVE the improvements were similar. Conclusion: The results of this study indicate that the early outcomes of SEMLS in a South African setting, with scarce resources, are similar to those seen in developed countries. It may also be possible to use the same SEMLS treatment principles seen in the management of children with CP for children with static HIVE. Further follow-up is however needed in both of these areas. Level of evidence: Level 4
Highlights
Current literature reveals that the gait, functional ability and quality of life does improve at a one- and fiveyear follow-up after SEMLS9,10 despite an initial regression in gross motor function classification system (GMFCS) level at three months post-surgery.[11]
The primary aim of this study was to investigate whether single event multilevel surgery (SEMLS) could have good short-term outcomes in a South African setting, and the secondary aim was to compare the outcomes of SEMLS in children with diplegia secondary to cerebral palsy (CP) and human immunodeficiency virus (HIV) encephalopathy (HIVE)
Due to the small sample size the data was analysed descriptively, using the minimum clinically important difference (MCID) as per the literature to determine whether the results showed clinical significance for each of the outcome scoring tools
Summary
Single event multilevel surgery (SEMLS) is the current preferred orthopaedic management of ambulant children with cerebral palsy (CP) in developed countries.[1,2,3,4] SEMLS by definition is when two or more orthopaedic procedures are being performed on the musculoskeletal system, at more than one level, at the same time.[2,5,6] The benefits of SEMLS include one hospital admission, one rehabilitation period and the prevention of further secondary deformities.[6]Bearing in mind that the natural progression for the walking child with CP is a regression in gross motor function,[7,8] the aim of SEMLS is to improve gait efficiency and appearance, gross motor function, independence and quality of life[9] and to maintain the child’s ability to walk into adulthood. SEMLS does not improve the gross motor function classification system (GMFCS) of the child but attempts to maintain it into adulthood.[1,2] Current literature reveals that the gait, functional ability and quality of life does improve at a one- and fiveyear follow-up after SEMLS9,10 despite an initial regression in GMFCS level at three months post-surgery.[11]. The primary outcome measures were the Edinburgh Visual Gait Score (EVGS), Gross Motor Function Measure-66 (GMFM-66) and the Functional Mobility Scale (FMS) measured pre-operatively (T1), at six months (T2) and at one year (T3). Conclusion: The results of this study indicate that the early outcomes of SEMLS in a South African setting, with scarce resources, are similar to those seen in developed countries. Further follow-up is needed in both of these areas
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