Outcome of single event multi-level surgery in the treatment of spastic cerebral palsy involving lower limbs

Background: Spastic cerebral palsy (CP) is a leading cause of childhood physical disability, characterized by muscle stiffness and movement limitations, primarily affecting the lower limbs. Single Event Multi-Level Surgery (SEMLS) is considered a gold-standard surgical intervention for managing musculoskeletal deformities associated with spastic CP. However, limited data exist on the effectiveness of SEMLS in low- and middle-income countries (LMICs) like Bangladesh. This study aimed to evaluate the outcomes of SEMLS in children with spastic cerebral palsy involving the lower limbs, focusing on improvements in gait patterns, gross motor function, range of motion (ROM) and postoperative complications. Methods: A quasi-experimental study was conducted at the National Institute of Traumatology and Orthopedics Rehabilitation (NITOR), Dhaka, Bangladesh, from September 2021 to March 2024. A total of 36 children aged 7–16 years with spastic hemiplegic or diplegic CP underwent SEMLS. Outcomes were assessed using gait analysis, GMFCS levels, ROM measurements and complication rates. Results: Postoperative outcomes demonstrated significant improvements in gait, with 72.22% achieving near-normal gait and 27.78% attaining normal gait. A substantial shift was observed in GMFCS levels, with 63.89% of participants improving to level I. Statistically significant improvements were also recorded in hip, knee and ankle ROM (p<0.001), with minimal postoperative complications observed. Conclusions: SEMLS is an effective surgical intervention for improving mobility, joint function and overall quality of life in children with spastic cerebral palsy, particularly in resource-constrained settings.