This pilot RCT is the first randomized trial of single-event multilevel surgery (SEMLS) in children with spastic diplegic cerebral palsy. It compared SEMLS plus postoperative physical therapy against progressive resistance strength training alone in 19 children (GMFCS II-III, ages 6-12). The primary question: does SEMLS actually improve gait compared with a controlled intervention — and when do functional gains follow?
For decades, SEMLS was performed widely on the basis of retrospective cohort data — with no randomized evidence and no control group capturing what happens to untreated children (progressive gait deterioration).
When you see a child with spastic diplegia aged 6-12, GMFCS II or III, with fixed multilevel deformities on instrumented gait analysis, this paper is the Level-II evidence foundation for offering SEMLS.
Crucially, counsel families that gait improves by 12 months, but gross motor function and quality of life take 24 months to show significant gains — early disappointment in functional scores does not mean the surgery failed.
The control group's natural deterioration is equally important: doing nothing is not neutral. Untreated children worsen, which amplifies the true benefit of surgical intervention beyond what the between-group difference alone conveys.
This pilot RCT is the first randomized trial of single-event multilevel surgery (SEMLS) in children with spastic diplegic cerebral palsy. It compared SEMLS plus postoperative physical therapy against progressive resistance strength training alone in 19 children (GMFCS II-III, ages 6-12). The primary question: does SEMLS actually improve gait compared with a controlled intervention — and when do functional gains follow?
For decades, SEMLS was performed widely on the basis of retrospective cohort data — with no randomized evidence and no control group capturing what happens to untreated children (progressive gait deterioration).
When you see a child with spastic diplegia aged 6-12, GMFCS II or III, with fixed multilevel deformities on instrumented gait analysis, this paper is the Level-II evidence foundation for offering SEMLS.
Crucially, counsel families that gait improves by 12 months, but gross motor function and quality of life take 24 months to show significant gains — early disappointment in functional scores does not mean the surgery failed.
The control group's natural deterioration is equally important: doing nothing is not neutral. Untreated children worsen, which amplifies the true benefit of surgical intervention beyond what the between-group difference alone conveys.