Short-term outcomes of single event multilevel surgery for children with diplegia in a South African setting
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