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Original ArticleOpen Access
Improvement of Ambulatory Function with Multilevel Soft Tissue Surgery in Children with Spastic Diplegic Cerebral Palsy
Thamkunanon V 
Abstract: Single Event Multilevel soft tissue surgery in spastic diplegic children also was effective for improving ambulatory
function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better
lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery.
Objective: Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue
surgery had been observed in these study groups of patients.
Material and Method: Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to
understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event
multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6- 12 months after operation. Analyzing
GMFCS change was performed by statistics.
Results: Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement
were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared
between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement
for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group
(92 month old), was a trend difference in statistic (p = 0.032).
Conclusion: Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It
changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more
benefit than older children.
Keywords: Single event multilevel soft tissue surgery, SEMLS, Multilevel soft tissue surgery, MLS, Gross motor functional
classification system, GMFCS, Ambulatory function, Spastic diplegic, Cerebral palsy
function obviously as multilevel bone and soft tissue surgery. Just muscle and tendon surgery seem to be enough for better
lever arm dysfunction of the lower extremity. It has safe, simple and rapid recovery.
Objective: Gross Motor Functional Classification System (GMFCS) improvement after single event multilevel soft tissue
surgery had been observed in these study groups of patients.
Material and Method: Retrospective review in 93 spastic diplegic children who were more than 3 years old, had ability to
understand communication, at least leaned sitting and one-hand gross function ability had been operated on by single event
multilevel soft tissue surgery. GMFCS was assessed at the time of pre-operation and 6- 12 months after operation. Analyzing
GMFCS change was performed by statistics.
Results: Average 7 site surgery per one patient, 84% GMFCS level improvement and 16% GMFCS level non-improvement
were reported. Nine cases (9.7%) were improved 2 level of GMFCS and 74% improved 1 level. GMFCS level compared
between pre- and post surgery had changed by the significant statistic (p < 0.001). The average GMFCS level improvement
for all groups was 0.93 level. The average age in the improved group (75 months old) was less than the non-improved group
(92 month old), was a trend difference in statistic (p = 0.032).
Conclusion: Single Event Multilevel Soft tissue surgery was effective in improving the GMFCS level average 1 level. It
changed ambulatory function of spastic diplegic CP children obviously, immediately and safely. Younger age might get more
benefit than older children.
Keywords: Single event multilevel soft tissue surgery, SEMLS, Multilevel soft tissue surgery, MLS, Gross motor functional
classification system, GMFCS, Ambulatory function, Spastic diplegic, Cerebral palsy
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