Objective: Pre-pubertal cerebral palsy (CP) patients, particularly those classified as gross motor function classification system (GMFCS) grade II, often develop fixed musculoskeletal contractures that impair gait efficiency and increase energy expenditure. Among available treatment options, single-event multilevel surgery (SEMLS) offers the advantage of addressing multiple deformities in a single operative session, potentially leading to more efficient functional recovery and improved mobility. This study aimed to evaluate the effects of SEMLS on gait characteristics and walking energy expenditure in pre-pubertal children with spastic CP.
Materials and
Methods: This study included patients aged 8–13 years who underwent SEMLS between November 2016 and September 2017. All participants had flexion and adduction contractures of the hip, a popliteal angle >50°, and equinus deformity, and were able to walk with or without support. Following long leg plaster cast immobilization for 6 weeks post-surgery, all patients received physical therapy. Three-dimensional gait analysis and walking energy expenditure (oxygen cost) were assessed one month before and 8–12 months after surgery.

Results: Post-operatively, there was a significant reduction in walking energy expenditure, despite no significant change in resting energy expenditure. Although not statistically significant, patients demonstrated an increased preferred walking speed. No significant differences were observed in mediolateral and vertical sacral displacement.

Conclusion: SEMLS significantly reduces walking energy expenditure and improves gait efficiency in pre-pubertal children with spastic CP (GMFCS grade II). These findings support SEMLS as an effective intervention, though larger studies with extended follow-up are needed to confirm long-term outcomes.