HMN 2025: What is the benefit of surgery for children with cerebral palsy

A new national study has found that single-event multi-level surgery (SEMLS) helps straighten the legs and improves walking ability in children with cerebral palsy.

Researchers at the Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS) have published findings of The Cerebral Palsy in the British Orthopedic Surgery Surveillance Study (CPinBOSS). It is the first U.K.-wide prospective cohort to examine how single-event multi-level surgery (SEMLS) is used in routine practice and its impact on outcomes for children with bilateral cerebral palsy.

Conducted across 20 NHS hospitals, the study examined data from 188 children aged between 5 and 18 years for two years after surgery and provides important evidence to inform treatment and health care delivery across the U.K.

Cerebral palsy (CP) is the most common serious physical disability of childhood, affecting around two to three children in every thousand births. Many children experience muscle tightness and bone deformities that worsen as they grow, affecting their ability to walk and move independently.

SEMLS allows surgeons to correct several of these problems in one operation, addressing the bones, joints, and muscles of both legs in a single sitting, followed by a period of rehabilitation. The approach aims to improve mobility and reduce the need for repeated operations and lengthy recoveries throughout childhood.

Professor Tim Theologis, Consultant Orthopedic Surgeon and Chief Investigator of the CPinBOSS study at NDORMS, said, “SEMLS has evolved over the past 30 years, but despite increasing use, there has been little evidence to show how SEMLS is performed across the NHS, or how effective it really is in improving children’s function and independence.”

All U.K. hospitals doing SEMLS took part and the CPinBOSS team recorded surgical techniques, complications, and outcomes including gait and patient-reported function. A total of 203 children joined the study and of the 188 eligible children, 139 underwent SEMLS involving an average of five surgical procedures per patient. Information was also collected on children who could potentially benefit from SEMLS but didn’t have the surgery.

Outcomes were measured through patient questionnaires with parents and children reporting on how well they were doing after treatment. Additional information on gait and function outcomes was collected by the participating hospitals in some of the children who took part.

Published in The Bone & Joint Journal, the study shows that two years after surgery, children who had SEMLS and a full set of outcomes showed a significant improvement in walking pattern, measured by the Gait Profile Score, exceeding the threshold for a clinically meaningful change. Parents also reported improved motor function and everyday mobility on the validated GOAL (Gait Outcome Assessment List) questionnaire.

In contrast, the small group of children who did not undergo surgery showed a tendency to decline in walking ability over the same period.

While about 1 in 5 children experienced complications, mostly transient ones, following complex orthopedic procedures, the overall findings point to improvements in walking. Although changes in walking speed and distance were small, there was an improvement in walking pattern for those undergoing SEMLS.

Theologis said, “This is the first national picture of how SEMLS is being delivered for children with cerebral palsy in the U.K. The study found considerable variation between centers in how surgery was delivered, underlining the need for more standardized approaches and the need for consistent outcome data collection. Despite that, there were clear indications of benefit from surgery for the children where outcome data were available.

“We consistently saw that the surgery improved gait, helping to counteract the decline that often occurs with growth. These findings will support better-informed discussions between surgeons, families, and children when planning treatment.

“Children with cerebral palsy deserve the same level of research evidence and standardization that we expect in other areas of surgery. The CPinBOSS network has built the foundation for national collaboration that can now support future clinical trials.”

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