SIMULTANEOUS MULTIPLE OPERATIONS FOR SPASTIC DIPLEGIA - OUTCOME AND FUNCTIONAL ASSESSMENT OF WALKING IN 18 PATIENTS

We assessed the outcome after simultaneous multiple operations perform ed on 18 children with spastic diplegia, with emphasis on the changes in the physiological cost index (PCI) of walking. Fourteen patients ha d a measurable reduction at one year, but the more severely affected p atients took up to two years to reach a new functional plateau. The le vel of the preoperative PCI allows prediction of the outcome of surger y in terms of reducing the effort of walking, or improving its appeara nce only. Intrapelvic intramuscular psoas tenotomy produced an improve ment of hip flexion deformity in 15 of 17 patients without the loss of muscle power to initiate the swing phase. Fractional lengthening corr ected hamstring tightness in 17 cases, and the mean popliteal angle wa s reduced from 63-degrees preoperatively to 30.2-degrees, with almost complete resolution of the fixed knee flexion deformity present in ten patients. Distal transfer of the rectus femoris, when it was shown to be contracting inappropriately, improved the knee flexion arc during walking from a mean of 28.3-degrees to 45.2-degrees.