الفهرس 
Title: Mini approach to lower limb single event multilevel soft tissue release in patients with spastic cerebral palsy
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Abstract
Background:The assessment and treatment of gait abnormalities in children with cerebral palsy are challenging.The interventions range from physical and occupational therapy, neurosurgical and pharmacological interventions to reduce hypertonia and orthopedic interventions. Orthopaedic surgical interventions are designedto correct moderate to severe soft-tissue contracturesand any secondary osseous deformities.SEMLS is a program of multiple orthopedic procedures conducted during a single operative intervention and requiring a single hospital admission and period of rehabilitation. Objectives: the study aims to evaluate the use of minimal approach lower limb single event multilevel soft tissue release in improvement of gait in patients with spastic cerebral palsy and evaluating the range of motion and spasticity pre and postoperative according to Gross Motor Function Measure (GMFM-88) score, range of motion (ROM score) and spasticity score at intervals of 3 and 6 months. Patients and methods: This is a prospective case series studyincluding 54 children with spastic cerebral palsy attending to pediatric orthopedic unit in Abo El-Resh Hospital, Cairo University and managed with lower limb single event multilevel soft tissue release.Their age ranged from 3 to 6 years in the period from February 2020 to February 2021. SEMLS was done to all patients; Hamstring release was done in 53 patients, Adductor release done in 40 cases; iliopsoas release done to 17 cases of them. Thirty seven children underwent surgery at ankle level; gastrocnemius recession done in only six of them while tendon achilis lengthening done to the remaining 31 cases.Each patient underwent 3 assessments which included GMFM-88 score, ROM score and spasticity score at three points; the week before surgery and at 3 months and 6 months after surgery. Results:Follow up of children postoperatively revealed marked improvement in the motor function as noticed by improvement in the GMFM-88 score. Improvement in the range of motion documented by decreased ROM score. Decreased lower limb spasticity also noticed by decreased spasticity score