Single Event Multilevel Surgery (SEMLS)
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Introduction[edit | edit source]
Single-event multilevel surgery (SEMLS) is a single complex surgical procedure whereby "...correction of all musculoskeletal deformities producing gait abnormalities..." are addressed. This has replaced older, single level surgery.[1]A combination of muscle-tendon lengthening, tendon transfers, rotational osteotomies and joint stabilizations are performed within the procedure. Thus addressing multiple anatomical levels from which gait abnormalities stem.[1] [2]
SEMLS was first described in 1985 by Norlin and Tkaczuk as well as Browne and McManus in 1987.[3]
The advantages in combining multiple procedures into one mean that hospital stay and rehabilitation time is decreased. There is also the possible decrease in complications. [3]
Important to note is the possibility of relapses and new biomechanical problems necessitating further surgical intervention.[3]
The procedure itself is based on a detailed biomechanical assessment. [2]
Success of the procedure requires intensive post-operative rehabilitation. [2]
Post operative level of function initially decreases, observed with follow-up 3 and 12 months.[2][1]
Initially, follow-up research done by Norlin and Tkaczuk (1992) reported improved gait patterns using video gait analysis. Further studies, performed more recently (between 2013 and 2020), have also found favorable outcomes. These however, have been limited to between 1 and two years post operative follow-up.[3]
Candidates[edit | edit source]
SEMLS is usually performed on children diagnosed with Cerebral Palsy, with a Gross Motor Function Classification System (GMFCS) of I, II or III. The procedure itself is most commonly performed on candidates with GMFCS level III.[2]
Aim of procedure[edit | edit source]
To produce functional changes in body structures and function which will create positive changes to the levels of activity, in particular gait, ultimately improving participation.[2]
In most studies home, school and community ambulation are assessed. Here paramenters such as structural gait analysis, ambulation with or without assistive devices, and long term quality of life are assessed. [2][3]
Physiotherapy[edit | edit source]
"After 6 weeks all patients followed
an intensive rehabilitation program performed three to five
times per week for 12 weeks or 4 to 6 weeks as inpatients in a
rehabilitation center. The aim of this postoperative rehabilitation
was to improve ROM, strength, balance, and function.
After this time all patients had semiannual clinic visits."
Resources[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 Edwards TA, Prescott RJ, Stebbins J, Wright J, Theologis T. What is the functional mobility and quality of life in patients with cerebral palsy following single-event multilevel surgery?. Journal of children's orthopaedics. 2020 Apr;14(2):139-44.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Harvey A, Rosenbaum P, Hanna S, Yousefi-Nooraie R, Graham KH. Longitudinal changes in mobility following single-event multilevel surgery in ambulatory children with cerebral palsy. Journal of Rehabilitation Medicine. 2012 Feb 1;44(2):137-43.
- ↑ 3.0 3.1 3.2 3.3 3.4 Rutz E, Baker R, Tirosh O, Brunner R. Are results after single-event multilevel surgery in cerebral palsy durable?. Clinical Orthopaedics and Related Research®. 2013 Mar;471:1028-38.
