Single Event Multilevel Surgery (SEMLS): Difference between revisions
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== Introduction == | == Introduction == | ||
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. | Single-event multilevel surgery (SEMLS) is a single complex surgical procedure whereby "...correction of all musculoskeletal deformities producing gait abnormalities..." (pg. 1) are addressed. This has replaced older, single level surgery. 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. The procedure itself is based on a detailed biomechanical assessment. <ref name=":0">Harvey A, Rosenbaum P, Hanna S, Yousefi-Nooraie R, Graham KH. [https://pubmed.ncbi.nlm.nih.gov/22266600/ 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.</ref><ref name=":1" /> | ||
== Aim of procedure == | |||
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.<ref name=":0" /> | |||
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. <ref name=":0" /><ref name=":2" /> | |||
== History and Development == | |||
SEMLS was first described in 1985 by Norlin and Tkaczuk as well as Browne and McManus in 1987.<ref name=":2">Rutz E, Baker R, Tirosh O, Brunner R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563809/ Are results after single-event multilevel surgery in cerebral palsy durable?.] Clinical Orthopaedics and Related Research®. 2013 Mar;471:1028-38.</ref> | SEMLS was first described in 1985 by Norlin and Tkaczuk as well as Browne and McManus in 1987.<ref name=":2">Rutz E, Baker R, Tirosh O, Brunner R. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3563809/ Are results after single-event multilevel surgery in cerebral palsy durable?.] Clinical Orthopaedics and Related Research®. 2013 Mar;471:1028-38.</ref> | ||
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.<ref name=":2" /> | |||
In a systematic review performed by McGinley et al. (2011) covering research papers on SEMLS (or similarly described surgical interventions) it was found that the level of research was of poor quality up until 1999. <ref name=":3">McGinley JL, Dobson F, Ganeshalingam R, Shore BJ, Rutz E, Graham HK. [https://pubmed.ncbi.nlm.nih.gov/22111994/ Single‐event multilevel surgery for children with cerebral palsy: a systematic review.] Developmental Medicine & Child Neurology. 2012 Feb;54(2):117-28.</ref>It was in 1999 that Thomas et al.<ref>Thomas SS, Buckon CE, Piatt JH, Aiona MD, Sussman MD. [https://pubmed.ncbi.nlm.nih.gov/15599225/ A 2-year follow-up of outcomes following orthopedic surgery or selective dorsal rhizotomy in children with spastic diplegia]. Journal of Pediatric Orthopaedics B. 2004 Nov 1;13(6):358-66.</ref> produced a study that included outcome measures of both the GMFCS and gait parameters. In the years following, other studies stood out which included outcomes linking to the ICF model.<ref name=":3" /> | |||
The | == Advantages == | ||
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. <ref name=":2" /> | |||
== Considerations == | |||
* There is always the possibility of relapses and new biomechanical problems necessitating further surgical intervention.<ref name=":2" /> | |||
* Success of the procedure requires intensive post-operative rehabilitation. <ref name=":0" /> | |||
* Post operative level of function initially decreases, observed with follow-up 3 and 12 months. Subsequent stabiliasation of function and then improvement is generally noted 2 years post-operatively<ref name=":0" /><ref name=":1">Edwards TA, Prescott RJ, Stebbins J, Wright J, Theologis T. [https://pubmed.ncbi.nlm.nih.gov/32351627/ 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.</ref> | |||
== Candidates == | == Candidates == | ||
SEMLS is usually performed on children diagnosed with [[Cerebral Palsy Aetiology and Pathology|Cerebral Palsy]], with a [[Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER)|Gross Motor Function Classification System]] (GMFCS) of I, II or III. The procedure itself is most commonly performed on candidates with GMFCS level III.<ref name=":0" /> | SEMLS is usually performed on children diagnosed with [[Cerebral Palsy Aetiology and Pathology|Cerebral Palsy]], with a [[Gross Motor Function Classification System - Expanded and Revised (GMFCS-ER)|Gross Motor Function Classification System]] (GMFCS) of I, II or III. The procedure itself is most commonly performed on candidates with GMFCS level III.<ref name=":0" /> | ||
== Physiotherapy == | == Physiotherapy == | ||
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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..." (pg. 1) are addressed. This has replaced older, single level surgery. 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. The procedure itself is based on a detailed biomechanical assessment. [1][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.[1]
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. [1][3]
History and Development[edit | edit source]
SEMLS was first described in 1985 by Norlin and Tkaczuk as well as Browne and McManus in 1987.[3]
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]
In a systematic review performed by McGinley et al. (2011) covering research papers on SEMLS (or similarly described surgical interventions) it was found that the level of research was of poor quality up until 1999. [4]It was in 1999 that Thomas et al.[5] produced a study that included outcome measures of both the GMFCS and gait parameters. In the years following, other studies stood out which included outcomes linking to the ICF model.[4]
Advantages[edit | edit source]
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]
Considerations[edit | edit source]
- There is always the possibility of relapses and new biomechanical problems necessitating further surgical intervention.[3]
- Success of the procedure requires intensive post-operative rehabilitation. [1]
- Post operative level of function initially decreases, observed with follow-up 3 and 12 months. Subsequent stabiliasation of function and then improvement is generally noted 2 years post-operatively[1][2]
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.[1]
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]
- bulleted list
- x
or
- numbered list
- x
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 4.0 4.1 McGinley JL, Dobson F, Ganeshalingam R, Shore BJ, Rutz E, Graham HK. Single‐event multilevel surgery for children with cerebral palsy: a systematic review. Developmental Medicine & Child Neurology. 2012 Feb;54(2):117-28.
- ↑ Thomas SS, Buckon CE, Piatt JH, Aiona MD, Sussman MD. A 2-year follow-up of outcomes following orthopedic surgery or selective dorsal rhizotomy in children with spastic diplegia. Journal of Pediatric Orthopaedics B. 2004 Nov 1;13(6):358-66.
