Single-Event Multilevel Surgery: Contender or Pretender.

Abstract

* Abbreviation: SEMLS — : single-event multilevel surgery Single-event multilevel surgery (SEMLS) refers to the surgical management of children and adult patients with cerebral palsy and spastic diplegia to address muscle imbalance, contractures, and musculoskeletal deformities secondary to untreated or inadequately treated spasticity.1–3 Spasticity is a movement disorder in which there is injury to upper motor neurons comprising the pyramidal tract. The upstream inhibitory influence of the central nervous system is interrupted, causing the local reflex arc in the spinal cord to become disinhibited and leading to continuous muscle contraction. The spasticity is characterized by a velocity-dependent increase in muscle tone with hyperreflexia. Surgical management consists of concurrent orthopedic procedures targeting the musculoskeletal system at ≥2 levels (eg, feet, ankles, knees, and hips). Procedures include tendon lengthening to correct contractures, tendon transfers for muscle imbalance, rotational osteotomies for torsional deformities, and stabilization of the hip and foot. The advantages of SEMLS include a single hospital … Address correspondence to Andrew Jea, MD, MHA, FAAP, Section of Pediatric Neurosurgery, Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Dr, 1134, Indianapolis, IN 46202. E-mail: ajea{at}goodmancampbell.com