What is Single Event Multi-Level Surgery?
Disclaimer: This fact sheet is for education purposes only. Please consult with your doctor or other health professional to make sure this information is right for your child.
Single Event Multi- Level Surgery or SEMLS is when a number of orthopaedic procedures are performed at the one time. This means children only need one anaesthetic followed by one block of rehabilitation therapy. Orthopaedic surgery means surgery to either bones and/or muscles. Multi-level refers to the fact that the surgeries performed usually occur around the hip, knee and ankle joints. This often involves the use of plates and screws to hold the bones in place.
How will SEMLS help my child?
There are numerous benefits after a successful surgery and rehabilitation. The aims of the surgery include improving walking patterns, improving independence with transfers, keeping children independent and active, and correcting deformities. The general aim is to keep children on their feet (walking) and out of the wheelchair for as long as possible.
Will My Child need Surgery again in the future?
Children often do require further smaller procedures. "Fine tuning" procedures are often required. The surgery will correct current deformities. After growth spurts further deformities may occur. For this reason the timing of the SEMLS operation is important to prevent the need for frequent "fine tuning" surgeries.
Do metal plates and screws stay in?
These are usually removed after about 12 months or if they become uncomfortable. The removal of hardware is a minor procedure and is usually not urgent and timed with other procedures to prevent the need for numerous general anaesthetics.
How long does my child have to stay in Hospital?
Usually for around 5-7 days. Once the child is comfortable and you can manage with day to day activities you can go home.
Can I stay with my child overnight in hospital?
Yes, there is a bed available for you next to your child (1 parent only).
Will my child need General Anaesthetic?
Yes, like all surgeries your child will need a general anaesthetic and will not be able to remember any part of the surgery. Please let us know if there are problems with this. You will see an anaesthetist in the pre-admission clinic prior to the surgery.
Will my child be in a lot of pain?
We try and keep the children as comfortable as possible after surgery. A spinal block (epidural) is put in before the surgery that works very well to help control pain. The epidural will come out when the Medical team feel the child is ready. Diazepam (Valium), morphine, Paracetomol, ibuprofen (Nurofen) and codeine are all drugs commonly used after surgery to keep children comfortable and pain free. We also try to make sure children are not too sleepy as a result to the amount of pain medication.
Will SEMLS make my child walk normally?
No. SEMLS will correct bone deformities and muscle contractures but unfortunately it will not be able to help with the strength or control of the muscle itself. It will not cure your child of Cerebral Palsy but it will try and correct bones and muscles so that it is much easier to walk straight. A lot of Physiotherapy with hard work will also help make this happen. The Rehabilitation process is a long and hard one, but definitely worth it!
Will the muscles that are cut heal again?
Yes. Usually when muscles are cut they are not completely cut in half. Only parts of the tendon or tendon sheath surrounding the muscles are cut or released and they will heal again. Therefore, even after surgery, the muscles still work.
Who can I speak to if I have more questions?
Surgery will be discussed/ explained by your surgeon and therapists in the team during your clinic appointments. You may ask to speak the clinical nurse consultant or physiotherapist present at clinics outside of your appointment if you wish. Your regular community physiotherapist and occupational therapist can perhaps also help you prepare and answer some questions as well.
© The Children's Hospital at Westmead - 1997-2006
This document was published on Wednesday,
28 June 2006.
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