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 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 means the surgeries performed usually occur around the hip, knee and ankle joints. Where bones are operated on, plates and screws are often used to hold them in place and allow healing.
How will SEMLS help my child?
There are numerous benefits after 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. These "Fine tuning" procedures will correct residual deformities. When your child has periods of rapid growth or children have 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.
How long does my child have to stay in Hospital?
After SEML's your child will be in hospital for around 5-7 days. Once your 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 of 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. Hard work and a lot of physiotherapy will also help make this happen. The Rehabilitation process is a long and hard one, but the results are 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 to 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.
Will my child have to wear Ankle Foot Orthoses (AFOs) and for how long?
Yes, AFOs are usually prescribed after SEMLS. These are usually moulded after the surgery in the clinic. It is important that your child wear their AFOs to protect the ankle joint and keep the muscles in a good position to heal. The AFOs should be worn 24 hours a day (except for showering) for the first 3-6 months and will then be reviewed by your orthopaedic surgeon.
Do metal plates and screws stay in?
These are usually removed after about 12 months or if they become uncomfortable. The removal of plates and screws (also called hardware) is a minor procedure and is usually not urgent and timed with other procedures to prevent the need for numerous general anaesthetics.
© The Children's Hospital at Westmead - 1997-2010
This document was updated on Thursday, 11 February 2010.
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