a novel minimally invasive surgical treatment for children with cerebral palsy


Pediatric Orthopaedic Surgeon
Head of Pediatric Orthopaedics at IASO Children's Hospital
Member of the Pediatric Orthopaedic Society of North America (POSNA)



SPML stands for Selective Percutaneous Myofascial Lengthening.

  • Selective – refers to selected areas of tightness caused by spasticity.
  • Percutaneous – an instrument developed for eye surgeries is used to make small (2-3mm) incisions in the areas of tightness/spasticity Percutaneous refers to a procedure perfomed through skin using a needle etc.
  • Myofascialmyo means muscle and fascia is defined as connective tissue made of collagen that covers a muscle or a group of muscles.
  • Lengthening

Roy Nuzzo MD, a Pediatric Orthopaedic Surgeon based in Summit, NJ, USA, used this term to describe the surgical procedure that he invented to improve the function of children with cerebral palsy.


It is a surgical procedure that is carried under general anesthesia where the surgeon through pin holes on the skin lengthens the affected muscles.It requires no hospital stay and the patient returns quickly back in therapy and resumes quickly his/her everyday activities.

This is a 5 ½ years old young guy with spastic quadriplegia. The Before video was taken at the gait lab. He underwent SPML and Alcohol Block on his lower extremities. Post operative videos were shot at six and eight months.

Alcohol Block


Case before & after Alcohol Block

This video shows that before the Alcohol Block when you try to move one leg, the other follows to the same direction. After the Alcohol Block each leg can be moved independently without cross reaction. This allows for voluntary muscle control (the child can move each leg without scissoring).


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Back in 2002, we had the opportunity to visit Dr Roy Nuzzo in his institution in Summit , NJ, where he kindly introduced us into his approach on treating patients with Cerebral Palsy. We had the chance to extensively discuss about patients but also to participate in SPML surgeries with him.

That was the beginning of a continuous scientific collaboration over the years that was enhanced by Dr David Yngve who also was following the same SPML approach in Galveston, TX ,USA


Up to nowadays more than 1000 children from Greece, Cyprus and other countries, with various forms of cerebral palsy, were  operated in Greece utilizing the SPML surgical principles. Initial surgical results were studied clinically with video analysis and PT evaluations. All patients were found at follow up with improvement in their function.No complications were noted.

Later on, pre and post operative gait analysis was utilized to collect measurable data. That enable our group to contribute to the medical literature.The effort is still ongoing to Drs Nuzzo’s and Yngve’s applauses.


Although all cerebral palsy children can benefit from SPML and alcohol blocks, there is a small group of children using walking aids that this procedure can transform to walkers.


If you wish to have SPML surgery with us in Greece, follow these steps:

Create videos as this one
You will then receive details about possible functional goals after SPML, cost, housing and transportation details. Recommended stay in Athens is 3 days.

  • Day 1: It includes pre operative gait analysis, physical therapy evaluation as well as pediatric orthopedic evaluation
  • Day 2: Hospital admission, surgery, postoperative physical therapy, hospital discharge.
  • Day 3: Post operative physical therapy at the rehabilitation center, pediatric orthopedic consultation

Further stay for rehabilitation can be arranged based on individual patient’s needs.

Visit the rehabilitation center ENA for more information.


Pre-operative assessment and surgery take place at
Iaso Children’s Hospital, in Athens ,Greece.


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