Frequently Asked Questions

What does SPML stand for? (Selective Percutaneous Myofascial Lengthening)

It refers to a surgery for the treatment of the spasticity found in children with cerebral palsy and is usually performed under a general anesthetic.

What ages can be treated with SPML?

It works well for children of all ages, as well as for adults. Because it uses micro incisions, there is very little scar that forms. This allows the procedure to work well even for groups that have a reputation for recurrent contracture following conventional tendon lengthening surgery such as very young children and adolescents.

What will I need in hospital?

You will need knee immobilizers and cast shoes.

How will I get home from the hospital?

You will return home the same way you arrived. Because the child will be wearing knee immobilizers, he/she normally takes the back seat and rests his/her back on the person accompanying the child.

How am I going to take a bath or shower?

As you normally do, covering the casts with special waterproof bags.

How long will I have to wear casts?

When the lengthening is performed on the calf muscle, usually three weeks.

For how long will I wear AFOs and knee immobilizers at night?

Until the muscle is fully developed, however, in some cases they can be removed for a few days, following doctor’s instructions.

Which activities are these? (school)

Cycling, swimming, martial arts, football, basketball etc.

What is exactly done in the SPML procedure?

Through small incisions in the myofascia, the muscles with spasticity are lengthened.

What are the long-term results of the SPML procedure?

The aim of the procedure, in combination with functional physical therapy and the collaboration of the family and environment, is for the child to gain maximum functional independence with regards to his/her problem.

How long will I have to stay in hospital?

The child does not stay in hospital; he/she can return home on the same day.

How will we manage pain?

Following doctor’s orders, it is usual to prescribe pain killers every four hours and it is advised that the child also take a pain killer half an hour before physical therapy.

How will I use the knee immobilizers?

During the first week, the child will wear the knee immobilizers 24 hours per day and will remove them every two hours in order to exercise and walk. It is advisable that the child rests in a long chair with the legs spread apart.

After removal of the casts will I need AFOs?


When can I stop wearing AFOs during the day?

When the child is strong enough, following doctor’s instructions.

Will I need to undergo another SPML procedure?

8 to 10% of children might. It usually is children who do not wear their knee immobilizers and AFOs during the night and children whose physical therapy program is aimed at stretching rather than strengthening and functional rehabilitation.

What parts of the body can be treated with SPML?

Common areas for surgery are the groin area, the hamstring, and the calf.

What is an alcohol nerve block?

The alcohol nerve block is a common procedure that is done at the same time as SPML in order to alleviate the scissoring gait and to help the child move its legs independently. The results are immediate.

When can I begin physical therapy?

Children who have the SPML procedure are allowed to walk when comfortable (usually the next day) and physical therapy begins on the same day.

What kind of clothing will I need to wear after the surgery?

Comfortable, loose fitting clothes are best.

When can I go back to school?

After seven to ten days. It is advisable that the school follows the physical therapists’ instructions with regards to the seating and mobilization of the child.

What sort of shoes will I wear with the AFOs?

Trainers, after you have removed the interior soles.

Can I exercise in school?

It is essential that the child participate in exercise classes in school, as well as in all other extracurricular physical activities.

What are the long-term results of SPML?

Dr. Nuzzo’s web site (www.pediatric-orthopedics.com) reports that in a 5 year review of 278 cases there were 0.01% post op admissions (4 cases, single night). There were no cases of infection, over-lengthening, and significant hematoma. Parent satisfaction was positive in 100% with similar follow up survey results one year later. Repeat procedures at any location were 10%.