What is SEMLS surgery, and who needs it?

What is SEMLS surgery? Children with neurological conditions, such as cerebral palsy (CP), often struggle with muscle tone disorders, contractures, and musculoskeletal deformities, which over time can affect their mobility and independence. In such cases, symptomatic treatment alone may not be sufficient—a comprehensive approach is necessary, one that takes into account the functioning of muscles and joints as well as the overall biomechanics of gait.

One of the modern methods used in neuroorthopedics is SEMLS (Single-Event Multilevel Surgery), which is a multilevel surgical procedure for children. It is an advanced procedure that allows for the correction of several orthopedic problems during a single operation, rather than performing multiple separate surgeries at different stages of the child’s life.

What is SEMLS surgery?

What is SEMLS surgery? It is a treatment method that involves performing several corrective procedures during a single surgical session. The procedure covers various levels of the lower limb—from the hip, through the knee, to the foot—making it possible to correct the entire movement pattern at once.

In children with neurological disorders, isolated deformities very often do not occur in isolation. Abnormal muscle tone can simultaneously cause soft-tissue contractures, bone misalignment, and joint dysfunction. Treating one problem without addressing the other factors may not produce the desired results.

Therefore,SEMLS aims to comprehensively correct all major abnormalities in a single procedure. The goal is to improve gait biomechanics, increase the child’s independence, reduce pain, and minimize the risk of further deformity progression.

Who is the SEMLS procedure intended for?

SEMLS for cerebral palsy is one of the most common indications for this procedure. The procedure is particularly considered for children with spastic cerebral palsy, especially those with diplegia or the quadriplegic form of the condition, who:

• can walk on their own or have the potential to learn to walk,
• have persistent limb deformities,
• struggle with muscle contractures,
• require improvement in their gait pattern,
• have misalignments of the hips, knees, or feet.

The procedure is most commonly performed on children between the ages of 6 and 12, but the decision is always made on a case-by-case basis. A key part of the evaluation process is a thorough analysis of the child’s motor functions, imaging studies, and a specialized 3D gait analysis.

SEMLS can also be used in patients with other neurological conditions, including spina bifida and disorders that affect the functioning of the musculoskeletal system.

What is the screening process for SEMLS surgery?

Preparing for surgery requires a thorough evaluation. Doctors do not simply assess a single joint or muscle; instead, they analyze the entire limb and the way the child moves on a daily basis.

The following factors are important in the selection process:

• orthopedic and neurological examination,
• assessment of joint range of motion,
• imaging tests,
• 3D gait analysis,
• assessment of a child's functional potential.

This approach makes it possible to create a personalized treatment plan that addresses precisely those factors that most limit the patient's functional ability.

What does multilevel surgery in children involve?

Multilevel surgery in children may involve several different procedures performed during a single operation. The scope of treatment depends on the specific patient's needs.

The SEMLS program includes, among other things:

• femoral and tibial osteotomies—which correct misalignment of the limbs,
• stretching of tendons and muscles —to reduce contractures,
• correction of foot deformities,
• soft tissue release in the hip, knee, or ankle joint,
• reconstructive procedures that improve limb function.

By combining several procedures, it is possible to simultaneously restore the limb’s proper alignment and improve the function of the entire musculoskeletal system.

Why are several procedures performed during a single surgery?

The “single-event” approach—that is, performing all necessary corrections during a single procedure—has many advantages. It helps reduce the number of hospitalizations and anesthetic procedures, and also shortens the overall treatment time.

The main benefits of SEMLS for children with cerebral palsy are:

• comprehensive correction of the entire limb in a single procedure,
• fewer operations in the future,
• the possibility of undergoing a single course of intensive rehabilitation,
• improving the effectiveness of treatment by simultaneously correcting all factors that affect gait,
• a better chance of lasting improvement in the child's functioning.

SEMLS at the Paley European Institute – A Comprehensive Approach to Children and Families

At the Paley European Institute, the treatment of patients with neuroorthopedic disorders is based on a combination of modern surgery, comprehensive diagnostics, and long-term care. The center specializes in treating complex musculoskeletal deformities in children and adults, drawing on the expertise of a team of physicians, physical therapists, and rehabilitation specialists.

The approachto treating cerebral palsy is not limited to the surgery itself. At the Paley European Institute, special attention is paid to preparing the patient for surgery, proper patient selection, and the subsequent rehabilitation process.

SEMLS is an example of a treatment in which orthopedic surgery is one component of a broader treatment plan. The goal is not merely to correct deformities, but to improve the child’s quality of life—by increasing independence, facilitating daily functioning, and enabling greater participation in social activities.

Postoperative Care Following SEMLS

The outcomes of the surgery depend not only on the procedure being performed correctly, but also on a properly planned rehabilitation program and adherence to postoperative instructions. After SEMLS, the child undergoes a personalized rehabilitation program.

The process includes, among other things:

• functional physical therapy focused on teaching proper movement patterns,
• exercises to improve muscle strength and balance,
• the use of appropriately selected orthoses,
• regular orthopedic checkups,
• an assessment of progress, including an analysis of postoperative recovery.

Collaboration with the family is also an important part of therapy. Parents receive guidance on daily care, exercises, and how to support their child during the recovery process. Detailed information on the process of returning to normal activities can be found in the postoperative instructions.

Outcomes of SEMLS Treatment

A properly performed SEMLS procedure can lead to a significant improvement in a child’s functioning. The results depend on many factors, including the type of condition, the severity of the deformity, and the consistency of rehabilitation.

The most important results include:

• improvement of gait pattern,
• reduction of contractures and deformities,
• pain relief,
• improving mobility,
• improving the quality of life for the child and his or her family.

Thanks to this comprehensive approach, it is possible not only to correct existing problems but also to reduce the risk of further deformities developing in the future.

Summary. How does SEMLS work in cases of cerebral palsy?

SEMLS is a modern treatment method used primarily in children with cerebral palsy and other neurological conditions that affect the musculoskeletal system. By performing several corrective procedures during a single surgery, it is possible to comprehensively improve limb function and gait patterns.

At the Paley European Institute, multi-stage surgery for childrenis part of a broader treatment process that includes diagnosis, advanced orthopedic surgery, rehabilitation, and long-term patient care. This approach helps support not only the child’s physical function but also their development and ability to actively participate in family and community life.