What does the preoperative consultation for SEMLS involve?

SEMLS (Single-Event Multilevel Surgery) is an advanced procedure used primarily in children with neurological disorders, such as cerebral palsy, who have complex musculoskeletal deformities. Due to the multi-stage nature of the treatment, proper preparation of the patient and family is an extremely important part of the entire process.

A preoperative consultation before SEMLS is not merely a visit during which the doctor discusses the surgery itself. It is a detailed planning phase that allows the family to understand the scope of the procedure, prepare for the postoperative period, and learn about all aspects of the subsequent rehabilitation.

At the Paley European Institute, the preoperative preparation process is part of our comprehensive patient care. Our team of specialists combines expertise in orthopedic surgery, rehabilitation, and neuro-orthopedics to ensure that every stage of treatment is tailored to each individual—from preoperative evaluation through to the child’s return to normal activities.

The First Pre-SEMLS Consultation—What Can Parents Expect?

The first pre-surgery appointment is intended to discuss the child’s condition in detail and prepare the family for the next stages of treatment. Parents receive information about the planned surgery, the hospital stay, rehabilitation, and daily care after returning home.

During the preparation phase, the family fills out a preoperative form that identifies the key individuals responsible for managing the treatment process, including:

• attending surgeon,
• lead physical therapist.

The preoperative nurse plays a very important organizational role. Parents can contact her with any questions regarding their child’s preparation for surgery, tests, the hospital stay, or practical matters related to recovery.

This support helps the family better prepare for the procedure and reduces the uncertainty associated with the next stages of treatment.

A detailed discussion of the planned procedures

One of the most important aspects of the consultation is a thorough analysis of the scope of the planned procedure. SEMLS involves performing several corrections during a single procedure, which is why the doctor discusses with the family all the procedures that will be performed on the specific child.

The plan may include both bone and soft-tissue procedures.

Bone procedures performed as part of SEMLS

Depending on the child's needs, the following options, among others, may be considered:

• pelvic osteotomy,
• proximal femoral osteotomy,
• distal femoral osteotomy,
• transposition of the tibial tuberosity or patellar tendon,
• derotational osteotomy of the tibia,
• calcaneal lengthening,
• arthrodesis of the talocalcaneal or talonavicular joint,
• osteotomy of the first metatarsal bone,
• medial cuneiform osteotomy,
• arthrodesis of the MTP joint of the big toe,
• Dwyer osteotomy.

Soft Tissue Treatments

The second group consists of procedures aimed at improving muscle tone, reducing contractures, and improving limb function. These may include:

• stretching of the iliopsoas muscle,
• adductor lengthening,
• lengthening of the hamstrings,
• rectus femoris muscle transfer,
• lengthening or recession of the gastrocnemius muscle,
• Achilles tendon lengthening,
• anterior tibialis muscle transfer,
• lengthening or transfer of the posterior tibial muscle,
• lengthening of the oblique muscles.

Such a detailed explanation of the surgical plan allows parents to fully understand which issues will be addressed during a single procedure and what the goal of each procedure will be.

Preoperative Tests and Appointments

Preparation for SEMLS also includes a series of tests and consultations aimed at assessing the safety of the procedure and carefully planning the treatment.

Before the surgery, the following may take place:

• PrePARE (Presurgical Patient Assessment and Risk Evaluation) preoperative risk assessment,
• gait and motion analysis,
• preoperative examination,
• checking the baclofen pump, if the child is receiving this type of therapy,
• preoperative rehabilitation,
• blood tests,
• educational activities related to SEMLS,
• an orientation to the hospital.

3D gait analysis is particularly important, as it allows for a precise determination of which biomechanical factors require correction. As a result, surgery is planned not only based on the appearance of the limbs, but above all on the way the child moves on a daily basis.

Preparing the Family for Life After Surgery

One of the most important parts of the preoperative consultation is discussing what will happen after the procedure. Parents need to know not only how the surgery will proceed, but also what daily life will be like after their child returns home.

During the preparation, it is a good idea to discuss, among other things:

• how the child will be transported to and from the hospital,
• preparing the home for the recovery period,
• the need to reorganize the space,
• the ability to position the bed or resting area closer to the caregiver,
• ways to cope with pain,
• how to safely carry a child,
• bathing and hygiene after surgery,
• using the restroom,
• dressing the child after the procedure,
• expected duration of cast wear,
• the opportunity to return to school.

Parents often emphasize that the biggest challenge isn’t the surgery itself, but adjusting to the new situation after it’s over. That’s why it’s so important for the family to receive specific information and support even before the procedure.

The Role of Rehabilitation in Preparing for SEMLS

Rehabilitation doesn't begin only after surgery. Preparing the child before the procedure is also important for the long-term outcomes of treatment.

Physical therapy and rehabilitation specialists help prepare the child for the changes that will occur after surgical correction. This includes, among other things, working on muscle strength and range of motion, as well as preparing the family for postoperative exercises.

After surgery, rehabilitation becomes one of the most important parts of the recovery process.

Comprehensive care from the Paley European Institute before and after SEMLS

SEMLS is a procedure that requires the collaboration of many specialists. At the Paley European Institute, the treatment of children with musculoskeletal deformities is based on a comprehensive care model—encompassing diagnosis, surgical planning, orthopedic surgery, and long-term rehabilitation.

The center's staff understands that the patient is not just the child—the treatment process involves the entire family. Parents need knowledge, preparation, and a sense of security to effectively support their child during rehabilitation.

That is why the preoperative consultation before SEMLS is such an important step. It allows for careful planning of treatment, helps address any concerns, and prepares the family for the coming months of rehabilitation.

Summary. What does the preoperative consultation for SEMLS involve?

The preoperative consultation prior to SEMLS is a detailed process designed to prepare the child and family for one of the most important parts of the treatment. It includes a case review, a discussion of the planned procedures, the completion of necessary tests, and preparation for postoperative rehabilitation.

Thanks to the comprehensive approach taken by the Paley European Institute, parents receive support not only regarding the procedure itself, but also in organizing daily life after surgery. This structured care enhances the safety of treatment and helps the child navigate the entire recovery process.