SPML (Selective Percutaneous Myofascial Lengthening) is a minimally invasive surgical procedure used to reduce muscle tension that limits movement in patients with Cerebral Palsy.
What does SPML stand for?
SPML surgery stands for Selective Percutaneous Myofascial Lengthening.
- Selective: it addresses selected areas of tightness caused by spasticity
- Percutaneous: no formal incisions are performed; needles and microscalpels are used
- Myofascial: this terms refers to the anatomical structures addressed: myo=muscles; fascia= the connective tissue that covers a muscle or a group of muscles
- Lengthening: by performing this procedure the contractures and shortening of muscles are addressed.
SPML – Selective Percutaneous Myofascial Lengthening: what is it?
It is a minimally invasive surgical approach developed by Roy Nuzzo, M.D. of Summit, New Jersey, USA to treat muscle and joint contractures seen in Cerebral Palsy and other neuromuscular disorders.
Dr. Lampasi and his OrthoChildren team (Bologna, Italy) have been using this method for years.
SPML – Selective Percutaneous Myofascial Lengthening: indications
SPML is an effective procedure when performed with the right indications and methods. However, it can be harmful if performed poorly or with incorrect indications.
Over the years, our team has progressively refined the indications compared to the original descriptions and the broad-spectrum applications initially suggested, to improve results and limit the complications recorded.
SPML – Selective Percutaneous Myofascial Lengthening: how is it performed?
- SPML uses needles and microscalpels so as not to leave extensive scars.
- SPML is carried out under general anesthesia
- No actual incisions are made, only small access points that do not require suture stitches
- It is possible to treat different muscles during the same procedure, so that at the end of the procedure the muscle tension will be reduced in different parts of the body
SPML: where to perfom the procedure?
SPML is performed in few centers in the USA (where the original description of the procedure was made) and in Europe (Germany, Greece, etc). Dr. Lampasi and OrthoChildren Center (Bologna, Italy) are among the international centers performing this procedure.
SPML – Selective Percutaneous Myofascial Lengthening: results
The results of SPML can be significant in terms of reducing muscle tension, with improved freedom of movement of some joints and of the patient more generally.
SPML: before and after
Results of SPML are significant.
SPML: is immobilization necessary?
- One of the objectives of the procedure is to reduce immobilization, so in most cases no immobilization is required
- in selected cases simple immobilization (brace) or temporary immobilization (cast) are applied to ease management, limit postoperative muscle spasms and improve results.
SPML and Cafè door procedure
Dr Nuzzo was one of the proponents of SPML in the USA, criticizing traditional surgery for cerebral palsy by recommending SPML. Likewise he criticized traditional surgery (VDRO, osteotomies, etc.) suggesting the use of Café door procedure.
Go to the related fact sheet on Cafè door procedure.
Are you interested in SPML? Contact us and send us a video
Contact our team to understand if SPML is suitable for you:
- Mail to: info@orthochildren.org
Why to perform SPML at OrthoChildren Center, Italy?
- Dr Lampasi and his team have a wide experience in all the surgical procedures required for children with Cerebral Palsy (see related factsheets: orthopedic surgery in CP, multilevel surgery, hip reconstruction, etc) and use SPML with the right indications
- OrthoChildren Center collaborates with a high-level Center for Intensive Rehabilitation. Children with Cerebral Palsy that undergo SPML start an intensive program of rehabilitation, starting the day after surgery and lasting 2 to 8 weeks. The intensive program is performed by experienced pediatric therapists.
Patients from abroad: can OrthoChildren Center treat foreign patients?
Yes, many patients come from all countries (Europe and USA):
- the surgical equipe has a wide experience with Cerebral palsy patients (see related fact sheets and results)
- an intensive rehabilitation program can be included
- the procedure is less expensive than in USA and other countries
- Families take advantage of this opportunity to combine a trip to the beauties of Italy