does SPML refer to?
(Selective Percutaneous Myofascial Lengthening) refers to an
outpatient surgery under a general anesthetic for the treatment
of the spasticity and tight tendons that are found in children
with cerebral palsy. The word “Percutaneous” in the name SPML
means using very small skin incisions 2-3 mm in length, so small
that stitches are not needed. The SPML method was developed by
Roy Nuzzo M.D. of Summit, NJ.
is exactly done with the SPML procedure?
procedure involves releasing tight bands of tendon. This is
done where muscle and tendon overlap. These areas of overlap
are areas where a tendon starts to blend into a muscle. The
tendon spreads out and is thinner at this location and is called
Myofascia. When the myofascia is cut, the muscle under
it can easily stretch and lengthen.
part of the body can be treated with SPML?
children have tightness and spasticity in many locations in the
legs. With the SPML procedure, many areas can be addressed
during the same procedure.
areas for the SPML procedure are:
the low calf for ankle / calf / heel cord tightness and
behind the knee for hamstring tightness and spasticity
the groin area for scissoring gait and groin spasticity
age can be treated with the SPML procedure?
works well for children of all ages and for adults. Because the
SPML procedure uses micro incisions, very little scar forms.
This is a good feature since scar is associated with recurrent
contracture. This allows the SPML procedure to work well for
all ages, including groups that have a reputation for recurrent
contracture following conventional tendon lengthening surgery
such as very young children, adolescents and adults.
What are the long term results of the SPML
data comes from Dr. Nuzzo’s web site where he reports a 5 year
review of 278 cases. “Post op admissions were 0.01% (4 cases,
single night). Repeat procedures at any location were 10%.
Recurrence of operative site contracture occurred in 7%. There
were no cases of infection, over lengthening, significant
hematoma.” My results have been similar.
the SPML procedure decrease spasticity?
Walking on a contracted joint puts a strong pull on the muscle-
tendon unit with each step. This stimulates spasticity.
Lengthening the muscle- tendon unit decreases the spasticity in
that area. The beauty of the SPML procedure is that since it is
practical with the minimal incisions to lengthen muscle- tendon
units in many locations in the lower extremities, spasticity can
be decreased in many locations.
is an alcohol nerve block?
alcohol nerve block is a common procedure that is done at the
same time as the SPML procedure in children who have
overactivity of the obturator nerves, which are nerves in the
groin that contribute to stiffness of the hips or scissoring
gait, in which the legs cross in front of each other in
walking. The alcohol block is also used to decrease spasticity
in the legs when it is associated with groin tightness. The
alcohol block takes the nerve from overactive spasticity to a
more normal state. It does this by dissolving the fatty
coating, called the myelin sheath which is wrapped around the
nerve. The nerve itself remains intact. The myelin sheath can
grow back in about 3 years.
is the ankle area treated after the SPLM procedure?
will be a cast from below the knee to the ball of the foot.
Walking is encouraged. It is best to put a shoe directly over
the cast. Often an inexpensive discount store shoe can be found
that fits over the cast.
is the knee area treated after the SPML procedure?
put on a knee splint made of cloth and foam with Velcro straps
after the procedure. You can take this off for daytime
activities. It should be worn every night for a month to
prevent sleeping in a curled up position.
is the groin area treated after the SPML procedure?
special is needed.
exercises are recommended after the SPML procedure?
Long sitting. This is
sitting on the floor with the knees out in front as straight as
possible. This helps to keep the backs of the knees stretched
Giant steps. Encourage
the child to take as big steps as possible. Try counting the
number of steps it takes to walk across the room. Then try to
walk across the room using giant steps. You should count fewer
Walking on uneven ground.
This teaches the ability to deal with the unexpected. It also
teaches fast reactions. It helps in learning new ways to use
soon can children resume PT following SPML?
who have the SPML procedure are allowed to walk when
comfortable, which is within a week and sometimes the next day.
If not walking by the third day, it is time to start! It
usually takes 1-2 months to regain the before surgery level of
activity, then expect monthly improvement up to 4-5 months from
surgery. Physical Therapy can be very beneficial and can be
resumed immediately following the procedure.
David Yngve, MD, (832) 505-1200
Primary Care Pavilion
South Shore Harbour
3023 Marina Bay Drive, Suite 101
League City, Texas 77573-1428
2240 Gulf Freeway South
League City, TX 77573