Selective percutaneous myofascial lengthening

Selective Percutaneous Myofascial Lengthening (SPML) is a minimally invasive surgical procedure designed to improve muscle flexibility and joint mobility in individuals with spasticity. This technique is often used for patients with conditions such as Cerebral Palsy (CP), where spasticity leads to muscle stiffness, pain, and restricted movement. SPML targets the myofascial tissues— the connective tissue that surrounds and supports muscles— to release tension and lengthen muscles.

Overview

SPML involves making small incisions through which special instruments are inserted to cut the fibrous bands within the myofascial tissue. This procedure is considered less invasive than traditional orthopedic surgery, such as tendon lengthening, and it typically results in a quicker recovery time and less postoperative pain. The goal of SPML is to provide patients with greater range of motion and improved functional abilities, potentially reducing the need for more invasive surgeries in the future.

Indications

SPML is primarily indicated for patients with spasticity that affects their mobility and quality of life. Conditions such as Cerebral Palsy, Stroke, and Traumatic Brain Injury (TBI) can lead to spasticity. Candidates for SPML are typically those who have not responded adequately to non-surgical treatments like physical therapy, occupational therapy, and medication.

Procedure

The SPML procedure is performed under general anesthesia. The surgeon makes several small incisions in the targeted area. Using specialized instruments, the surgeon then carefully cuts the fibrous bands within the myofascial tissue without damaging the surrounding muscles and nerves. The number and location of incisions depend on the patient's specific needs and the muscles being targeted.

Recovery

Recovery from SPML is generally faster than from traditional orthopedic surgeries. Patients may experience some pain and swelling at the incision sites, but this is typically manageable with medication. Postoperative care includes physical therapy to maximize the benefits of the procedure, improve muscle strength, and enhance joint mobility. Most patients can return to their normal activities within a few weeks, although full benefits of the procedure may take several months to realize.

Benefits and Risks

The benefits of SPML include improved muscle length and flexibility, increased range of motion, reduced spasticity, and decreased pain. These improvements can lead to enhanced mobility, better posture, and improved quality of life. However, as with any surgical procedure, there are risks involved. These may include infection, bleeding, and the potential for nerve damage. The risk of significant complications is relatively low, but the decision to undergo SPML should be made after a thorough discussion with a healthcare provider.

Conclusion

Selective Percutaneous Myofascial Lengthening offers a minimally invasive option for managing spasticity in patients with conditions like Cerebral Palsy. By targeting the myofascial tissues, SPML can improve muscle flexibility and joint mobility, enhancing the patient's functional abilities and quality of life. As with any medical procedure, potential candidates should consult with a healthcare professional to determine if SPML is appropriate for their specific situation.