Scoliosis surgery / Top clinic in Germany, Friedrichshafen

Scoliosis surgery in Germany

Scoliosis treatment

In a scoliosis, the spine curves to the side. Mostly, the vertebral bodies are twisted. Symptoms usually develop only with a stronger spinal curvature. Light forms can often be treated with physiotherapy and a special corset, heavy cases need surgery.

Scoliosis: short overview

Definition: permanent lateral curvature of the spine

Common symptoms: shoulders of different heights, oblique pelvis, head tilted, lateral "rib hump", back pain, tension

Consequences: stiffening of the respective vertebral section, early wear

Important examinations: physical examination, Adams test, mobility / strength tests, X-ray, determination of skeletal maturity

Treatment options: physiotherapy, corset, plaster, brace technique, surgery.

Structure of the spine

A healthy spine consists of about 33 vertebral bones: seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, five fused sacral vertebrae, and about four - likewise coccygeal - coccyx vertebrae. Bone processes connect the vertebral bodies to the adjacent vertebrae and ribs.

Seen from the side, the spine has the shape of a double "S". The cervical and lumbar spine bulge forward (lordosis), the thoracic and sacral vertebrae (sacral) posteriorly (kyphosis). Looking at the spine from behind, it forms with its spinous processes a nearly straight line from the head to the anal fold. The vertebral bodies are equally spaced and between each two of them is an intervertebral disc as a shock absorber.

What is scoliosis?

In case of scoliosis the spinal column structure is disturbed. The name of the disease is derived from the Greek word skolios, which means "crooked": In this case, the spine curves not only forward and backward, but also to the side.

According to the guidelines-compliant scoliosis definition, this condition is "a persistent (fixed) lateral spinal curvature of at least ten degrees Cobb angle, which indicates how severe the lateral curvature of the spine is and can be determined from an X-ray image Depending on which side of the spine curves, doctors speak of a right or left convex scoliosis.

In addition, the individual vertebrae are twisted in itself and the entire spine in its longitudinal axis (rotation and torsion). This shows the bony vertebral body processes (spinous process, spinous process). The side of the appendages that points to the abdomen or chest thus turns in the direction of the spinal curvature. The rotation is strongest at the apex of the scoliosis and decreases again at the foothills of the curved spine segment.

Due to the different degrees of torsion stress and compressive forces arise between the individual vertebral bodies. As a result, the vertebral bone also has a warped bone structure (torqued): on the outwardly arched side, the vertebral body is higher than on the inward facing side. The same applies to the intervertebral discs between the vertebral bones. This results in a permanently existing Schiefwuchs. The twisted and crooked spine also refer experts as torsion scoliosis.

Most torsion scoliosis occurs only at the main curvature. In order to compensate for a strong scoliosis, muscular force causes secondary curvatures of the spine in the immediate vicinity of the main curvature (static compensation). However, the minor curvatures have no rotation or torsion. If it does, it's called a multiple scoliosis.

Which scoliosis forms are there?

A scoliosis can be divided into different forms, depending on the point of view. For example, idiopathic scoliosis is generally differentiated from a secondary one.

Idiopathic means that no specific trigger for the disease can be found.

Secondary scoliosis, on the other hand, is always the consequence of a known cause.

Note: These "real" (structural) scolioses are to be distinguished from a scoliotic malposition (also functional scoliosis).

A scoliotic maladjustment is temporary and normalizes again through passive or active movements. It arises, for example, to compensate for a pelvic obliquity.

Attention: Since in many cases the cause of scoliosis is unknown, it can not be effectively prevented.

True scolioses can be further differentiated according to age and curvature pattern:

Scoliosis of different age groups

Among other things, scolioses can also be distinguished according to the time of their first appearance. The early form is called infantile scoliosis and in most cases recovers without therapy. Doctors refer to infantile scoliosis when the curvature of the spine occurs up to the age of three. Scoliosis in children aged four to ten years is called juvenile form.

Most common, however, is adolescent scoliosis from the age of eleven. The spine is usually bent to the right in the thoracic region (right convex scoliosis). Girls are more often affected than boys.

Scoliosis curve pattern

In addition, scoliosis may be assigned to the center (or apex) of its major curvature in the spine. In a thoracic scoliosis, the curvature is in the area of ​​the thoracic spine (thoracic spine). Thoraco-lumbar scolioses have their strongest lateral deflection where the thoracic lumbar spine (LWS) passes. A spinal curvature in the lumbar region is called lumbar scoliosis.

In some cases sufferers suffer from BWS and at the same time a lumbar scoliosis. It forms a curvature pattern, which - when viewed from behind on the back of the patient - the letter "S" recalls (double-curved).

If the spine is completely bent to one side, doctors speak of a C-shaped scoliosis.

Curves of the spine in all sections (thoracic, lumbar and their transition) alternately to the right and left, creates a double-S spine, also called triple scoliosis.

Scoliosis degree of curvature

Also, depending on how strongly the spine is curved, a scoliosis can be divided:

  • slight scoliosis: angle up to 40 degrees (1st degree scoliosis)
  • Moderate scoliosis: angle between 40 and 60 degrees (second degree scoliosis)
  • severe scoliosis: angle from 61 to 80 degrees (3rd degree scoliosis)
  • very severe scoliosis: angle over 80 degrees (scoliosis grade 4)

Scoliosis frequency: The frequency of the disease is so high

About two to five percent of the population suffer from idiopathic scoliosis. According to a study by the Maimonides Medical Center (USA), the incidence in old age (60 to 90 years) can rise to 68 percent.

The greater the spine curvature and the higher the age, the more frequently women or girls are affected. In boys, especially mild scolioses can be found. More pronounced scoliosis, with a Cobb angle greater than twenty degrees, is found about seven times more frequently in women than in men.

Scoliosis: symptoms

Scoliosis is in many cases a purely cosmetic problem. However, the longer it remains untreated, the more likely it is for pain to develop in the course of the disease. Because how pronounced the symptoms are always depends on how advanced the curve is.

Among the cosmetic symptoms of scoliosis that can be seen with the naked eye include, among others

  • different height shoulders
  • oblique or outstanding on one side pelvis
  • head held awry

Note: In pronounced scoliosis often occurs the so-called rib hump, it can form muscle bulges in the lumbar and neck area.

Due to increasing signs of wear and tear, people have more problems with muscle tension and pain, especially from the middle of the third decade of life. The lung capacity may also decrease and respiratory distress, a feeling of pressure on the chest or palpitations occur.

Scoliosis: causes and risk factors

About 90 percent of all scolioses are idiopathic, so you do not know why they arise. The remaining ten percent - secondary scolioses - have various causes that can lead to spinal curvature.

Malformation scoliosis

This form of scoliosis is due to congenital malformations of individual spinal components, for example:

  • wedge-shaped vertebral bodies (different edge heights)
  • split or semi-formed vertebral bones
  • congenital malformations of the ribs (synostoses)
  • Defects in the spinal canal (eg diastomatomyelia)
  • Experts therefore call them congenital scoliosis.

Myopathic scoliosis

These spinal curvatures are based on muscle diseases (including hereditary muscle weakness diseases). The most common is Duchenne muscular dystrophy, in which a certain muscle protein is not formed. As a result, children already suffer from increasing muscle weakness and atrophy at an early age. More than half of all patients develop scoliosis during Duchenne muscular dystrophy, usually in early adolescence and after loss of walking ability.

Arthrogryposis may also lead to severe scoliosis in severe cases. It is a congenital stiffness caused by changes in the tendons, muscles and connective tissue.

Neuropathic scolioses

In this form, damage in the nervous system leads to a crooked spine. Muscles that stabilize the spine (abdominal and back muscles) then no longer function as usual. This creates an imbalance, the spine curving in the direction of the flaccid muscles.

Among other things, these diseases of the nervous system lead to scoliosis:

  • Myasthenia gravis (muscle paralysis)
  • viral spinal cord inflammation (myelitis)
  • Early childhood brain damage (eg infantile cerebral palsy)
  • Neurodegenerative diseases with damage and loss of nerve cells (eg spinal muscular atrophy with decrease of the second nerve tract to the musculature)
  • Cyst formation in the spinal cord caused by cerebrospinal fluid (syringomyelia)
  • malignant or benign growths (eg spinal tumors).

Scoliosis: diagnosis and examination

The specialist for diseases of the musculoskeletal system is the orthopedist. There are also scoliosis pediatricians and pediatric orthopedists. First, the doctor raises the medical history (anamnesis) and asks the patient or his caregiver, among others, the following questions:

  • When did the crooked spine first strike you?
  • Do you suffer from ailments such as back pain?
  • Has it already come to the first menstruation (menarche) or the voice break?
  • How fast have you grown in recent years?
  • Are other known disorders, such as deformities of the feet, a crooked pelvis, muscle or nervous disorders?
  • Are there any cases of scoliosis in your family?

In many cases, the doctor can diagnose scoliosis based solely on physical examination. However, if suspected spinal curvature, he will always have an X-ray. The whole spine is shown standing, once viewed from the front (or back), once from the side.

With the help of the X-ray images, the physician can measure the Cobb angle (RVAD in the case of infant scoliosis), determine major and minor curvatures, make the vertex and end vertebrae, and determine the curvature pattern. This procedure is important for later scoliosis therapy. In addition, malformations or deformations of the bones can be detected.

Determination of skeletal maturity

In order to assess the course of scoliosis in adolescents, it is important to determine the state of spinal growth. Skeletal maturity is assessed on the basis of the ossification of the iliac crests (apophyses). These processes ossify more and more as they grow older, when they are completely ossified and the apophyses are closed, skeletal growth is complete. The bone age can also be determined by means of an X-ray image of the wrist and classified according to Greulich and Pyle.

Although the age usually depends on the skeletal maturity, but it may also differ. For the prognosis of scoliosis the bone age is more reliable than the age.

X-ray Alternatives

In addition to a conventional X-ray diagnosis, there are also a number of imaging procedures without radiation exposure for the investigation of scoliosis

Scoliosis: treatment

Scoliosis is treated conservatively with physiotherapy or corset and in severe cases surgically. Scoliosis therapy should begin as soon as possible after diagnosis. The choice of treatment depends on the extent, cause and location of the spinal curvature, as well as the age and physical condition of the patient. Physiotherapy is often sufficient for mild scoliosis; doctors with a scoliosis corset are treated more severely. If there is a very strong curvature, surgery can help.

Objectives of scoliosis therapy

With the treatment of spinal curvature, doctors and other professionals, such as physiotherapists, are trying to reduce or at least not worsen scoliosis. If scoliosis therapy can reduce the curvature, further treatment steps will ensure that this success is achieved. For children and adolescents, the guidelines set a clear goal: the Cobb angle should be below 40 degrees when the growth is completed. If this succeeds, according to experts, surgical scoliosis therapy is no longer necessary.

Scoliosis corset

A scoliosis corset is used for stronger spinal curvatures of the child (Cobb angle 20-50 degrees). Often one achieves thereby very good results with scoliosis, which are not based on heavy basic illnesses (malformations, muscle or nervous illnesses among other things).

The corset (orthosis) is made of plastic and has both built-in pressure pad (pads) and open spaces (expansion zones).

It is custom-made, attached to the body with straps and Velcro straps and is designed to return the spine to its natural state. The orthosis should be worn 22-23 hours daily. Depending on the height of the main curves, different scoliosis corsets are available.

Depending on the course, girls can gradually reduce the daily wear duration approximately two to three years after the first menstrual period. In boys it should first be reached a certain skeletal maturity (Risser stage four or five), so that a large growth of the spine is no longer expected.

Note: Adults benefit little from this scoliosis therapy because their bone growth is already complete. Nevertheless, the orthoses are also used in later life, for example, to stabilize and thus mitigate the disease process.

Gypsum treatment

In some cases of early spinal curvature (less than five years old, early onset scoliosis) scoliosis therapy using plaster corsets may be considered. Here, the spine can continue to grow normally. The gypsum treatment is usually followed by therapy with a scoliosis corset.

Operative scoliosis therapy

In some cases, conservative scoliosis therapy (physiotherapy, corset) is not sufficient. If scoliosis deteriorates rapidly and the curvature is pronounced, doctors generally recommend operative scoliosis therapy. They take into account several factors:

  • the curvature severity (from a Cobb angle of about 40 lumbar and 50 degrees thoracic)
  • a rapid progression and imminent wear
  • the age (if possible, not before the tenth to twelfth year of life)
  • the general physical condition (mental stress, chronic pain)

Amongst other things, the use of surgical scoliosis therapy should prevent spondylosis stiffening. In a spondylosis, the body builds bone substance to the vertebral edges so as to be able to compensate for increased stress. These bony paws of neighboring vertebrae can, however, grow together and the spinal column stiffens due to the resulting bone bridge. Possible effects on the cardiovascular system and lung function are also tried with surgery.

During the actual surgical procedure, the surgeon releases the affected spinal column section. The surgery is performed either from the front, via the thoracic or abdominal cavity, or from behind. All surgical scoliosis therapies have the common goal of stretching the crooked spine and eliminating its rotation. In addition, the doctor stabilizes the spine, for example by means of screws and rods.

Scoliosis surgery: stiffening therapy

With the so-called spondylodesis (spinal fusion) intentionally causes the merging of vertebrae at the affected site. So you want to stiffen the spine in its previously corrected form.

Newer surgical scoliosis therapies for children and adolescents

A stiffening of the spine prevents their natural growth. That is why it is not an option for children and adolescents. Instead, doctors use special titanium rods in these cases, for example.

The so-called VEPTRs (vertical expandable prosthetic titanium rib) are used in this way - for example, from the rib to the vertebra - so that they do not prevent the spine from growing.

Caution: In this scoliosis therapy, doctors need to periodically adjust the bars to growth through further minor procedures, approximately every four to six months.

Modern variants of such rods, the "growing rods" (= growing rods), include a small remote-controlled motor. In this way, they can be adjusted from the outside and without renewed intervention to the respective spine growth.

A complex system of screws, rods and a special plate called the Shilla procedure also promises scoliosis therapy without impeding growth. The rods used "grow along with" because they can slide in their mounting screws. Once bone growth is complete, the system can be removed.

Correction system

Another method is the correction system ApiFix. It is attached vertically in the arc of curvature of the scoliosis. Physiotherapeutic treatments follow in the months following implantation.

The correction system can react to this by means of a ratchet mechanism: If the spine extends through an exercise, the system is pulled along and locks in place. As a result, the spine can not fall back into its crooked starting position. This scoliosis therapy takes place gradually, so that the surrounding tissue can adapt better.

Clip art

This form of operative scoliosis therapy is suitable for bending angles below 35 degrees. Doctors attach special, claw-shaped clamps (Shape-Memory-Alloy, SMA) to the curvature side of the spine. After the procedure, they are cooled, and after the procedure, the patient's body heat gradually causes them to return to their original shape, correcting scoliosis.

Scoliosis surgery

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DM Thomas Benz

DM Thomas Benz
Head of the Spine Department

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  • 243 spinal stenosis surgeries
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