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It’s crucial to underline the difference between simple disorders of the spine and scoliosis. The main symptom of scoliosis is crank of vertebrae called “torsion”.
There are multiple reasons for deformation of the spinal column, we will highlight four basic causes:
In the case of large abnormalities in the skeleton, for example, severe shortening of the lower limb, scoliosis can also develop. Here it should be considered as an incorrect compensation mechanism.
In the vast majority of patients, scoliosis develops since childhood. Weakened ligaments of the spine, incorrectly located centers of growth of the vertebral bodies can lead to scoliotic changes.
When a kid starts attending school, routine daily activities pose huge load on the back – the backpack with books, static posture during writing, etc. Pretty often, this load triggers spine deformations in children from risk groups: the ones who have hormonal disorders, or inborn abnormalities of bone-ligamental apparatus.
In an average person, the growth of the skeleton ceases by 20-22 years. Therefore, real progression of scoliosis is untypical for adults. People with long-lasting condition have symptoms of chronic scoliosis:
These are crucial peculiarities that should be taken into account to perform an efficient rachilysis surgery. Therefore, surgical techniques are divided into two major categories: operations on a growing spinal cord, and operations on a formed spinal cord.
In layman’s terms, some methods are suitable for children and teenagers while the others are better for adults.
Treatment of scoliosis is a real challenge. It’s better to start treating the condition at its early stages that are classified according to the angle of spine deformation and misplacement from the vertical axe.
Many different operations for scoliosis can be performed. All of them are combined by six basic methods:
By anatomical principle, operations can be performed on the front or the back part of the spine. There are different indications, peculiarities of accessing, and methods of straightening for both approaches.
Non-surgical treatment includes manual therapy, physiotherapeutic treatment and exercise therapy. Non-surgical treatment could help patients with early disease stage with angle of inclination less than 25°. Specialists of orthopedic surgery and traumatology center of GHK Clinic create individual programs alternating different types of non-surgical treatment.
Manual correction is the main step in the non-surgical treatment of scoliosis. This allows you to stop the development of scoliosis. Manual therapy translates the pathology of the structure of the spine, ligaments and muscles into the correct state.
Physiotherapeutic treatment is a very beneficial method of treating scoliosis, but this is only a secondary measure aimed at strengthening the back muscles. It also affects the endocrine system and all internal organs. Among all physiotherapeutic procedures for the treatment of scoliosis, electrical stimulation is the most effective. A special electronic device provides gradual selective training of muscles for further natural correction of spinal curvature.
Physiotherapy exercises are beneficial for the entire musculoskeletal system. In addition, the patient acquires the correct movement skills while maintaining the correct posture. Highly qualified doctors choose exercises without axial load applying to the spine, but providing the necessary training for various muscle groups. This type of training allows patients to feel better stability and flexibility, as well as the gradual elimination of scoliosis.
It is noteworthy that non-surgical treatment provides the best results (99,5%) for children 4-11 years old.
A certain method is figured out individually for every patient. Many different factors are taken into account, and patient’s age is the basic one.
Surgical treatment helps to solve various problems, including:A remedial surgical procedure for scoliosis treatment is a must, when the angle of spinal misplacement from the vertical axe is 50 ° and more.
The fourth degree of spinal deformation usually means that conservative and physical therapy treatments appeared to be useless. This is why surgical invasion is inevitable.
Elimination of spinal deformations is made with the help of special constructions and posts. Adult patients usually have immovable constructions installed – they keep vertebrae in the right position. Children and teenagers whose spine is continuously growing need expensive movable constructions that can grow together with bones. There are many different methods for scoliosis treatment. Some of the most widespread are:
A classic operation is called “posterior spine fusion”. This technique is widely spread among orthopedic surgeons and is greatly researched. It is aimed at making a rigid immovable structure from several vertebrae and ceasing deformation in the corresponding spinal department.
Indications for the operation – scoliosis with high mobility of vertebrae, when their anatomical structure should be preserved.
In some cases, this operation can also be prescribed for rigid forms of scoliosis when vertebrae do not move much. As a rule, it concerns young people who:
In this instance, spondylosyndesis helps to form an immovable bone block in projection of body center of gravity. It also helps to prevent further deformation of spine arc under intervertebral osteochondrosis and sinking of intervertebral discs.
To have this operation indicated, a person should prepare the spinal cord. This procedure is aimed at strengthening the spine and fixing it at some certain position with orthopedic surgeons’ help.
The choice of certain method, duration of procedure, and peculiarities of preparation depend on overall health and characteristics of scoliosis in every single patient.
During pre-operational period, doctors manage to reduce the angle of spinal deformation by 10-20 degrees.
In a weak point of the spine, a rigid block is fixed: it does not allow the spine to deform further on. Progression of scoliosis is ceased.
The operation implies installation of a vertical transplant made of patient’s own bone in the spine. It is installed by the hollow (inner) side of curvature arc.
Patients and simple readers won’t find detailed description of posterior spine fusion operation interesting. But we should mention its basic stages:
As a rule, a fragment of patient’s own shin bone serves as material for transplantation. Sometimes surgeons only apply bone chips into the formed bed. When the transplant is fixed, it is covered with muscles that were separated on the second stage.
Since the thick cortical bone is removed, all bone formations and the transplant contact with each other via a spongeous bone and grow together rigidly.
It’s crucial to have the transplant located along the projection of centre of gravity of the curved spinal cord. Only this way you can fix the block and make sure it won’t move along high and low parts of the spinal cord.
When rigid (immobile, static) scoliosis is developed, a posterior spine fusion surgery won’t be efficient enough. In such cases, the present curvature should be eliminated first, and the new rigid vertebral block should be formed after that.
Initially, metal constructions were used for spinal straightening – they were called “distractors” and worked by the principle of an adjustable jack. The problem is that they should be removed some time later, and such operation is very traumatic.
A coarse-meshed polyethyleneterephthalate (lavsan) band can be used as an alternative to a temporary metal distractor – it may not be removed.
S-shaped thoracolumbar scoliosis is the main indication for such type of operation. It is aimed at correcting and stabilizing the spinal cord in the lumbar spine.
The band maintains dragging aimed at straightening the bulging of scoliosis arch – it does not have to be removed. After the operation, a patient is put into a corrective plaster bed for 3 months.
After that, a plaster bed is replaced by a plaster jacket that should be worn. It is also used for 3 months. If new operations are not required anymore, the plaster jacket can be replaced by an orthopedic removable jacket that must be worn for at least a year.
This operation is aimed at making vertebrae move in certain direction.
First, processus transversus are bared. When a surgery on the thoracic section is performed, all adjacent parts of ribs are removed, but periosteal coverage is preserved.
Therefore, invertebral discs are bared. Annulus fibrosis of several discs is cut from the arched side. At this side, an homeotransplant (bone chips made of removed rib parts) is put. After the operation, a patient should rest for at least 12 months. Plaster constructions are used for that.
This is a suitable method for spinal surgery for progressive scoliosis in childhood. The approach is called "Episodez." It is aimed at the destruction of the growth zones of the vertebral bodies from the convex side.
Quite often, this is shown in case of guessing the chest. As during a discotomy, the lateral surface of the vertebrae is exposed, but on the convex side.
Removing part of the disk is as follows. Its widest part is an object only for resection. The pulpous nucleus is always removed. Defects between the vertebrae are covered with bone chips from the removed ribs.
After surgery, the patient should use a plaster bed before removing the stitches. After that - a gypsum jacket with a headrest should be worn for 2 months. Then, an x-ray is taken of the operated area. If everything is in order, the jacket for horizontal position is removed and given a jacket for walking.
This is an additional technique that is used to treat serious forms of scoliosis. The main indication is severe scoliotic deformity of the spinal cord.
The operation involves the removal of a wide part of the vertebrae on the convex side. Sometimes several vertebrae are operated on. To maintain normal proportions of the spinal cord, fragments of the narrowed part and the back of the spinal cord are also removed.
The main stages of this operation are the same as for discotomy and epizootics. Recovery and postoperative care are also similar.
All above-mentioned and some other operations with similar approaches have a few disadvantages. The most serious cons are necessity to remove a lot of tissues, and long-term recovery process. Classic methods of scoliosis treatment affect the quality of life and require at least a year for recovery.
Modern methods of surgical treatment of scoliosis are different from the ones that were used in the 20th century. The main differences are:
Evolution of distractor method lies in the base of such operations.
Today, many orthopedic clinic allow installing low-traumatic metal constructions on the spinal cord. The principles of such operations are similar, only minor details differ. The main principle is the following:
Since transpedicle screws are installed at both sides of the spinal cord, and guides are bilateral and can be rendered any shape, the spinal cord is straightened symmetrically.
The main benefit of spinal constructions is that the guiding element can be moved in front-back body axis while the patient is growing.
The entire spinal construction is placed under back skin and almost does not interfere with normal life. When the spinal cord stops growing, the construction can be removed.
A patient after operation can need additional dragging while the block is growing together. However, stretching jackets should not necessarily be worn right after the operation.
It’s recommended to wait for 10-12 days to make sure that the wound after surgery is healing well and without complications. After that, a plaster jacket with head holder can be fixed.
A patient should wear a jacket for up to 4 months staying in bed rest. Therefore, the patient and family members should prepare for post-surgery care beforehand. 16 weeks after the operation, a patient is allowed to walk.
In 7-8th month, the plaster jacket is put off and replaced by a usual orthopedic one. If the operation was performed on the upper thoracic spine or thoracocervical spine, a head holder is typically used. Patients usually wear them for about a year.
Before the jacket can be removed, patient’s well-being is examined. The following aspects are evaluated:
X-ray imaging, computer tomography, and magnetic resonance tomography allow getting a lot of useful information about patient’s health. Plaster jacket cannot be removed without these analyses.
05.03.2019
No one likes to operate on the spine. Although back problems are widespread and the number of people requiring back surgery is increasing, many patients are more concerned about spinal cord injury during surgery.
Priv-Doz. Dr. Jan Siewe, Medical Director of the Department of Spine in the Leverkusen Health Center, knows the fears of his patients. As a specialist in his field, he has done countless operations on the sensitive musculoskeletal system, which gives us the upright gear. His field of expertise ranges from classic herniated discs, fractures and pediatric scolioses to tumor treatments and prosthetic surgeries.
For about five weeks now, he has been able to rely on a precise navigation system during the operation in the hospital. "This gives us the opportunity to follow closely on a screen by navigation, at which point in the body of the patient is currently the instrument or a screw must be set," said Siewe the procedure. For this purpose, 3D X-ray images are previously created by the patient while he is lying on the operating table.
The rotating X-ray machine produces 360 shots in 40 seconds, which together provide an exact representation of the area to be operated. These are the basis for later navigation with a kind of pin-shaped miniature camera. This transmits the images to a monitor, which allows a precise, enlarged view of the spine. This gives the surgeon even more security, especially in operations where accuracy in the millimeter range is important.
In addition, diseases such as the treatment of scoliosis (the lateral deviation of the spine), which must be performed at a young age, can be optimally treated. "Many parents and adolescents are afraid to straighten the bent spine," explains Jan Siewe. "Even if you are symptom free at a young age, scoliosis becomes painful as you get older from the age of 30." The even more precise way to operate using computer navigation will hopefully make it easier for parents and children to decide on the spine straightening step.
"I would let my daughter operate," says Siewe convinced. For the hospital, the approximately three-quarters of a million-euro investment to equip the operating room is a further step in specializing in a specialist field.
"With the high-tech navigation device of the new generation, we are pioneers in the region," explains Prof. Dr. med. Leonard Bastian, Director of the Department of Orthopedics, Trauma, Hand and Reconstructive Surgery.
The Klinikum Solingen, with which the Leverkusen house is currently in cooperation talks, do not have such facilities. Even the device in the Cologne University Hospital is older. Nonetheless, the medical profession agrees, this technology will also be used in most operating theaters in the coming years. Then the surgical robot will also determine the future in spinal medicine.
04.03.2019
They come from New Zealand, England, Spain, Nicaragua or Greece - the patients of Dr. med. Per Trobish.
The reason: head physician Per Trobisch has successfully completed a new, non-stiffening scoliosis operation since June 2017. This method of spinal surgery is still very new in Germany and Europe and attracts international patients to the Eifel. Especially children and young people benefit from the treatment technique, as it maintains the mobility of the spine.
A non-stiffening scoliosis surgery? Even experienced spine surgeons are surprised. For what chief physician Dr. Per Trobisch in the Eifelklinik St. Brigida offers mainly for his young scoliosis patients is still very new in Germany.
Scoliosis is a curvature of the spine that usually occurs in children and adolescents. Three percent of all girls are affected. If the scoliosis has reached a certain extent, it must be stiffened with many screws and rods. But Dr. Trobisch, who has been working in the Eifelklinik since 2014, uses a special rope that keeps the crooked spine in the right path and sets the direction for growth. "Like an inner corset," explains the chief spinal surgeon in St. Brigida. Although stiffeners are still standard, the new method is on the rise - Dr Trobisch performs two scoliosis operations per week in Simmerath, and thus about every tenth scoliosis surgery in Germany, represents the 40-year-old the importance of the Eifelklinik in this medical Fachbereich out.
04.03.2019
She was in constant pain, she could not lean back on a chair and never dance as ballet as she wanted. Alina has a spinal curvature - a so-called scoliosis, due to which her back was postponed. The student was not wearing tight clothes - afraid that someone might stare at her crooked back. For a long time, the 17-year-old looked for suitable therapy with her family. Finally, they decided on a new surgical technique, the Dynamic Scoliosis Correction.
Dynamic scoliosis correction basically works like an inner corset: A flexible plastic rope is attached to the side of the spine with screws, on the outside of the curve. This band is put under tension and is intended to raise the crooked spine gently and minimally invasive. The body of children and adolescents is thus kept in shape during growth. The back remains mobile. Therefore, the Dynamic Scoliosis Correction is especially suitable for young scoliosis patients whose skeleton has not yet fully grown Per Trobisch, who performed the operation at Alina.
Dynamic scoliosis correction has only recently been carried out in Germany. So far, scoliosis patients have been able to stiffen their backs with screws and rigid metal rods, severely restricting mobility, causing individual vertebrae to grow together, and often causing the discs below the stiffener to wear out more quickly. Also, the recovery phase is significantly shorter with a dynamic scoliosis correction with one to two weeks than with a spinal fusion, after the sport is banned for a year.
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