Spinal surgery

There are many causes of scoliosis. The most common is idiopathic (= without recognisable cause) scoliosis. It plays a particularly important role in childhood and adolescence. Idiopathic scoliosis can occur primarily during growth, i.e. from birth to puberty. The reason for this is that the growth of the vertebral bodies is less pronounced on one side than on the other. This results in the rotation of one or more vertebrae, which then causes the entire spine to twist. As a result, the spine is laterally curved to the right or left. Girls are four times more likely to suffer from idiopathic scoliosis than boys.

Degenerative scoliosis of adulthood, which typically develops after the age of 50, must be distinguished from idiopathic scoliosis. The cause is uneven wear of the intervertebral discs and small vertebral joints. The loss of height of the intervertebral discs and the instability of individual segments lead to a lateral curvature of the spine. This form is often associated with back pain, limited resilience and sometimes also with a constriction of nerve structures.

There are also various causes of kyphosis. The most common is Scheuermann's kyphosis, a growth disorder of the vertebral bodies in adolescence in which they grow in a wedge shape. This results in an increased hunchback formation.

In addition to idiopathic scoliosis / kyphosis, other, rarer forms are known that are caused by other diseases:

• Congenital: The curvature of the spine is congenital and the result of developmental disorders that occur before birth.
• Metabolic: Curvature of the spine is the result of a disease of the bone metabolism. These include rickets, juvenile osteoporosis or brittle bone disease.
• Post-traumatic: A spinal curvature can occur after serious accidents.

If the spinal curvature is only slightly pronounced, treatment is sometimes not necessary. Physiotherapy can be useful. Even in the case of mild kyphosis, conservative therapy is initially the priority, in particular posture training, muscle building and physiotherapy. If the scoliosis is more severe or increasing, targeted therapy should be pursued: If the curvature is more than 20 degrees but less than 45 degrees, wearing a supportive corset is recommended. This type of corset treatment is carried out over a longer period of time, usually until growth is complete. A corset can also be used in adolescents with pronounced kyphosis to prevent the progression of poor posture.

In the case of pronounced scoliosis with a curvature angle of more than 45 degrees, surgical treatment may be advisable, especially if the curvature progresses or causes discomfort. The aim of the operation is to correct the spine, restore balance and prevent further deterioration. Surgery may also be necessary in cases of severe kyphosis, particularly if there is a significant misalignment or persistent pain. In adolescents, surgery is usually carried out taking into account the time of growth, often around the time of the pubertal growth spurt, in order to achieve optimal correction. In selected cases, however, earlier surgery may also be necessary. In adults, however, pain, functional limitations and the restoration of balance are the main indications for surgery.

Surgery usually involves a so-called spondylodesis, i.e. the fusion of several spinal segments. Screws are inserted into the vertebral bodies and connected to each other using metal rods in order to gradually straighten and stabilise the spine. Depending on the situation, small placeholders (so-called cages) can also be inserted between the vertebral bodies to restore the height of the intervertebral discs and improve stability.

Intensive care is often required in the first few days after such operations. Younger patients can leave the hospital after a few days. Older patients often require rehabilitation in a specialised rehabilitation clinic. Although the operations are complex and often take several hours, they improve the quality of life of those affected. In young adults, good results and correction of curvatures can be achieved surgically: Rib humps and lumbar bulges are levelled out. Complications such as rod fractures or signs of wear on the neighbouring vertebral joints rarely occur. In older patients, pain can be reduced and posture improved. Follow-up operations cannot be ruled out.