What are the types of spinal deformity?
Scoliosis (from greek skolios "crooked") is an abnormal curvature of the spine from side to side, and each vertebra twists on the next one in a corkscrew manner. Scoliosis was first described and treated by Hippocrates. It is the most important deformity of the spine.
Kyphosis (from greek kyphos "hump") is a forward rounding of the upper back and describes an exaggerated rounding, also known as "hunchback".
Spondylolisthesis, or Olisthesis, is a condition in which one vertebra slips forward in relation to the vertebra beneath it. The slippage is cause of spinal instability.
Who can suffer from a spinal deformity?
Spinal deformities can either be congenital or the result of degenerative diseases or trauma. A scoliosis can be already evident in babies and small children. A typical age for developing a scoliosis is the adolescence (age between 10 and completion of puberty). Girls, or young women, are diagnosed with scoliosis four times as often as boys, or young men. Scoliosis affects approximately 3% of the population.
Adults may develop spinal deformities from spinal instability due to fractures, infections or degenerative disc disease.
What are the causes of scoliosis?
The most common type of scoliosis is idiopathic scoliosis, which means that it occurs without known causes. Idiopathic scoliosis is usually categorized into different age groups: infantile idiopathic scoliosis, if the person is less than 3 years old, juvenile idiopathic scoliosis if the person is between 3 and 10 years old, adolescent idiopathic scoliosis if the person is between 10 and 18 years old. As scoliosis often runs in families, genetics may play a certain role. But there are also biomechanical factors, problems of the central nervous system, disturbances of growth and hormones that can be cause of development of spinal deformities.
Only 20 % of all cases have a known cause, as for example:
- congenital scoliosis (wedge vertebra, malformation)
- neuropathic scoliosis (paralytic scoliosis)
- myopathic scoliosis (scoliosis in muscular dystrophy)
- scoliosis in systemic diseases (e.g. neurofibromatosis)
- scar contracture scoliosis
- posttraumatic scoliosis
- static scoliosis (amputation of the upper extremity, inequality length of the legs)
- post-rachitic scoliosis
What are the effects of spinal deformities?
Scoliosis and kyphosis affect body function and its movability. Furthermore, they may lead to visceral problems, affecting especially heart and lungs. Severe distortions of more than 60 degrees can result in a progressive deterioration and distortion even in adulthood.
Distortions of more than 80 degrees affect the activity of heart and lungs strikingly and lead to decreased breathing capacity and right-heart overload. Nonetheless spinal deformities have an incontestable psychological effect on the affected person due to the obvious deformation.
How are spinal deformities diagnosed?
An x-ray of the whole spine in standing position confirms the diagnosis of a spinal deformity. The degree of deformity is then measured by taking the "Cobb's angle". In case that surgery is required, it is necessary to take further side-bending x-rays in order to determine spinal flexibility and estimate the possibilities of the surgical correction. If there is a complex scoliosis (e.g. congenital, neuropathic of myopathic scoliosis), a MRI and/or a CT-scan have to be performed.
An early detection of a spinal deformity in children and adolescents can help prevent a surgical intervention and to determine an appropriate conservative therapy. It is very easy to see a spinal deformity even without technical supplies:
- ask your child to bend forward
- have a look at the child's back and check if one side is higher than the other
If yes, a scoliosis may be suspected.
How is scoliosis treated?
An early diagnosis of scoliosis is essential for a successful treatment. A curve of 10 to 20 degrees can be treated with physiotherapeutic exercises. Curves that are between 20 and 30 degrees, especially in growing children, have to be treated with physiotherapy and bracing. The brace works by applying pressure to the curve to prevent its progression. Pads in the brace place pressure on the curve, "relief holes", which are located opposite these pads, release the pressure.
All braces for scoliosis have to be selected for the specific problem and fitted to each patient. The brace must be worn every day for the full numbers of hours prescribed until skeletal maturity and then weaned slowly. We recommend concomitant rehabilitation stay in a specialist hospital.
If the curvature is more than 30 degrees the treatment depends on the age of the patient and the cause of the scoliosis. Surgery is recommended if the curvature is greater than 50 degrees or if the scoiliosis appears in early childhood respectively in case of congenital scoliosis. Likewise surgery is recommended in children who suffer neuropathic and myopathic scoliosis.
Which kinds of surgery will be performed to correct spinal deformities?
The surgical correction of a deformed spine is a very complex procedure that has to be prepared carefully by an expert. There are two main approaches to correct a spinal deformity: the anterior and the posterior approach. In case of severe or inflexible curves, a combined anterior and posterior approach may be necessary. During surgery, the spine will be reduced and stabilized by a titanium rod and screw system.
Are corrections of spinal deformities performed in the BGU Frankfurt?
Our multidisciplinary staff is experienced in conservative and surgical treatments of spinal deformities. Please make an appointment to get further information by one of our experts. We offer special consultation for children and adolescents.