Fig. 11.1 Entire spinal column images in standing position from the front: clear degenerative distortion (scoliosis) of the thoracolumbar spine with tilting to the left.
Fig 11.2 Lateral x-ray in standing position: standing straight is no longer possible because of an abnormal curve (hyperkyphosis) in the lumbar spine. The patient is tilting forward.
Fig 11.3 Treatment outcome as seen in the x-ray one year after correction of the deformity with thoracolumbar-pelvic support.
Fig 11.4 Lateral spinal algiment one year after surgery. The balance of the spine is permanently restored.
A 59-year-old lady lives in the country. Her quality of life has deteriorated in recent years. She does not have a driver's license and is always dependent on help from others to attend the visits to her family doctor and physiotherapist.
The patient has had health problems associated with the degenerative changes of her discs and vertebral joints for many years, which have greatly increased over time. The structure of her lumbar spine has become more and more distorted. Consequently, she has become a few centimetres smaller and can no longer straighten her upper body when walking. The x-rays in standing position impressively show the patient’s unstable condition (Figs. 11.1 and 11.2). This spine disorder is called degenerative lumbar scoliosis. This situation is aggravated by the hunchback formation of the thoracic spine (hyperkyphosis). A permanent overload of the muscles and joints leads to severe pain and the inability to walk upright.
Especially when various nonoperative therapeutic approaches have been unsuccessful and there is no prospect of a positive outcome, surgical treatment can help, even for patients with severe malformation and kyphoscoliosis. The degree of suffering associated with the disease is the crucial point in helping a patient decide whether they are prepared to expose themselves to the risks associated with an operation and its potential complications
For this patient, an operation with correction of the pronounced dysbalance is the solution. This procedure requires accurate planning of the operation in two steps. First, the specific removal of an exactly calculated wedge-shaped bone piece from the lumbar spine is planned. In the first stage of surgery, pedicle screws are implanted in the vertebral bodies. In the second stage, a week later, axis correction of the spinal column is carried out with subsequent stabilisation using two rods connected to the pelvis for additional support and stability. The spine profile of the back is restored and supported.
The complete rehabilitation phase for the patient spans between three and six months. Thereafter, longer periods of standing and walking are also possible and a significant improvement in the patient’s quality of life is noted.