Spinal deformity, or scoliosis, is a process of spinal deformation characterized by pathological bending of the spinal column with rotation of the vertebrae. Typically, the deformed section of the spine has one or two curves, resembling the English letters "C" or "S".
Doctors at the Ichilov (Sourasky) clinic correct such spinal deformities using a full range of modern methods – from the use of the latest designs of derotating orthopedic braces to surgeries for spinal fusion performed on robotic systems.
Treatment of Spinal Deformity in Israel – Methods Available at Ichilov (Sourasky)
Typically, the cause of spinal deformity cannot be determined, which is why up to 80% of scoliosis cases are idiopathic – a term in medicine for diseases that arise without visible causes, as if by themselves. In 20% of cases, primary disorders such as muscle spasms, cerebral palsy, genetic connective tissue diseases (e.g., Marfan syndrome), and certain types of tumors (neurofibromatosis) are the causes of scoliosis.
The choice of treatment method for spinal deformity depends on the degree of curvature and the location of the deformed section. Various methods of conservative therapy and surgery are used for treatment. Conservative methods include therapeutic exercises and wearing a brace, while surgical methods include various types of spinal fusion with anterior or posterior access. Both conservative and surgical methods are applicable to both children and adults, with the only difference being that in childhood, when the skeletal bones continue to grow actively, surgical treatment of spinal deformity using fixation metal constructs is undesirable and is used only in extreme cases when the deformation is rapidly progressing and conservative methods do not yield the desired effect.
Conservative Methods of Treating Spinal Deformity
The conservative approach to correcting the spinal column allows for good results with a posture deviation of up to 45 degrees. If a patient has a mild degree of scoliosis and the angle of deviation does not exceed 20-30 degrees, posture can be corrected through physical exercises. A very effective method of therapy in this case is the exercise program developed by German physician Katharina Schroth. The Schroth system includes a set of breathing, isometric, and exercises aimed at reverse rotation of the vertebrae, allowing for the development of a stereotype of physiologically correct spinal column positioning. Exercises for each patient are selected individually.
For angles of posture deviation exceeding 20-25 degrees, scoliosis treatment may require wearing a corrective brace. Orthopedic braces come in various designs, made of metal or plastic, and provide correction of posture in the desired direction. Most commonly, our clinic uses Sheno braces, Milwaukee braces, and Boston braces for scoliosis correction. They differ slightly in their structural design. Boston braces are made of plastic and are typically used for treating idiopathic scoliosis in children. Milwaukee braces differ from Boston braces by having metal reinforcements and are more frequently used for treating spinal deformity in adults. Sheno braces, in some cases, combine the advantages of the first two types of orthopedic braces and can be used for spinal correction in both children and adult patients.
Braces are usually required to be worn for most of the day, and in some cases, they can be removed for just 1 hour for hygiene procedures and performing therapeutic exercises. Therefore, while the use of derotating braces effectively corrects scoliosis, it is associated with a number of psychosocial inconveniences and physical discomfort. However, there have been certain successes in this area – global orthopedics is not stagnant, and more advanced designs of derotating braces are replacing classical constructs. Thus, in addition to the braces described above, our clinic uses several types of modern orthopedic orthoses – Charleston night braces, SpineCor braces with elastic elements, plastic-aluminum SpoRT braces, improved Sheno braces (dynamic asymmetric Crass-Sheno orthosis), etc.
Surgical Methods of Treating Scoliosis
Surgical methods for correcting spinal deformity are usually recommended for posture deviations greater than 40-50 degrees and involve performing spinal fusion – correction of deformed sections of the spinal column using metal or bone implants. Open surgery is performed with posterior or anterior access – the incision is made along the midline of the back or along the side near the ribs, respectively.
To restore physiologically correct angles of the spine, special metal implants are used that connect to each other and to the vertebrae with transverse bridges and screws. This approach is used in performing spinal fusion with posterior access.
Surgical correction of scoliosis with anterior access involves the removal of one or more intervertebral discs and filling the freed space with bone cement. The correction of the position of the vertebrae is also performed using metal screws.
Patients at the Ichilov (Sourasky) clinic also have access to a modern method of surgical treatment for scoliosis, such as minimally invasive surgeries using the Renaissance robot. The Renaissance system allows for spinal fusion with a much smaller incision compared to open surgery. Using the robotic system, the surgeon fixes the deformed section of the spine with metal fasteners and implants fragments of the patient's or donor's bone tissue into the space between the vertebrae. These implants can be solid bone grafts or sleeves (plastic, metal, made of carbon fiber) filled with bone cement. After some time post-surgery, the grafts or crushed bone tissues that make up the bone cement fuse with the adjacent vertebrae and reliably immobilize them, achieving the desired correction of the spine. The Renaissance installation allows for orientation on a computer model of the spine during surgery, thus reducing the frequency of intraoperative X-rays, ultimately minimizing the radiation exposure to the patient.
- Endoscopic correction of the spine
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Diagnosis of Spinal Deformity at Ichilov (Sourasky)
Examination of patients with scoliosis at our clinic takes no more than 3 days.
First Day – Visit to the Clinic
On the first day, the patient, arriving in Israel, meets at the airport with a case manager – a representative of the clinic who will act as a guide and translator, as well as coordinate the entire process of diagnosis and treatment. Together with them, the patient goes to the hotel where they will stay, and then proceeds to the clinic for the first consultation with the leading specialist. The specialist reviews the medical history, conducts a primary examination, and prescribes a series of diagnostic procedures.
Second Day – Diagnosis
On the second day, all diagnostic procedures prescribed by the leading specialist are carried out. These may include various procedures.
- X-ray examination.
- Scoliometry (determining the Cobb angle).
- Genetic testing. By analyzing the patient's DNA, doctors study several dozen gene markers, the ratio of which allows them to conclude either about a high probability of further deformation or about the stability of the spine.
Third Day – Selection of the Method for Spinal Correction
On the third day, the leading specialist, along with a team of other doctors, analyzes the results of the diagnosis and selects the most effective method for correcting scoliosis.
- A new minimally invasive diagnostic method in Israel – thoracoscopy
Treatment of Spinal Deformity in Israel – Prices
The cost of treating spinal deformity in Israel is much lower than in other countries. Thus, scoliosis correction at our medical center allows for savings of up to 30-50% compared to similar treatment in hospitals in the European Union or the United States.
Advantages of Scoliosis Treatment at Ichilov (Sourasky) Center
An important factor in assessing the effectiveness of scoliosis treatment in Israel is the feedback from patients who have already received highly professional assistance in Israeli clinics. Patients who have undergone spinal correction at the Ichilov (Sourasky) center generally speak warmly and gratefully about both the clinic and its doctors. Ichilov (Sourasky) is a center that is one of the leading medical institutions in Israel; our clinic has several important advantages compared to other Israeli hospitals.
- Spinal surgeons and orthopedic specialists working at Ichilov (Sourasky) have extensive experience in treating spinal diseases and correcting deformities. Orthopedics is one of the most developed fields of Israeli medicine, and research by Israeli specialists largely determines the development paths of global orthopedics. Therefore, by receiving treatment at Ichilov (Sourasky), you can be confident that you have entrusted your health to the best of the best.
- Only the most modern equipment is used at the Ichilov (Sourasky) clinic, enabling our specialists to accurately localize spinal deformities, determine their parameters, and conduct effective treatment. Robotic systems used at Ichilov (Sourasky) for spinal fusion allow for a fundamentally new level of surgical treatment for scoliosis and significantly reduce the duration of postoperative rehabilitation for patients.
- Every patient with scoliosis admitted for treatment at the Ichilov (Sourasky) medical center receives a personalized therapy program. Individual attention to the patient, ensuring comfortable living conditions, and full support from a coordinator-translator are just a few of the principles on which our center's work is based.