Knowledge Creation

As an important part of the musculoskeletal system, the spine has different mechanical functions and provides a broad field for research.

Below you will find some information about the anatomy and biomechanics of the spine as well as the recent publications of our department.

 Anatomy of the spinal column

The spine is divided into 5 separate sections: the cervical spine, thoracic spine, lumbar spine, sacrum and the coccyx. Each section is made up of individual vertebrae, so that a person has

    • 7 cervical vertebrae
    • 12 thoracic vertebrae
    • 5 lumbar vertebrae
    • 5 sacral vertebrae
    • 5 coccygeal vertebrae

the sacrum and coccyx vertebrae are usually fused together.

If you look at the spine from the side, you can see their so-called Double-S-curve, which consists of the cervical lordosis, thoracic kyphosis and lumbar lordosis.

Apart from the upper cervical spine (C0 - C2), the individual spinal segments diplay a similar structure

    • vertebra
    • vertebral arch
    • vertebral joints
    • intervertebral discs
    • ligaments

The vertebrae form the front column along with the intervertebral discs. This takes the load of more than 80% of the body's weight during upright walking. The vertebral arches start from the vertebrae that form the bony protection of the spinal cord. Adjacent vertebrae are interconnected via vertebral joints and ligamentous structures. These spinal joints and ligaments at the back carry the remaining 20% of the body's weight.

 Function and biomechanics

The spine is the central load carrier in our bodies. It recieves pressure and shock loads, dampens them and and then sends them onwards. In addition, the spine is involved in the overall mobility of the head and torso.

The smallest functional unit of the spinal column is a motion segment, which consists of two adjacent vertebrae, the intervertebral disc between them, the vertebral joints and the ligaments.

In a motion segment, the essential bending (flexion) and extension, rotation and lateral movements to the right and left are possible, and individual sections of the spine are able to move in different ways.

The most mobile section is the cervical spine, followed by the lumbar spine. The thoracic spine between them however, is so closely joined to the ribs and the sternum (and thus the bony thorax) that only very limited movement is possible.

Spinal injuries often occur through acceleration or abrupt deceleration of the body and therefore can be found mostly at the transition zones of very mobile to rather immobile sections. So the most common injuries are in the transitional area of the thoracic spine to the lumbar spine.

Surgical Procedures

Surgical procedures applied in spinal surgery:

 Dorsal Procedures

Dorsal procedures are indicated for unstable fractures of the spinal column. With the classic operation, straightening and stabilizing of the affected portion of the spine is achieved with an internal fixator. The patient is operated in a prone position.

Transpedicular screws are introduced in the vertebrae above and below the injured vertebrae, afterwards the longitudinal member of the fixators are placed and the spine is re-established anatomically.

By restoring the physiological shape of the spine, existing narrowing of the spinal canal can be eliminated or decisively improved.

If a (partial) exposure of the spinal canal is necessary, eg. because bone fragments are pressing on the spinal cord, it is necessary to proceed openly. If this is not the case, a minimally invasive operation such as the so-called percutaneous procedure may be performed. In this case only very small incisions are required through which the screws and the longitudinal carriers are introduced.

There is also the possibility of a cement augmentation, ie. bone cement is applied to the vertebra through the pedicel screws, resulting in improved anchoring especially in osteoporotic bone and reduces the risk of loosening of the screws.

 Ventral Procedures

If the anterior column of the spine is destroyed, ventral stabilization is indicated, either as the sole method or following on from dorsal care.

Through this operation, which in most cases can be performed endoscopically (thoracoscopic or mini-lumbotomy, depending on the height of the injured vertebral body) and thus can be performed in a minimally invasive way, the injured vertebra is reconstructed, and the load capacity of the spine is restored.

For these minimally invasive procedures special instruments and implants have been developed in our clinic. In the surgery the patient lies on his side. The camera and then instruments required for the operation are initially introduced via 4 small incisions in the intercostal spaces.

During the procedure it is frequently necessary to remove the broken portions of the vertebra and the intervertebral disks and to replace them with a bone block or a metal basket made of titanium in order to produce the immediate load capacity of the spine again. A metal plate made of titanium, which is anchored with screws to the adjacent vertebrae, provides additional security for the reconstruction.

 Kyphoplasty

Kyphoplasty (Greek: "form new vertebrae"), which has been carried out in our clinic since 2000, is a minimally invasive procedure, which is applied to (osteoporotic) vertebral fractures.

This operation has its main indication for severe pain that does not respond to conservative treatment.

As a result of Kyphoplasty the deformed vertebra is again straightened so that the back pain is improved significantly immediately following surgery.

During the procedure, a balloons are introduced via 2 cannulas into the fractured vertebra. Then the balloons are first filled with contrast medium, whereby the collapsed vertebra is partially straightened. Finally, bone cement is injected into the resulting (balloon) cavity and stabilization of the fractured bone is ensured.

  Director of department

Dr. Oliver Gonschorek

Secretariat :
Ina Bertelmann

  +49 8841 48-2400   +49 8841 48-4678 ina.bertelmann@bgu-murnau.de   V-Card Dr. Oliver Gonschorek