The world's first operation of paediatric scoliosis with a new spinal system took place at the Brno University Hospital

"The Ennovate system meets today's state-of-the-art requirements. The more modern the instrumentation, the better the three-dimensional views and safer is becomes for the correction of the spine". explains prof. MUDr. Martin Repko - the world-renowned specialist in spinal deformities in children, head of the Orthopaedic Clinic at the University Hospital in Brno and the Dean of our faculty, who performed the operation. The Ennovate system was developed in cooperation with the Czech Orthopaedic Clinic for spine surgeries all over the world, and Brno University Hospital was the first to operate using the system.

How the operation went

First, doctors exposed the individual posterior parts of the vertebrae and gradually inserted screws into the vertebrae on both sides of the spine. They then fastened the rods to the screws and used these rods to straighten the curvature of the spine. All parts of the Ennovate system are made of titanium and chromium-cobalt, they are very light and do not irritate tissues inside the body. At the end of the operation, they lined the sections of the spine where they inserted the screws and rods with bone grafts obtained during the operation from loose parts of the operated vertebrae. This will cause the operating section of the spine to fuse and not move in the future. "The patient will not notice any immobility during normal movement. Thanks to Ennovate, it was possible to operate on only a minimal section of the spine. The operation is more comfortable for the surgeons and safer for the patient, "explains MUDr. Alan Munteanu, Member of the Management Board of the B. Braun CZ / SK Group. Doctors are also satisfied with the shorter operation time. The operation lasted 4.5 hours from the moment the patient was put to sleep until awakening. "Thanks to Ennovate, we were able to shorten the scope of instrumentation with a perfectly effective correction. We have to operate on many vertebrae to straighten the spine. The more sophisticated or more perfect the instrumentation, the fewer vertebrae we have to connect. Which is great because the more non-operated vertebrae remain, the better the child moves after the operation", explains the head of the Orthopaedic Clinic and chief surgeon prof. MUDr. Martin Repko. The deformity worsens during puberty when children begin to grow rapidly. They grow not only upwards, but also to the sides, and then the deformities worsen the most. "Our task is to balance this imbalance of the spine back and return the children to normal life," adds Professor Repko.

Diagnosis of scoliosis

Scoliosis, or three-dimensional deformity of the spine, is a disease that occurs in 2% of children in the Czech Republic. One hundred children out from the affected children then suffer from such a severe form of spinal deformity that they have to undergo surgery. Every year, about 130 children are operated on here with this diagnosis at the orthopaedic clinic at Brno University Hospital. In most cases, doctors do not know the cause of scoliosis. Some children are even born with scoliosis, but they are few. Scoliosis most often occurs in children aged 10 to 12 years. Most children are only monitored by doctors, they can alter the deformity, for example with a corset or other conservative therapy. "Although we sometimes have the reputation of 'bloodthirsty orthopaedists' in some non-surgical fields, we approach surgery only for the most severe deformities. We deal with most mild spinal deformities conservatively", adds Professor Repko. "Even young children of preschool age are operated on, and the operation does not disrupt the healthy growth and development of the child in any way. The healing process of children who have been operated on is relatively fast, usually no further fixation with a corset is needed and they return to school about a month after the operation. After 3-4 months, the children can return to basic recreational sports activities."

Ennovate - a novelty on the market brings a number of benefits

The Ennovate system, developed by the German company B. Braun in cooperation with Czech and foreign experts, has several exceptional features. The entire system is adaptable to different types of surgical procedures and includes simple options for combining implants and surgical instruments. Thus, fewer tools are needed in the operating room, which is effective both for the surgeons themselves and for the entire hospital. “The new spine system meets the most advanced 3D spine correction requirements. With the Ennovate system, we have come up with the most modern way to deal with scoliosis in children, while it contains other features that make it unique, ”explains Alan Munteanu on behalf of B. Braun. Another thing that makes Ennovate unique is the type of "screw" that allows for better spinal correction. "We can fix the screw head in exactly the position we need, which has not been possible before," adds Professor Repko, who performed the first operation with Ennovate. According to him, both of these things very rationally help surgeons to perfectly correct the spine. The PentaCore threaded screw offers excellent biomechanical performance and precise anchoring to the vertebrae. The surgeon will also use the function of the PolyLock screw, which allows it to convert one type of screw into several types, thus simplifying the operational steps and facilitating work in the theatre. The PolyLock mechanism and intuitively designed tools give the surgeon versatility and intraoperative flexibility during every step of the operation. The screws are made of titanium and are available in diameters from 4.5 mm to 10.5 mm. By making the entire system compatible, it also makes it easier for doctors to work in the ward.

Czech footprint in the development of the Ennovate implant

The Orthopaedic Clinic at the University Hospital in Brno is an elite clinic that specialises in operations for deformities of children's spines. That is why its head, Professor Martin Repko, was approached a few years ago by the German company B. Braun to take part in the design and planning of a new implant. The new Ennovate system is designed for the global market. "The process took several years, when together with colleagues from B. Braun and other experts, especially German professors, professors from Malaysia, Japan and the United States, we created a product that would meet the most modern requirements for the correction of spinal deformity. At the start of the technological process, we had to figure out how to correct the spine in 3D, because that was exactly what we wanted. Then it started to be solved technologically, and finally, the Ennovate system was created, "explains the leading Czech orthopaedist. However, according to Repko, everything doesn't end with the Ennovate system. His vision is for the top Brno clinic to become not only a medical workplace, but also an educational one in the future. "We would like to work in our clinic in the future on cases like this one. This means that we must continue to educate experts in the given field, so that they can use new and modern instruments effectively, "concludes Repko.

Scoliosis in numbers

A study by the State Institute of Public Health conducted in 2016 confirmed poor posture in 42 per cent of Czech children, aged 5 to 17 years. Poor posture is more common in boys at 46.2%. Of these, 13 percent of children have the most serious defect, scoliosis. It is however more common in girls, in a ratio of one to ten. "During the coronavirus period, the percentage of children with poor posture increased slightly due to excessive sitting at a computer and lack of exercise. However, the percentage of children with scoliosis did not increase or decrease dramatically", concludes the head of the Orthopaedic Clinic of the University Hospital in Brno, prof. MUDr. Martin Repko.

Scoliosis: myths and facts

"A child will grow out of scoliosis."

It won't grow out. The disease changes as the child grows. The deformity worsens at a time when the child begins to grow rapidly. In general, physicians try to resolve the deformity in childhood to prevent adverse consequences in adulthood.

"Scoliosis is caused by, for example, carrying a backpack on one shoulder.”

Not true. In 80% of cases, the deformity is idiopathic, i.e. unfortunately, we still do not know the cause of the disease. In 20% of patients, we can identify a clear cause of the deformity consisting of a congenital defect of the spine, or neuromuscular impairment of the child.

"Scoliosis can be prevented."

Unfortunately, it is not possible. There is no diet, type of exercise or lifestyle that will prevent this type of disease. The natural development of the deformity can be alleviated or suspended with the help of physiotherapy or corsets, but unfortunately it cannot be reversed.

"Children with scoliosis cannot play sports."

Children with scoliosis can play some sports normally. They have to avoid certain types, such as gymnastics, but in principle, they are children, who are all quite active when it comes to sports. Recreational sports are recommended, more intense physical sports are however not recommended.

"Scoliosis can cause organ damage."

Scoliosis shrinks the internal cavities. It can therefore compress the heart, lungs, digestive organs, for example. If the disease is not treated, degenerative changes occur in adulthood, accompanied by pain and neurological symptoms.