Prof. Dr Markus Kröber, Head of the Department of Orthopedics, Trauma and Spinal Surgery at Helios Klinik Rottweil, is one of Germany’s leading spinal specialists. The specialist clinic he heads at Helios Clinic Rottweil has three main areas of focus: the treatment of spinal deformities, spinal tumor surgery and trauma care. The clinic’s certified trauma center is part of the Schwarzwald Baar Trauma Network and is therefore of great importance throughout the region. In an interview with Leading Medicine Guide, Prof. Kröber provides insights into the work of his specialist clinic – and explains what a trauma center actually does.
Leading Medicine Guide: A road traffic accident, a sports injury or an accident at work – and suddenly you’re being rushed to hospital or a specially equipped trauma center by ambulance or helicopter. As the person affected, you are barely aware of all the processes that interlock professionally in such an acute situation. What exactly is a certified trauma center?
Prof. Dr Markus Kröber: The Helios Clinic Rottweil is part of the Black Forest-Baar Trauma Network within the German Society for Trauma Surgery. We cover a large catchment area and have proven expertise in the care of seriously injured patients. Among other things, patients with complex spinal injuries are treated at our clinic in accordance with the latest standards. We are regularly certified as a trauma center by the German Society for Trauma Surgery, which attests to our exceptional standard of care. Our clinic has a helipad, so that emergency patients can also be transported quickly by air. In the central A&E department, we have a trauma resuscitation room and a CT scanner that is on standby 24 hours a day.
Leading Medicine Guide: The large catchment area also means long journey times. Are accident patients with spinal injuries taken directly to you at the Helios Clinic Rottweil, or do they sometimes go via a smaller general hospital first?
Prof. Dr Markus Kröber: It depends on the situation. Often, the emergency doctor decides on the spot that the patient should be taken to Helios Klinik Rottweil. Incidentally, our own medical staff also go out on emergency calls. Or the patient is taken first to a hospital that isn’t specialized in spinal injuries, and initial examinations then reveal that they would be better off with us. With the help of telemedicine, we doctors exchange information based on X-rays and findings and assess the situation together. The Helios Clinic Rottweil invested in these technologies at an early stage; telemedicine makes our work more efficient and easier, particularly in our large catchment area.
Leading Medicine Guide: You and your team are on standby 24 hours a day, 365 days a year, to treat seriously injured patients. Surely there are often situations that cause a rush of adrenaline, aren’t there?
Prof. Dr Markus Kröber: Adrenaline, yes, but not chaos. Because we work according to clearly defined, internationally established procedures. Every step is precisely defined, and everything fits together seamlessly. With our highly experienced team, we can quickly assess the overall situation and act accordingly. We are able to treat all spinal injuries around the clock.
Leading Medicine Guide: A second focus of the Department of Orthopedics, Trauma and Spinal Surgery at Helios Klinik Rottweil is the treatment of spinal deformities. What does this include?
Prof. Dr. med. Markus Kröber: Spinal deformities primarily include scoliosis and kyphosis. The surgical treatment of these conditions is a key focus of our clinic, and we have patients coming to us from all over for this reason. In medical terms, we define scoliosis as a lateral curvature of the spine. We primarily treat scoliosis in adults; these cases either originated in childhood or adolescence and only became clinically significant later in life. Alternatively, they may have developed as a result of wear and tear – in which case it is known as degenerative scoliosis. Trauma, a tumor, inflammation or osteoporosis can also lead to scoliosis. Unfortunately, we are seeing an increase in cases of scoliosis, commonly referred to as spinal curvature. In kyphosis, we see what is colloquially known as a hump – a convex curvature of the spine. Kyphosis often develops in old age due to vertebral fractures resulting from osteoporosis. As this primarily affects women, the condition was formerly often referred to as a ‘widow’s hump’.
Leading Medicine Guide: When do scoliosis patients come to see you in Rottweil?
Prof. Dr. med. Markus Kröber: They come when they have exhausted all conservative treatment options. In other words, when no further improvement in their general condition can be achieved through physiotherapy and pain management. At that point, surgical treatment makes sense and restores the patient’s quality of life. If nothing is done, the condition and pain unfortunately continue to worsen.
Leading Medicine Guide: What does the procedure for scoliosis involve?
Prof. Kröber: Spinal surgery requires a great deal of experience, technical skill, state-of-the-art equipment in the operating theater and an experienced, specialized team. After all, we are dealing with a very delicate surgical area where precision down to the millimeter is essential. During the procedure, we straighten the spine and stabilize it using a screw-rod system. Patients subsequently experience significantly less pain, walk upright and enjoy a marked improvement in their quality of life in the long term.
Left: Schematic representation of scoliosis. Right: Healthy spine © Koterka Studio / AdobeStock
Leading Medicine Guide: Do you follow a similar approach for kyphosis?
Prof. Dr. med. Markus Kröber: Here too, we perform a spinal realignment operation. The individual segments of the spine are realigned and stabilized, much like a string of pearls. Sometimes it may also be necessary to build up bone; in such cases, we transplant the patient’s own bone or insert bone substitute material. A bone density scan provides information on whether it is advisable to follow up with osteoporosis treatment after the procedure.
Leading Medicine Guide: What does rehabilitation look like following spinal surgery?
Prof. Dr Markus Kröber: It is somewhat different from, for example, after joint replacement surgery. This is because the healing process is simply different and the bone healing should be complete first. Our patients can get out of bed after two to three days, and we discharge them home after ten to fourteen days. However, they should then allow themselves about six weeks of rest at home before rehabilitation begins. After three weeks of rehabilitation, the process is usually complete, and we then see the patients again for regular check-ups.
Leading Medicine Guide: Spinal tumor surgery is the third main focus of your clinic.
Prof. Dr Markus Kröber: Exactly. Many tumors metastasise to the spine, and we can treat this today; that wasn’t possible in the past. We thereby give patients a better quality of life. There are two types of procedure for spinal metastases. One is tumor ablation combined with bone cement injection, a minimally invasive operation. In this procedure, we insert a probe into the vertebral body and destroy the tumor tissue using high-frequency electrical current waves. We then inject bone cement into the resulting cavity to close it. In the other method, vertebrae affected by the tumor are replaced with artificial vertebrae. With the exception of the top two cervical vertebrae, we can replace any vertebra, even up to three at a time. The replacement vertebrae are made of plastic or titanium and are, so to speak, virtually indestructible and capable of withstanding heavy loads.
Leading Medicine Guide: Removing a vertebral body and replacing it with an implant requires complex surgical skill.
Prof. Dr. med. Markus Kröber: Yes, it requires specialized surgical techniques; after all, we are operating in an extremely sensitive area, and the spinal nerves and spinal cord must not be damaged during the procedure. I have also published a number of articles on this subject in the medical literature.
Prof. Dr. med. Markus Kröber, we would like to thank you very much for the detailed account of your interesting and extremely important work at the Trauma Center of the Helios Clinic Rottweil. You can contact the specialist directly via his profile page on the Leading Medicine Guide.
Prof. Dr. med. Markus Kröber has earned a reputation in professional circles through numerous publications and has repeatedly set new standards. Here we have compiled a small selection of his most important publications:
- M. Kröber, T. Gühring, F. Unglaub, L. Bernd, D. Sabo. Comparison of surgical and non-surgical procedures for spinal metastases: A retrospective study of 259 patients. Z Orthop. July–August 2004. 142(4):442–448.
- M. Kröber. The surgical treatment of spinal metastases. JATROS Orthopedics and Rheumatology 6/2012. pp. 34–38.
- P. Zwolak, M. Kroeber. Acute neck pain caused by atlanto-axial instability secondary to pathological fracture involving the odontoid process and C2 vertebral body: treatment with radiofrequency thermoablation, cement augmentation and odontoid screw fixation. Arch Orthop Trauma Surg (2015) 135:1211–1215 DOI 10.1007/s00402-015-2266-y
- P. Zwolak, M. Kroeber. Management of metastatic tumors to the cervical spine. J Spine 2015. Vol 4, Issue 5. P 4–5.
- Kröber M. Back pain caused by vertebral metastases. Orthopress 2016. pp. 6–7.
