Tokuda Hospital Sofia



What is scoliosis?

Scoliosis is sideways curvature of the spine. This curvature could be in “S” (double curved) shape, or in “C” (single curved) shape. Girls are more often affected than boys.

In the cases of scoliosis the spine changes in its structure of rotation (twisting). This twisting leads to change of the ribs position and thorax deformity.

Types of Scoliosis:

About 15% of the scoliosis’ cases are:

  1. Unstructured (functional) – the scoliosis deformity is temporary, as it appears in cases of difference in the length of the legs, muscle spasm, etc. where treating the reason corrects the curvature.
  2. Structured - there is a spine curvature due to: congenital anomalies of the vertebrae (sphenoid bone, or blocked vertebrae), cerebral palsy, neurofibromatosis, muscle dystrophy, poliomyelitis etc.

In 85% of the cases scoliosis is idiopathic – the reasons for its appearance are not completely clear, though some theories exist.

According to the time of its appearance it can be classified as:

1. Infantile – appears up to the 3rd year, boys suffer more often;

2. Juvenile – appears between the 3rd and the 10th year;

3. Adolescent – appears after the 10th year;

Medical tests and examinations needed:

When the scoliosis is established a consultation with Orthopedic Surgeon is needed. The most common tests are: x rays of the spine (face and profile). According to the specialist’s assessment additional x-rays in special body poses might be needed.

MRI and CT scan may also be needed for the diagnostic process.

 Which are the most important points of assessment of idiopathic scoliosis?
  •  Size of the scoliotic curvature
  • Placement of the curvature – cervical, thoracic or lumbar part of the spine.
  • Movability of the spine in the zone of the of the curvature
  • Size of the  vertebrae’s twist
  • The level of bone maturity (growth potential). This is important point because of the fact that the idiopathic scoliosis develops and progresses during the period of bone growth. Sometimes this is the reason for additional x ray tests
How to discover scoliosis

The change in the shape of the spine is usually noticed by the parents, the GP or during preventive check- ups at school.


  1. The spine is curved. The curvature is best observed when the kid bends forward and the figuration of spine is noticeable.
  2. One of the shoulders is positioned higher than the other, the waist is smoothed.
  3.  One size of the pelvis is higher than the other.
  4. In the front part of the body the mammillary glands are asymmetric
  5. In the back asymmetry is at the shoulder blades.   



Consultation with orthopedic specialist and treatment of scoliosis

Consultation and the observation of an orthopedic specialist are needed in order to specify the type of scoliosis, the level of deviation, the progression of the condition. Sometimes the scoliotic deviations are accompanied by other anomalies in patient’s development. These anomalies may require additional diagnoses or treatment. In most cases of light scoliosis the patients don’t have major complains. A fast coming fatigue, disturbed walk or pain in the back may appear. In cases of heavy untreated scoliosis may appear symptoms related to problems with respiratory, cardio- vascular and neurological systems due to changes in the positions of the organs in the thorax.

What is the treatment of scoliosis?

The treatment of idiopathic scoliosis depends on the size of the curvature, the affected level of the spine, the bone age.

The following types of treatment exists:

  1. Observation – this type of treatment applies to patients with angle of the curvature up to 20 degrees. An eventual progression is followed through regular check-ups and x-rays.
  2. Bracing treatment – the braces are specialized devices, very often designed according to the individual needs of the patient. Their aim is to stop the progression of the condition. They do not correct the spinal curvature. The positive results of bracing treatment is related to the continuation of wearing the braces – between 16 and 23 hours a day.
  3. Surgery – The medical indications for surgery are heavy, over 45 degrees scoliotic curvatures, fast progressive, in patients with unfinished growth, and also in cases of “unacceptable” for the patient deformities.


Different operative techniques can be applied for frontal, back or mixed correction and stabilization depending on the size of the curvature, its position and elasticity.


The correction is performed till a technically and physiologically acceptable curvature size is reached. Afterwards it is stabilized with different metal instrumentations. The most important moment is providing a vertebrae coalescence in affected zones through bone grafts.



According to the nowadays surgery practice this type of treatment is performed by specialized teams, which include neurophysiologist for following the function of the spinal cord during the surgery.

Significant part of the cases do not need to wear braces during their postoperative period. A phased rehabilitation is held with the help of the physiotherapists. Three months after the spinal fusion the patients could afford more active lifestyle.







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Hospital location

51B "Nikola I. Vaptsarov" blvd. (if you drive, the entrance is from "At. Dukov" str.), "Hladilnika" distr., 1407 "Lozenets".

The hospital has a parking lot. The first 30 min. are free of charge, then a fee of 3 bgn/hours applies.

Public transport:
Buses: №88, 120
Shuttle bus: 32

Subway: Getting off at "James Bourchier" station, after that walking through "Lozenets" distr., or tram №10, taking off at "Nikola I. Vaptsarov" stop. or a bus №88, taking ff at "Tokuda Hospital" stop.


From the Central Railway Station

Bus line №305 getting off at "Romanian embassy" stop
From "Romanian embassy" stop – Bus line №120 getting off at "Tokuda Hospital" stop.
(after the traffic lights at "Atanas Dukov" str.

With a subway, from "Central Railway Station" station, getting off at "James Bourchier" station, after that walking through "Lozenets" distr., or tram №10, taking off at "Nikola I. Vaptsarov" stop. or a bus №88, taking ff at "Tokuda Hospital" stop.