We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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The commitment of Vall d'Hebron University Hospital to innovation allows us to be at the forefront of medicine, providing first class care adapted to the changing needs of each patient.
The word scoliosis comes from Greek and means “curvature”. It is not considered a disease, but rather, a three-dimensional deformity. This is why the Scoliosis Research Society (SRS) defines it as a lateral curvature of the spine with a rotation of the vertebrae inside the curve of more than a 10º Cobb angle.
It is important to distinguish structural scoliosis from non-structural scoliosis, also known as pseudoscoliosis. In structural scoliosis, the spine shows a lateral deviation (the severity of which can be measured using the Cobb angle, which quantifies spinal deformities) and a rotational deformation that is measurable via the Adams Forward Bend Test and a scoliometer. In non-structural scoliosis, the lateral deviation does not involve vertebral rotation and this condition can be corrected via postural training.
Scoliosis, in turn, is divided into the idiopathic and secondary types. Idiopathic scoliosisis that for which no cause can be established.
Idiopathic scoliosis in adolescents is a three-dimensional structural abnormality, with lateral deviation and a rotation in the curvature of the spine that affects the health of young people around the age of puberty. This diagnosis is established only when other potential causes of scoliosis, such as vertebral deformities, neuromuscular abnormalities, or other syndromic disorders, have been ruled out. If any of these are the cause, it is called secondary scoliosis.
Idiopathic scoliosis is classified according to the age at which it appears: infantile (0-3 years old), juvenile (3-10 years old), and adolescent (over 10 years old).
Idiopathic scoliosis affects between 2% and 3% of young people between 10 and 16 years old (the age range with the most risk). Recently, in China, the percentage of children in this age range who suffer from this deformity has been shown to be up to 5.14%.
In scoliosis, as the severity of the curve increases, the number of sufferers decreases. Scoliosis with curvatures above 20 degrees affects between 0.3% and 0.5% of these individuals, and it is estimated that the proportion of patients who require surgical treatment does not exceed 0.1%.
Detecting scoliosis is generally done using the Adams Forward Bend Test, which, as its name implies, consists of the patient bending their torso forward, allowing a “hump” to appear, which is subsequently measured with a scoliometer. However, a definitive diagnosis cannot be made without measuring the angle on an X-ray in which the patient is standing up.
The most common forms of secondary scoliosis are those associated with neuromuscular diseases. Sometimes, the first sign of some of these diseases is scoliosis, and until it manifests, the scoliosis can seem idiopathic, but in reality, it is secondary.
Children and adults of all ages.
The paediatrician will be able to detect this condition, and then the rehabilitation specialist will be in charge of making the diagnosis and evaluating treatment options, in collaboration with the orthopaedic team and the physiotherapist, who will be the ones to follow up and monitor the progression of this deformity.
In adolescents, the progression of the curve is prevented using conservative treatment based on observation and the use of a corrective brace if the curvature progresses and surpasses 25 degrees.
To treat small curves that are at low risk of progression,physiotherapyis recommended.
Surgical treatmentis only used in specific cases, such as adolescents who have a primary structural curve greater than 45 degrees and adults who do not respond to conservative treatment.
To diagnose scoliosis, imaging tests such as conventional X-rays are carried out. Using these, the degree of the curvature can be precisely quantified. If another clinical symptom is associated with the deformity, an MRI will be requested.
Poliomyelitis is a highly contagious disease caused by any of the three human poliovirus serotypes, which are part of the enterovirus family. Europe was certified free of poliomyelitis in June 2002. Immunisation and vigilance of the disease continue to ensure the region is free of poliomyelitis. Post-polio syndrome has no defined causal mechanism but it affects between 20% and 80% of patients afflicted with poliomyelitis.
Initial symptoms are those of a influenza-like illness (fever, headache, joint and muscle pain, vomiting, among other things) and can last up to 10 days. Its most serious forms may cause respiratory paralysis leading to death. Post-polio syndrome presents a new neurological weakness that may be progressive or abrupt on muscles previously affected or unaffected. It may or may not be accompanied by new health problems such as excessive fatigue, muscle pain, pain in the joints, intolerance to cold, reduced physical stamina and function, and atrophy.
It mainly affects children and the mechanisms for its transmission may be through faecal-oral channels or a common vehicle (contaminated water or food).
Post-polio syndrome affects patients who have had poliomyelitis for 20 years or more.
Diagnosis is given clinically, supplemented with laboratory and electromyographic (EMG) tests.
Symptomatic treatment with analgaesics, a ventilator where necessary, gentle exercise and possibility of orthopaedic devices to prevent deformities or to enable function.
In acute diagnoses, studying secretions, stools and cerebrospinal fluid. EMG in acute and later stages for diagnosing post-polio syndrome.
Poliomyelitis has no cure but it can be prevent by vaccination.
Cerebral palsy is a group of disorders affecting movement, posture and muscle tightness, caused by damage to the developing brain (in children up to approximately three years old). The severity of the symptoms varies widely: some patients can walk and lead independent lives, while others are more severely disabled. There may also be associated intellectual disabilities, problems with vision or hearing, problems when eating, seizures, etc.
These can be categorised according to the moment when the brain damage occurs: prenatal, perinatal and postnatal. Currently, the most frequent causes are: extremely premature birth, hypoxia of the brain during birth, and paediatric stroke.
In babies, we see slower psychomotor development, with difficulties in movements or activities. We usually see spasticity, which could be defined as increased tightness in a certain group of muscles. There are major musculoskeletal abnormalities, including spinal deformity, hip dislocation and ankle equinus.
Fundamentally clinical diagnosis, depending on the patient's history. But confirmation is needed by additional imaging tests such as cranial ultrasound and magnetic resonance imaging. However, these can be normal.
Unfortunately, there is no cure for cerebral palsy. However, we can deal with the pathology in different ways, both in prevention and in treatment:
No specific prevention is possible.
Apart from the physiotherapy and/or occupational therapy which can be offered or recommended to these patients, physical exercise can always be suggested, depending on the abilities of each person. We also recommend stretching certain muscle groups and trying to correct posture.
The lower part of the back has to carry the weight of the upper body and enables the torso to move, bend and stretch. Most lower back pain is the result of injury to muscles, ligaments, joints or spinal discs.
Lower back pain is limited to the lumbar region of the back, and may be associated with radiating pains and/or numbness in the legs.
Most acute lower back pain originates in muscles or ligaments, and is self-limiting, although it can still be incapacitating. It is usually the result of injury to muscles, ligaments, joints or spinal discs.
Chronic lower back pain is defined as pain persisting for more than 3 months, and is one of the most frequent and costly musculoskeletal problems of modern society. It is estimated that up to 80% of the adult population will suffer from lower back pain at some time in their lives. The most common causes of chronic lower back pain include degenerative disc disease, lumbar facet arthrosis, spondylolisthesis, facet dysfunction, herniated disc, lumbar spinal stenosis, the after-effects of trauma or deformity, among others.
Pain in the lower back, which is usually mechanical in nature.
it can affect up to 80% of the population. In the case of younger people, it is usually caused by trauma and/or inflammation, while among the older population the cause is usually degenerative.
The main diagnostic tools are patient history and physical examination. They can be complemented by scans, which are helpful when considering invasive treatments.
Relative rest, local heat, medication, changes to activity. Once the acute pain episode is over, rehabilitation treatment can begin, with physiotherapy and back school therapy. There are cases where the causes of the pain indicate a need for surgery, and after more conservative therapies have been tried, an operation is required.
X-rays, tomography and MRI
Regular exercise and posture correction.
Arthrosis is a degenerative process characterised by lesions of the cartilage in joints. A joint is the area where a bone connects with another bone, allowing movement. Cartilage is a tissue that covers the joints, acts as a shock absorber for impacts, and also allows the joints to move without friction. Normally, this condition appears in the spinal column, neck, hip, knees, and hands.
The most common manifestation is pain that improves with rest, stiffness when initiating movement, deformities, and difficulty moving the affected joints. There can be a certain degree of inflammation, which will cause swelling due to the excessive accumulation of liquid in the joint.
However, it must be differentiated from arthritis, which is a rheumatic inflammatory disease rooted in joint inflammation that can cause pain which does not improve with rest. Arthrosis is often also called osteoarthritis, which can create some confusion.
This disease is very prevalent and has a high social and health impact. The EPISER2016 study, by the Spanish Society of Rheumatology, showed that the prevalence in the population over 40 years of age is 29%.
Age is the main risk factor. It is more frequent in women. A deterioration of the cartilage is clearly associated with obesity and a lack of regular physical exercise. A misaligned joint or poor posture can also be predisposing factors. Sometimes the cause is a traumatic injury or previous disorder of the affected joint. It has a genetic component (especially arthrosis of the hands).
A diagnosis is obtained by looking at the symptoms, physical examination, and the imaging tests.
Treatment for this disease is aimed at improving symptoms and quality of life for patients while slowing down its clinical evolution. A treatment plan must be individually prepared for each patient and type of joint.
Non-pharmaceutical treatment is essential. We recommend:
Pharmacological treatment normally consists of conventional pain relievers such as paracetamol, which is the analgesic treatment of choice. There are slow-acting treatments, such as chondroitin sulphate (taken orally) or hyaluronic acid (given as an injection), which can improve pain, especially in arthrosis of the knees. Surgery (joint replacement) is reserved for cases in which the joint is destroyed and other measures have failed.
Amyotrophic Lateral Sclerosis (ALS) is the most common degenerative motor neurone disease in adults. It is also known as Charcot disease after the famous French neurologist Jean-Martin Charcot who discovered it in 1869. In North America, it is known as Lou Gherig’s disease in honour of a famous baseball player who died at 38 years old as a result of this disease.
Amyotrophic Lateral Sclerosis manifests in the form of progressive paralysis that affects most of the muscles in the diaphragm. The life expectancy is less than five years. In rare cases, longer survival times may be observed, especially if artificial ventilation devices are provided.
ALS is a neurodegenerative disease caused by the death of motor neurons in the brain and the spinal cord.
There are two types of motor neuron: upper and lower. The first are found in the motor cortex and establish connections with the lower motor neurons located in the brain stem and spinal cord, which innervate muscles. When the upper motor neurons die, spasticity, weakness and hyperreflexia appear.
When the lower motor neurons die, twitching, weakness and muscle atrophy occur. Other neuron populations can also be affected, such as the temporal and frontal behavioural and executive circuits.
Epidemiologically speaking, ALS has an incidence of 1.5-2 new cases a year per 100,000 people (3 new cases are diagnosed per day in Spain). The total number of cases (prevalence) is 2-5 per 100,000. According to this data, the total number of patient with ALS in Spain is approximately 4,000 cases. This is why it is included in the rare or minority disease group.
90% of cases of ALS are sporadic (no family history). Around 10% of ALS cases are familial, usually inherited as dominant traits. The incorporation of new molecular genetics techniques in the field of research has allowed more than 25 genes involved in ALS to be identified.
As a consequence of the continuous decrease in motor neurons, symptoms of the disease appear. These usually depend on the location of the motor neurons undergoing the most advanced processes of degeneration. In most patients (70%) the first symptom is loss of strength with muscular atrophy in the hands or clumsiness when walking, with frequent falls. In approximately 25% of patients, the first symptom is difficulty talking or swallowing, which indicates that degeneration of the bulbar motor neuron population is the most intense. There are also other possibilities for clinical presentation of this disease, although much less frequent: respiratory failure, weight loss or unexplained lack of energy (asthenia), cramps and twitches in the absence of muscle weakness, spasticity in legs, rapid mood changes or cognitive impairment.
In advanced phases, the disease can also paralyse the eye muscles. In the final stages of the disease, paralysis of the respiratory muscles leads to respiratory failure, which is often the cause of death.
The condition particularly affects people aged between 40 and 70. The incidence is greater in men (3:2.2 per 100,000) in sporadic forms. The age of first onset of symptoms reaches its peak between 58 and 63 years old in sporadic cases and between 47 and 52 years in familial forms. Incidence decreases markedly after the age of 80. The risk of suffering ALS is 1:400 for women and 1:350 for men.
The differing ways in which ALS manifests is one of the two reasons for a delay in suspected diagnosis of the disease, which can be up to 15 months. The other is that there is no test or biomarker to objectively confirm the diagnosis in the initial stages of the condition. A diagnosis of ALS is a diagnosis of exclusion, based on clinical criteria and conducting tests (MRI, clinical analysis, genetic tests, electromyography, EMTC, neuropsychological exam, nuclear medicine techniques and others) to rule out other illnesses with similar clinical findings. In most specialised ALS units, the disease diagnostic criteria used are the revised El Escorial criteria and the Awaji-shima criteria.
There is currently no medication that can cure or stop the disease. Riluzole and Edaravone are the only medications approved for ALS treatment, although their effect on survival is moderate (months).
The European (EFNS) and American (ANA) associations of neurology recommend that patients with ALS be treated in specialised centres, where possible in multidisciplinary units, so that they might be prepared for any complications. These units should offer solutions to control the symptoms, including the use of a feeding tube, control of saliva secretions, cough assist devices, respirators for mechanical ventilation, technology to improve the patient’s ability to move around and facilitate communication in patients who have lost the ability to speak.
These multidisciplinary units are the centres preferred by those running new drug trials.
The reality is that there is currently no effective treatment, although patients and their relatives often desperately search online for miracle drugs that might cure the condition. ALSuntangled, a group made up of 80 international experts in ALS, was born with the aim of protecting these patients from the numerous products advertised. It mission is to review the veracity and safety of the alternative treatments offered online that have not gone through the proper regulatory channels. It publishes its results in the official magazine for the disease and on its website.
Diagnostic imaging techniques (MRI, CAT, PET), electrophysiology (electromyography, EMTC, PESs), laboratory analysis (haematology, biochemistry, antibodies, hormones, enzymes, serology, genetics), respiratory functional tests, gasometry, pulse oximetry, overnight pulse oximetry, capnography, BMI, calorimetry, lumbar puncture, functional scale for the disease (ALS-FRS-R). A muscular biopsy may be required in exceptional cases. It is advisable to admit the patient in order to arrange for testing and offer them a report on discharge detailing the ALS diagnostic category and degree of functional repercussion (ALS-FRS-R).
Although various environmental risk factors have been suggested (geographic, occupational, dietary habits, proximity to electrical channels, contact with pesticides or other neurotoxins), there is no agreement on preventative measures to take.
In family forms, it is possible to offer genetic counselling to people with a desire for offspring.
During the natural course of the disease, complications often appear that may be prevented and treated. Among the most significant are malnutrition, respiratory failure, hypersalivation, spasticity, pain, loss of independent movement and communication, depression, anxiety, sleep disorders, bed sores, cognitive deficits and burden on carers.
Acute spinal cord injuries, both in adults and children, are a complex and significant health problem that negatively affects the patient in terms of morbidity and mortality, but that also has an impact on their personal environment.
The main symptoms are those derived from motor paralysis and lack of feeling below the area of the injury, and also and above all, effects on the autonomic nervous system which produce: changes to the cardiovascular and respiratory systems, to the urinary tract including changes to the capacity to store and evacuate urine, to the digestive system causing severe constipation, incontinence and faecal impaction, as well as changes to sexual function.
Treatment is integrated rehabilitation aimed at early intervention once the acute spinal cord injury has occurred in order to prevent complications and achieve the greatest functional independence possible in all physical, emotional and social aspects. Re-establish self-esteem by maximising the remaining abilities; encouraging the best social reintegration possible (active, independent and satisfying); and informing and advising the family to help them understand and manage the disability.
When it comes to young people, prevention of complex spinal cord injuries is focused on avoiding risky activities: reckless driving or driving under the influence of alcohol and drugs, diving into shallow water and dangerous sports such as climbing, MTB or skiing. In the case of adults, especially the elderly, it centres on eliminating risks to prevent falling such as carpets or heights, by using walking sticks and controlling medication to avoid orthostatic hypertension which can cause falls.
Parkinson's disease is a dysfunction of the basal ganglia caused by degeneration of the cells that produce dopamine in the substantia nigra.
It is a progressive neurodegenerative disease of the central nervous system that affects the parts of the brain involved in controlling and coordinating movement, muscle tone and posture.
The prevalence of Parkinson’s in Catalonia is 229 in every 100,000 people.
This is focused on empowering patients and their carers to achieve behavioural changes within their own control and to motivate them to continue treatment long term. It centres on reducing medication and gaining quality of movement. The main goal is functional independence for the individual and general physical condition from the onset of the disease. It is all geared towards minimising secondary complications and the risk of falls.
There are a growing number of studies emphasising that aerobic activity may have a neuro-protective effect. Likewise, during treatment, preventing inactivity, falling and fear of getting around or falling is stressed.
Osteoarthritis is a condition that causes the cartilage developed by the bones to protect them from the wear caused by using the knee to break down. Once this deterioration has started, it develops progressively. At advanced stages of the condition, this breakdown causes pain and prevents patients from walking or standing normally. There are currently no medications to halt the breakdown at this stage.
When the pain cannot be managed with the usual painkillers, total knee replacement surgery is required, also known as arthroplasty.
The aims of knee replacement surgery are to:
During surgery, joint surfaces that are missing cartilage are replaced by an artificial implant made of chrome, cobalt or titanium.Once the affected part has been removed, the metal implant is put into place and fixed to the bone using cement.
At Valld’Hebron Hospital, we perform up to 500 knee replacement operations a year.
Early treatment by expert neurologists and admission to specialised units significantly reduces mortality and long-term dependence in people who suffer from acute stroke. It is essential, then, that if you suspect that you or someone else is having a stroke, you call 112 and follow their instructions to get treatment at the appropriate hospital.
It is also important to state as accurately as possible the time of onset of symptoms. If the patient is unable to give this information or has woken up with signs of a possible stroke, the start time will be considered the last hour he was awake and asymptomatic.
In the case of ischemic strokes, the purpose of treatment is to undo or remove, in the shortest possible time, the clot that is cutting off the natural blood circulation in the brain. There are two ways to do this:
In haemorrhagic strokes, the treatment aims to stop the bleeding that has been caused by the rupture of a vessel and prevent the increase in size of the haemorrhage. Therefore, regular monitoring of the patient is performed to gauge the level of consciousness and any neurological deficits. This is maintained for at least the first 72 hours after suffering a stroke. We also perform intensive monitoring of blood pressure, blood sugar levels and temperature to foresee possible complications.
Brain bleeding can cause inflammation of the surrounding brain tissue (known as oedema). If this happens, it is necessary to administer medication intravenously to reduce it. In people who are being treated with oral anticoagulants or who have alterations in haemostasis (a process that the body performs to slow down bleeding), it should be corrected as soon as possible.
In more severe cases, specialists may recommend surgery to drain the bleeding. The decision on surgical treatment is made based on factors such as the location and size of the haemorrhage, age, and the patient’s medical history. This is a difficult decision as it is not always possible to access it without causing damage to other areas of the brain.
The purpose of neurorehabilitation is to regain lost or diminished neurological functions as a result of a stroke. However, there are phases of recovery:
The interdisciplinary team involved throughout the different stages works so that the patient has the maximum independence and adaptation to their environment. To meet these goals, it is advisable to start recovery as soon as possible and, from the initial stages, foster the participation of patient and caregivers.
It should be mentioned that there is “Spontaneous recovery”: this is when the brain has the ability to recover from the damage it has suffered on its own. This recovery, however, may not be enough to reduce the sequelae. That is why it is advisable to always follow the instructions of specialists.
An interdisciplinary team deals with the recovery of a patient who has suffered a stroke. Each of the professionals acts according to the evolution of the condition and the needs that arise at any given time:
Other professionals such as doctors, nurses and orthopaedic technicians are also involved in the rehabilitation process.
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