In our center, the appropriate treatment for the patient’s scoliosis is determined according to the amount of curvature and the stage of bone growth. The earlier treatment is started, the higher the success rate.

In patients with spinal curvature below 20 degrees and in patients whose skeletal development is close to completion, only observation and periodic check-ups are sufficient.

The purpose of the brace is to prevent the increase in scoliosis curvature. The corset is particularly effective in children with curvatures of more than 25 degrees and in children who are still growing. The effect of the brace begins to decrease in children with curves over 40 degrees and in children with many years of skeletal development. The curve may also increase despite brace treatment. Today, this increase rate can be detected by 99% with gene analysis studies performed from saliva samples and this analysis is performed in our center.

For curves over 40 degrees and in patients with continued growth potential, surgical treatment is the first option. Surgical treatment can be successfully performed with the help of implants (screws and rods) placed in the back and lower back. Monitoring of spinal cord functions during surgery (neuromonitorization) is a method that increases the reliability of the procedure for the patient and the physician and is routinely used in our center.

Our center is one of the reference centers in the world for scoliosis surgeries. The surgical process is organized in a highly professional manner for the comfort of the patients. The surgical method to be applied is determined by your doctor according to the type of scoliosis (congenital, idiopathic, neuromuscular, traumatic, degenerative) and the procedures to be performed are explained to you in detail.

In 90% of our patients, results are obtained with a single surgery. Patients are ambulatory the day after surgery. The hospital stay is approximately 5 days. It is usually possible to return to daily activities after the third postoperative week.

Scoliosis exercises, a rehabilitation program specific to scoliosis, reorganize the impaired body balance with the Schroth method, which includes a 3-dimensional approach.

Exercises are done with the guidance of the therapist using exercise bars and mirrors. 

Exercises include stretching, proper positioning of the arms and trunk and strengthening of the muscles. Floor exercises and sandbags are used to apply pressure on various body parts to correct curvatures. The exercise also includes exercises for breathing techniques. It is aimed to correct asymmetrical posture and to maintain the corrected posture in daily life.

Schroth scoliosis exercises can be done individually or in group therapy. The program is supported by home exercises. This program can be effective in reducing the pain associated with scoliosis.

Treatment of kyphosis aims to correct and stabilize the deformity, reduce pain and improve neurological function. Flexible deformities can be treated with posterior fusion and instrumentation (connecting the vertebrae with screws and rods). Fixed deformities often require more serious surgery, including removal or amputation of the vertebrae. All these procedures are successfully performed by the experienced surgeons of our clinic.

Observation is usually the first line of treatment…

Observation is often the first line of treatment in young children with spinal deformities. Significant changes are recorded each time the patients come for examination by measuring the differences on direct radiographs. More than 45 degrees of severe or progressive congenital kyphosis deformity or kyphosis associated with neurologic weakness is often treated surgically. An early surgical approach usually gives the best results and stops the progression of the curve. Depending on the nature of the deformity, the surgical procedure varies.

It can be used to remove the front and back of the spine from the posterior (back area). It may also be necessary to perform several of these procedures together. These osteotomy procedures, which are highly specialized and require a certain level of experience, have been performed in our department for many years. With the increase in experience, special osteotomy techniques developed in our clinic and presented and accepted in various scientific platforms are also applied in appropriate patients.

Treatment of developmental kyphosis

Observation in developmental kyphosis is often recommended in the following cases

• Postural hyperkyphosis
• Curvatures less than 60 degrees in the growing age
• Curves of 60-80 degrees with incomplete growth spurt

Check-ups are done every 6 months with radiographs taken standing up on a long scoliosis cassette. If the child has pain, an exercise program is often recommended. If the deformity is moderately severe (60-80) and the patient has not completed his/her bony development, corset therapy may be recommended in treatment with an exercise program. Full-time use of the brace (20 hours a day) is recommended until maximum improvement is achieved. In the last year during the completion of skeletal development, corset use may be reduced to 12-14 hours a day. Corset use should be continued for at least 18 months in order to achieve a complete and permanent improvement.

Surgical treatment may be recommended if the kyphotic deformity is severe (more than 80 degrees) and the patient has increased back pain. Surgical treatment provides a significant improvement and there is no need to use a corset after surgery. With the spinal fusion technique, the spine is straightened and lengthened by fixing the screws placed in the vertebrae with rods. Surgeries are often performed through back surgeries. Patients can return to their normal daily activities within 4 to 6 months. The change provided by surgical correction is visible.

Treatment of spinal injuries varies according to the type of injury and the presence or absence of spinal cord damage. The aim of treatment can be summarized as obtaining a spine that will not be damaged by normal physiological loads and returning patients to their former activities painlessly in a short time. Patients with collapse only in the anterior part of the vertebrae and whose soft tissues connecting the bones are not affected by the injury can be treated with bed rest and a corset. Patients can return to their daily work in the corset after approximately the second week. The average duration of corset use is three months.

If the injury has led to an unstable fracture or fracture-dislocation and has caused or is at risk of causing spinal cord damage, surgery is the treatment of choice. In surgical treatment, the strength of the vertebrae is usually restored with screws and rods inserted from the back. In appropriate patients, the insertion of these rods can also be performed by closed methods (stabilization with percutaneous pedicle screws), thus minimizing postoperative pain and hospital stay. If there is a risk of nerve damage or injury, decompression is added to the treatment during surgery.

For collapse fractures caused by osteoporosis, vertebroplasty or kyphoplasty is preferred. In the vertebroplasty method, bone cement is injected into the vertebra to relieve pain and prevent the progression of the collapse. In the kyphoplasty method, the collapse in the vertebra is corrected with a balloon before cement application. Both methods are performed in our center under the guidance of radiological imaging called scopy and closed.

Stent treatment is another method that has been used in our clinic as well as in the world in the treatment of vertebral fractures in recent years. In this method, the collapse is corrected with cages placed into the vertebrae. Patients treated in this way can return to their old work and activities in a short time and painlessly.

In the treatment of spinal infections, the causative microorganism must first be identified. For this purpose, taking a sample from the infection site should be a priority. After determining the type of infection in the laboratory, appropriate antibiotic treatment is started. Rest and the use of a corset are usually added to the treatment.

The main goal of treatment is to eliminate the infection and prevent damage to the functional stability of the spine with normal loading. Depending on the type and stage of the disease, the clinical picture of the patient and the causative microorganism, it may be necessary to surgically drain the area of infection. Especially in patients with osteomyelitis of the vertebral body and infections that cause neurological damage, early surgical intervention may be necessary to prevent progressive paralysis.

Cervical disc herniation (herniated disc in the neck) usually has a good prognosis. Patients should primarily be treated conservatively. Conservative treatment includes rest, neck collar, painkillers and muscle relaxants as well as physical therapy. In some patients, transforaminal steroid injections to relax the nerve roots may be useful.

Two types of complaints occur in patients with cervical hernias and canal stenosis;

a) radicular symptoms caused by pain and dysfunction of the nerve roots due to compression of the nerve roots,
b) myelopathic symptoms caused by loss of strength in the arms and legs, loss of balance, and falls due to spinal cord compression.

Surgical treatment should be performed in patients with severe neurologic findings such as loss of sensation and movement at the onset, especially in patients with myelopathic findings and in patients who do not benefit from conservative treatment.

The aim of surgery is to remove the part of the disc that is compressing the nerve. After removal of the compressing disc, fusion (fusion) of the vertebrae is a common procedure. In cases of canal stenosis, especially in advanced ages, very effective results are obtained with canal widening and stabilization surgery performed posteriorly (from the back of the neck).

Another treatment option applied in our center is disc prosthesis applications, which are preferred to preserve movement, especially in young patients or patients without advanced arthrosis.

The back (thoracic spine) consists of 12 vertebrae located in the thoracic region. A very small proportion of all herniated discs in the spine, approximately 0.25-0.75%, are located in this region.

Between the vertebrae in this area are nerve roots that radiate to the thoracic region, and the compression of the herniated disc causes pain and burning sensation along the ribs, known as dermatomal pain. In larger herniated discs, the most common symptoms are dermatomal pain and sensory changes, as well as loss of movement and sensation in the legs.

The primary treatment begins with the use of appropriate medication and relief of pain through rest. Physical therapy applications can be useful in this regard.

If the symptoms do not go away and become progressive, surgical removal of the disc is required. Microscopic or endoscopic methods can be used to remove the compressing disc material.

The primary goal in the treatment of disc herniation is to relieve the patient’s pain and return them to their normal daily life. The first step is to educate the patient along with bed rest and medication. The physician should explain to the patient the causes of the pain and what to do to prevent recurrence of the disease.

Physiotherapy applications aim to strengthen the structures around the spine to ensure a more balanced distribution of body mass and to alleviate complaints by reducing the load on the disc to a certain extent. Epidural injections or blocks are another method used to relieve patients’ pain. These are provided by corticosteroid injections into the space around the spinal nerves.

If conditions such as loss of strength and sensation in the leg and foot occur, or if conservative treatment methods fail to relieve patients’ complaints, the nerve is relieved by surgically draining the herniated disc material.

In lumbar disc surgery, microscopic or endoscopic surgical methods can be applied depending on the clinical condition of the patient and radiologic findings. Another treatment method applied in our clinic is disc prosthesis. The use of disc prostheses in appropriate patients makes it possible to relieve pain by preserving the movement of the spine. By preserving movement, degenerative problems that may occur in the future are also prevented.

An important spinal problem in the lumbar region is narrowing of the canal through which the nerve roots pass. In this disease called spinal stenosis, in addition to pain, problems such as difficulty walking, severe shortening of walking distance, urinary incontinence, and impairment in sexual functions may be added. In these patients, a special complaint called neurogenic claudication occurs, which causes pain in the legs, loss of strength and stopping when walking a certain distance, which improves slightly when stopping and resting.

As the stenosis increases, this walking distance becomes much shorter over the years, and the patient may even become unable to walk at all. In cases where pain is at the forefront, treatments aimed at relieving pain are primarily applied. However, in the event of nerve compression symptoms, it is imperative to plan an operation to relieve the nerves and strengthen the spine.

Dislocations, especially in the lumbar region, may be associated with other spinal problems or they may occur on their own.

This condition, called spondylolisthesis, occurs when the stability of the spine is compromised. The alignment of the spine is often disturbed, especially when standing and bending forward and backward.

Slipped discs can occur due to degenerative, congenital, traumatic or congenital causes and their treatment may vary depending on the cause.

In mild cases, exercise, bracing and medication can be applied. In advanced cases, surgery may need to be planned, including correction of the slippage, achievement of union and removal of nerve compression, if any.

As a reference center for spine diseases, an important group of patients who apply to our department are those who have undergone spine surgery in other institutions but whose complaints have not improved. This so-called “failed back syndrome” is an extremely difficult condition for patients.

Patients often have complaints that do not respond to treatment and have difficulty in finding a center that will undertake their treatment, which is a medical, family and social problem. The problem in failed back surgery syndrome may be due to reasons such as inadequate nerve relaxation, failure to achieve union, implants not in the appropriate position, implant failure or breakage, postoperative infections or a combination of several of these reasons.

Considering that spine surgeries are highly specialized even in patients who have never undergone surgery before, it is clear that revision surgery in a patient who has undergone a failed surgery should be performed in much more experienced hands.

Further osteoporosis can lead to fractures of the spine and hip bones. Apart from postmenopausal osteoporosis, osteoporosis can occur in men and women at older ages.

Vertebroplasty or kyphoplasty is preferred for collapse fractures caused by osteoporosis. In vertebroplasty, bone cement is injected into the vertebra to relieve pain and prevent the progression of the collapse.

In the kyphoplasty method, the collapse of the vertebra is corrected with a balloon before cement application. Both methods are performed under the guidance of radiologic imaging called scopy and closed (no skin incision).

Another method that has been used in the treatment of vertebral fractures in recent years is stent treatment. In this method, the collapse is corrected with cages placed inside the vertebrae.

Depending on the tumor type and location, methods such as surgical intervention, radiotherapy, chemotherapy, immunotherapy can be used alone or in combination. 

In some patients, follow-up may be chosen. Spinal surgeons, radiology and oncology specialists should work together in this decision. Benign tumors that do not show signs of compression can be monitored regularly.

Surgical removal of tumors with neurological symptoms or fractures or at risk of fractures is especially appropriate.

Options such as radiotherapy, chemotherapy and immunotherapy can also be used before or after surgical treatment depending on the tumor type.

Congenital Scoliosis

Scoliosis due to spinal anomalies that occur during the development of the child in the womb. Since it is congenital, it is usually progressive. The treatment process of scoliosis varies according to the disease that causes scoliosis and the scoliosis that occurs in the person. The appropriate treatment is decided in the light of the age at which scoliosis is diagnosed, the location and degree of curvature, the underlying cause of scoliosis and radiological findings.

Chiari malformation

It is a congenital disease that occurs when an extension of the cerebellum called tonsil prolapses through the skull into the spinal canal. It can cause compression of the brain stem, which has vital functions, through the skull opening and can lead to serious neurological findings. In this disease, water accumulation in the spinal cord in the neck region (sirengomyelia) often occurs and causes the symptoms to increase even more. It can be seen as a disease alone or in combination with scoliosis. For this reason, scoliosis patients should undergo MRI to check for this and other intraspinal pathologies. In the surgery of this disease, the posterior side of the exit canal of the skull is widened. This surgery usually also corrects syrengomyelia.

Syringomyelia

The spinal cord starts where the brain stem joins the spine and continues to the upper back. Sirengomyelia is the widening of the millimeter-sized canal that already exists in the middle of the spinal cord for some reason. It can be associated with Chiari disease. It can also be seen due to spinal cord compression, tumors and trauma. Eliminating the cause of the problem usually leads to the improvement of syrengomyelia, but in cases where it is unexplained or persists despite other treatment, an operation based on the principle of transferring the excess fluid in the spinal cord to another location can be performed.

Tethered cord syndrome

Anatomically, the spinal cord extending down to the back and lumbar region remains free within the spinal canal. However, congenitally, the end of the spinal cord is attached to a place in the spine, causing tethered cord syndrome (tethered cord syndrome). Initially there is no problem with this condition, but as the child grows taller, the spinal cord cannot rise upwards and the spinal cord becomes tethered. Due to spinal cord tension, there may be loss of strength and sensation in the legs and urinary control problems. This condition may occur in childhood or rarely in adulthood. It is especially important to detect this anomaly in scoliosis patients. If scoliosis is corrected without opening the spinal cord adhesion, severe neurological damage may occur due to increased tension.

Diastematomyelia

The spinal canal, which is formed embryologically in the womb by the fusion of a cleft, is formed by the fusion of different layers. Congenital anamolies that occur when these layers are out of the normal anatomical order include problems such as double spinal cord (diplomyelia), bone or fibrous band penetration into the spinal cord (diastomatomyelia). Correction of these disorders, which are seen as intrasspinal congenital anamoli accompanying scoliosis patients, before scoliosis surgery is important to prevent neurological damage.

Spina Bifida (Open Spinal Cord)

Spina Bifida is a condition in which the bones that make up the spine fail to complete their development in such a way that they form a gap or opening in the spine.

During the embryonic stage (the period in the womb), when the baby’s spine is first formed, it is not closed. It is open on both sides. The spine on both sides joins into a single line in the middle and becomes a closed formation. In spina bifida, this closure does not occur and babies are usually born with sacs on their backs that are empty (meningocele) or filled with nerves (meningomyocele). Spina bifida occurs in approximately one in 1500-2000 live births and is most common in the lumbar region.

There are 3 forms of spina bifida:

Spina Bifida Oculta

Many people have spina bifida occulta and most of them do not show any symptoms. It can be recognized incidentally by an X-ray taken for back pain. This is the mildest form of spina bifida. There are small defects in one or more of the bones that make up the spine. The spinal cord and nerves are normal. Possible symptoms include excessive hair growth on the skin in the area of the defect (e.g. the lower back), discoloration of any part of the spine in the midline, a small orifice.

Meningocele

This is the rarest form of spina bifida. The membranes surrounding the spinal cord form a pouch outward from the open parts of the spine and the pouch contains the cerebrospinal fluid and membranes surrounding the brain and spinal cord. In babies born with this condition, the spinal cord membrane is repaired and the sac is removed by surgery. It usually does not cause permanent disability.

Meningomyelocele

It is a disease in which the spinal cord and spinal fluid herniate into a sac in the lumbar or back region of the baby, causing paralysis in the legs of the patient. The herniated sac may also contain nerve roots and the spinal cord itself. The opening is closed with open surgery.

These are surgical treatments performed in patients with chronic pain in spine or other system diseases when pain control cannot be achieved despite all treatments. For this purpose, spinal cord stimulation, intrathecal morphine pump, epidural catheter applications can be performed. 

In patients with severe spinal cord injury, excessive contraction and stiffness, especially in the legs, is a serious problem that both causes pain and impairs the patient’s walking. 

Intrathecal baclofen pump and spinal cord stimulation are performed in patients who are not successful with medication. Orthopedic surgery, tendon transfer, contracture release and osteotomies are performed in patients where the problem has turned into a structural disorder.