Scoliosis is a sideways and rotational three-dimensional curvature of the spine that can be seen in the thoracic and/or lumbar regions. In a normal and healthy spine, the vertebrae run in a straight line from top to bottom when viewed from behind. In scoliosis, the vertebrae are displaced to the right or left and also rotate around their axis. These bends can occur in one part of the spine or in multiple parts and in different directions. Scoliosis is more common in adolescence and can cause irreparable damage both cosmetically and to the cardiac and respiratory systems if not intervened early.

Scoliosis is a sideways and rotational three-dimensional curvature of the spine that can be seen in the thoracic and/or lumbar regions. In a normal and healthy spine, the vertebrae run in a straight line from top to bottom when viewed from behind. In scoliosis, the vertebrae are displaced to the right or left and also rotate around their axis. These bends can occur in one part of the spine or in multiple parts and in different directions. Scoliosis is more common in adolescence and can cause irreparable damage both cosmetically and to the cardiac and respiratory systems if not intervened early.

Scoliosis can occur due to many diseases and can be seen at different ages and in different parts of the spine. There are different treatment methods for scoliosis depending on the person and the type of scoliosis.

1. Congenital Scoliosis

It is caused by anomalies during the development of the baby in the womb. Congenital scoliosis is usually due to a defect in the spine or fused ribs. While the diagnosis can be made in early infancy if there are clear external signs, usually congenital scoliosis progresses very quickly, so the diagnosis is usually made in childhood or adolescence. If the diagnosis is delayed, the scoliosis may progress and worsen and asymmetries may develop in the body as growth continues. In this case, treatment of congenital scoliosis requires surgical intervention.

2. Idiopathic Scoliosis

The cause of more than 80 percent of scoliosis cases is unknown. Idiopathic scoliosis is the most common form of scoliosis. It occurs especially in girls during puberty, when rapid growth is experienced and the skeleton develops. Infantile-onset idiopathic scoliosis is seen in the 0-3 age group, juvenile-onset idiopathic scoliosis is seen between the ages of 4-9, and adolescent-onset idiopathic scoliosis seen between the ages of 10-18. Scoliosis that occurs in adolescence is also difficult to detect because it does not give any symptoms such as pain. Therefore, scoliosis may have started several years before it is diagnosed or recognized. Since it can occur at any time during adolescence, it needs to be checked regularly until the spinal growth is complete.

3. Early Onset Scoliosis

Spinal curvatures that occur for any reason under the age of 10 are called early-onset scoliosis. Scoliosis that starts at a young age progresses very quickly due to the growth rate of the child. Scoliosis that occurs at an early age can be of unknown cause (idiopathic) or congenital (present at birth) scoliosis, the symptoms of which are observed at an early age and progress rapidly. In addition, scoliosis can also occur at an early age due to some muscle and nerve diseases and connective tissue diseases. The most important factor determining the progression of the curve in early onset scoliosis is the remaining growth potential of the child. The more the child grows, the greater the risk of scoliosis progression. Therefore, the principles of treatment are different from those of adolescent scoliosis. The treatment method to be chosen in this group should not interfere with the development of the child’s spine, thorax and lungs while keeping the curvature under control. Although the treatment options for scoliosis that occurs at a young age vary according to the age of the child and the type and location of the curvature, they are generally listed as observation, corset treatment and surgery.

4. Traumatic Scoliosis

Scoliosis caused by any trauma.

5. Degenerative scoliosis

It is an adult type of scoliosis that develops over years due to degenerative disc disease.

6. Neuromuscular Scoliosis

Scoliosis caused by paralysis of the muscles due to neurological diseases such as cerebral palsy, Polio (polio) or muscle wasting. It is the most common type of scoliosis after idiopathic scoliosis. In patients in this group, early diagnosis and treatment is extremely important in eliminating progressive defects. With early treatment, it is possible to slow down the progression of the curvature in the child and prevent the negativities that may arise. Neuromuscular scoliosis, unlike idiopathic scoliosis, can cause problems such as sensory defects and respiratory distress. In its treatment, surgery is utilized in early intervention.

7. Other Causes of Scoliosis

Scoliosis can be seen in various connective tissue diseases such as neurofibromatosis, osteogenesis imperfecta, Marfan syndrome, Ehler Danlos, spinal fractures, spinal infections, various metabolic diseases such as Morquio, Gaucher disease and some genetic syndromic diseases.

The diagnosis of scoliosis is based on a standing X-ray of the entire spine and the presence of one or more of the symptoms mentioned below on clinical examination. When scoliosis is diagnosed, MRI examination for the cause is necessary. In the anterior, posterior and lateral radiographs of the entire spine taken in standing position, the angle between the vertebrae where the curvature begins and ends is measured and monitored according to the progression of this angle. This angle is called the Cobb angle.

• Inequality between shoulder levels
• Asymmetry in the waist dimples
• One side of the spine protruding forward
• Bony swelling on one side of the back (appearance of a bump on the shoulder blade)
• Body balance shifts to the right or left

The treatment process of scoliosis varies according to the disease that causes scoliosis and the severity of scoliosis. In other words, there is no single correct treatment option for scoliosis. 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. 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 the treatment is started, the higher the success rate.

Three basic methods of treatment;

1. Monitoring

The first alternative is follow-up. In patients with a spinal curve of less than 20 degrees and nearing completion of skeletal development, only observation and periodic check-ups are sufficient. During the follow-up period, the patient should also engage in sporting activities and improve his/her general body condition.

2. Corset Treatment

Corset treatment is particularly effective in children with a curvature of 20-40 degrees and in children who are still growing. The effect of the brace starts to decrease in curves over 40 degrees and in children with completed skeletal development. The curve may also increase despite brace treatment. Regular corset use reduces the possibility of surgery. For the corset to be effective, it should be worn for 20-23 hours a day.

3. Surgical Treatment

Surgical treatment is generally the first option for curvatures above 40 degrees and in patients with continued growth potential. Scoliosis correction and fixation surgeries are performed in patients with complete lung development. Surgical treatment can be performed successfully with the help of implants (screws and rods) placed in the back and waist. 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.

The Anterior Tethering technique has been developed as an alternative to fusion surgery with screws and rods, which is the standard treatment for scoliosis requiring surgical treatment. In this minimally invasive technique, tiny incisions are made in the thoracic or lumbar cavity, screws are inserted and the correction is performed using a specially designed polyethylene band with a stretching technique. Successful results are obtained with the “fusionless surgery” technique, especially in patients who still have growth potential. With this technique, curvatures are corrected while flexibility is completely preserved.