Scoliosis is a three-dimensional spinal curve characterized by the rotation of the vertebrae around their own axis, typically occurring in chest and lower back regions. In a normal spine, the vertebral column appears straight when viewed from behind. In cases of scoliosis, the spine curves to the right or left, forming an "S"-shaped or "C"-shaped deformity.
Spine surgery is an interdisciplinary medical specialty that focuses on the treatment of structural spinal deformities, traumatic injuries and degenerative disorders of the spine, with scoliosis being one of its primary areas of concern. The goals of spine surgery are to improve the patient's quality of life, relieve nerve compression and restore proper spinal alignment and overall body balance.
What is Scoliosis?
Scoliosis is a spinal deformity defined as a lateral curvature of the spine measuring 10 degrees or more and it is most commonly detected during periods of rapid growth (before puberty). Scoliosis is not merely a cosmetic concern; it is also a systemic health condition that can affect respiratory capacity and impair the function of internal organs in more severe cases. Main characteristics of scoliosis are as follows:
- Spine curving to the side (lateral deviation)
- Rotation of vertebral bodies (twisting motion)
- Shoulder and hip asymmetry
- Prominent hum (rib hump) appearance in one side of the back.
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What are The Symptoms of Scoliosis?
Scoliosis often presents with visible asymmetries that can be detected during a physical examination. Particularly in adolescents, the first warning signs may include clothing not fitting properly or one shoulder appearing higher than the other. Symptoms of scoliosis are listed below:
- One shoulder staying higher than the other one
- One of the shoulder bones being more prominent or sticking out
- Asymmetry between the right and left sides of the waistline contours
- Uneven spacing between the arms and the torso when the arms are hanging loosely at the sides.
- The body leaning to one side
What Is Spine Surgery?
Spine surgery encompasses all surgical procedures performed on the 33 vertebrae starting from the neck region to the tailbone, the discs between these bones and the spinal cord tissue they protect. In spine surgery, advanced medical technologies are used to treat the anatomically complex networks of nerves and supporting tissues, with the aim of improving their function and structural integrity.
The fundamental principle of modern spine surgery is to achieve spinal stabilization and perform decompression (relieving pressure on the nerves). Surgical intervention is generally considered necessary to protect the patient’s neurological health when conservative methods such as physical therapy, medication or injections are insufficient.
What Diseases Does Spine Surgery Deal With?
Spine surgery specialists treat a wide range of conditions, from degenerative processes to genetic disorders. These conditions can disrupt the mechanical alignment of the spine and may also include factors that directly threaten the nervous system. The problems treated by spine surgery are as follows:
- Lumbar and Cervical Herniations (Disc Hernia): It is a condition in which the intervertebral discs shift out of place and press on the nerves.
- Spinal Curvature (Scoliosis and Kyphosis): Structural disorders characterized by abnormal sideways or forward curvature of the spine.
- Narrowing Of Spinal Canal (Spinal Stenosis): It is a condition in which the spinal canal narrows, restricting neural transmission and compressing the nerves.
- Lower back displacement (Spondylolisthesis): It is the forward or backward shifting of one vertebra over another, resulting in spinal instability.
- Spinal Tumors: They are benign or malignant masses that develop within or around the spinal cord and in the surrounding bone structures.
- Spinal Fractures and Traumas: They are unstable bone injuries resulting from accidents or falls.
- Ankylosing spondylitis: It is a condition of reduced mobility caused by inflammation of the spinal joints.
When To Visit Spine Surgery Department?
A disorder of the spinal system may present not only with back pain but also with various symptoms that radiate along nerve pathways. Changes felt in the extremities (arms and legs) are important signals that may require surgical evaluation. Symptoms that indicate surgical intervention are as follows:
- Sharp, electric shock-like pains that spread to arms and legs
- Permanent numbness and tingling sensation felt in hands and feet
- Shortening of walking distance and legs getting exhausted quickly (neurogenic claudication)
- Muscle strength loss (inability to hold objects or developing drop foot)
- Suddenly developing losses in control of urine or stool (this is an emergency surgery indication).
- Visible postural disorders and shoulder asymmetry
What Are The Diagnostic Methods Used In Spine Surgery?
An accurate treatment plan begins with radiological and electrophysiological tests that allow for millimeter-level evaluation of the spine. After performing a physical examination, the spine surgeon uses advanced imaging techniques to clearly identify the source of the problem. the most frequently used diagnostic methods in spine surgery are listed below:
- Magnetic Resonance Imaging (MRI): It is the gold standard for detailed evaluation of soft tissues, intervertebral discs and nerve roots.
- Computed Tomography (CT): It is preferred for clearly visualizing bone structure and fracture lines.
- X-ray: It is used to assess the overall alignment of the spine and to determine the degree of curvature.
- EMG (Electromyography): It is performed to measure nerve conduction velocity and the extent of muscle damage.
What Are The Treatment Methods Used In The Spine Surgery?
Advancing technological infrastructure enables the development of surgical solutions tailored to each patient and each condition.
Lumbar and Cervical Herniations (Disc Hernia) Treatment
In the treatment of lumbar and cervical disc herniation, non-surgical methods such as rest, physical therapy and epidural injections are considered first. However, surgery is inevitable in cases where neurological deficits are present. The most commonly applied methods are:
- Microdiscectomy: It is the removal of herniated disc material through a small incision using a surgical microscope.
- Fully Endoscopic Discectomy: It is the procedure of removing a herniated disc by inserting a camera through an approximately 0.5-1 cm opening.
- Disc Prosthesis: In cervical disc herniation, it is a procedure in which an artificial disc is implanted to replace the damaged disc in order to preserve mobility.
Spinal Curvature (Scoliosis and Kyphosis) Treatment
The treatment of scoliosis is planned according to the degree of curvature and the patient’s age. In mild curvatures, observation and bracing are used, while in progressive curves or those that threaten internal organ function, the following surgical methods are employed:
- Posterior Fusion and Instrumentation: It is the correction and stabilization of the spinal curvature using screws and rods through the back part.
- Magnetically Controlled Growing Rod Systems: It is the use of special expandable systems that can be periodically lengthened in order not to restrict spinal growth in young children.
Narrowing Of Spinal Canal (Spinal Stenosis) Treatment
Spinal stenosis is the narrowing of the spinal canal due to aging or degenerative changes (such as calcification) and compression of the nerves. These patients typically experience numbness in the legs and a need to stop after walking a certain distance. The primary goal of treatment is to widen the spinal canal and relieve pressure on the nerves. Treatment methods applied for spinal stenosis are as follows:
- Laminectomy (Decompression): It is the partial or complete removal of the bony arch at the back of the spine (the lamina) to reduce pressure on the nerves.
- Foraminotomy: It is the surgical widening of the openings (foramina) through which nerve roots exit the spine.
Lower back displacement (Spondylolisthesis) Treatment
Spondylolisthesis is the condition in which one vertebra slips forward or backward over the vertebra below it. This condition can cause severe lower back pain and nerve root compression. Physical therapy and corset are effective in mild cases, while in cases where instability develops, the following treatments are applied:
- Spinal Fusion (Stabilization): It is the procedure of stabilizing and fusing the slipped vertebrae using titanium screws and cage systems.
- TLIF/PLIF Methods: It is a procedure in which the intervertebral disc space is accessed to both remove the herniated disc material and support spinal fusion.
Treatment Of Spine Tumors
Spinal tumors can originate from the spine itself or develop as a result of metastasis from cancers in other organs. The treatment process is carried out in collaboration with oncology and radiotherapy departments. Surgical intervention is generally based on the principles of tumor removal and spinal stabilization and includes the following:
- Tumor Resection: It is the removal of the mass to the greatest possible extent without damaging the neural tissue.
- Vertebroplasty / Kyphoplasty: It is the injection of a special medical cement into the vertebra in cases of tumor-related compression fractures, to relieve pain and strengthen the bone.
Spinal Fractures and Trauma Treatment
Fractures resulting from traffic accidents, falls or osteoporosis may require emergency intervention due to the risk of spinal cord injury. Treatment is determined according to fracture type and spine stability:
- Internal Fixation: It is the stabilization of the spine by placing screw-rod systems above and below the fractured segment.
- Minimally Invasive Percutaneous Screwing: It allows earlier patient mobilization by inserting screws through small entry points without making a large skin incision.
Ankylosing Spondylitis Treatment
Ankylosing spondylitis is a chronic rheumatic disease characterized by inflammation of the spinal joints, leading to fusion of the vertebrae and a bamboo spine appearance. The main treatment consists of medication management prescribed by rheumatologists; however, in cases where severe deformities develop, the following surgical options are considered:
- Osteotomy: It is an operation performed in cases of excessive forward curvature of the spine (kyphosis), in which bone is removed to restore the patient’s upright posture.
- Interventions For Joints: In cases where the hip and knee joints are also affected, joint replacement surgeries may be included in the surgical plan.