Spine Curvature Surgery Center – Scoliosis
A center distinguished by its doctors who are experts in scoliosis operations
Scoliosis occurs in about 2% to 4% of the population, the majority of these curves are low-grade, we can see about 8-10 times more often in girls than in boys. Only 10% of people who suffer from the spine curvature advance to the degree of scoliosis. Regular exercise, strengthening back muscles, and increasing physical fitness are essential elements in almost every step of scoliosis treatment.
Scoliosis, which begins at a young age, especially under the age of ten, has different characteristics from scoliosis in older children.
Scoliosis, which begins at a young age, usually continues to progress. The most important factor in determining the development of scoliosis is the speed of the child’s physical development.
For young children, it is not recommended to repair the spine, eliminate movement and stop growth to prevent the spine from remaining short. This surgery may cause pediatric spinal stenosis under 5 years of age, poor lung development under 8 years of age, and poor rib cage growth under 10 years of age. If the rib cage does not grow sufficiently, problems in the lung and respiratory system in particular may occur. Fusion under the age of 10 can cause the body to remain short.
In adolescence, the merger process does not cause any problems in children due to the complete completion of growth such as the spinal canal, lung, rib cage and elongation.
Future health problems that can be caused by scoliosis if not treated
- Lung and respiratory problems
- Cardiac problems
- Energy loss
- Spinal cord compression and stroke rarely in very advanced malformations
- Serious cosmetic and psychological problems.
Scoliosis at a young age
You can face two important problems with scoliosis that begins at a young age. The most important factor that determines the development of scoliosis is the physical development of the child. The child’s growth rate is directly proportional to the development of scoliosis. It may be difficult to control this type of curvature of the spine by treating with a corset, which is another treatment method. For these reasons, the need for scoliosis surgery is more for younger patients than for adolescents.
The second difference is the disadvantages of fusion surgery, which means spine growth and spine movement in the surgical treatment of younger scoliosis.
Causes of scoliosis that occurs at a young age
Idiopathic scoliosis occurs in infants (0-3 years) and juveniles (3-10 years).
Congenital scoliosis develops rapidly while symptoms appear at a young age, the early scoliosis may occur in some syndrome’s patients. The other reasons are that scoliosis is caused by diseases of muscles, nerves and metabolic diseases.
Symptoms of scoliosis that occur at a young age
- Side curvature, abnormal hump, or abnormal internal curvature.
- Abdominal skin malformations: hair growth, dimples, discolouration.
- Abnormal arms or legs.
- Unequal shoulder, waist, or hips.
- Disproportionate tightness in the trunk, relative to the legs.
- Balance disorders.
- Notice the wheel protrusions when the person leans forward.
Treatment of scoliosis at a young age
The treatment options for scoliosis that occur at a young age vary according to the age of the child and the type and location of the curvature, but can be broadly categorized under 3 headings and include:
- corset treatment
- Scoliosis surgery
If the degree of curvature of the spine (scoliosis) is less than 20 degrees, the patient is observed under the supervision of a doctor.
Conditions where spinal fusion for surgical treatment of scoliosis can be applied at a young age
The expansion rods may not be appropriate or always successful in treating pediatric scoliosis who grow. Delaying fusion by letting the curvature progress for patients by this method is unsuccessful and can have very bad results. In this case, short smooth spine, long and curved spines are preferred and at an early period it may be necessary to apply fusion. In some exceptional cases, short sectoral fusion and increasing rods may be applied, which we call the “mixed” method. In short, scoliosis in early childhood. The early diagnosis is important and surgical intervention is often necessary. Often early surgical intervention is the application of methods that allow growth to continue. For young children, the treatment is difficult and arduous, but it is often successful in cases when it is diagnosed early.
Spinal curvature has one concave side and one convex side. On the concave side, the pressure forces cause excess pressure on the facial joints that provide movements among the vertebrae, this pressure can cause nerve damage in the canal. In addition, excessive bone formation in the joints or thickening of the soft tissue causes a problem in the structure of the spine, which may increase nerve pressure.
Adult idiopathic scoliosis
It starts with a painless in childhood, however, it is a condition in which symptoms (pain, attitude disorder, etc.) may appear in subsequent years. Since the cause of this type of scoliosis that can occur in childhood is unknown, it is also called idiopathic scoliosis. In adult idiopathic scoliosis, severe pain may occur due to facial joint degeneration. Excessive malformation of the rib cage may affect respiratory functions and may lead to rapid fatigue and shortness of breath.
Adult degenerative scoliosis
Adult degenerative scoliosis is a type of scoliosis that occurs as a result of aging in the structure of the spine with age. It usually occurs for people over 50 years old. Osteoporosis, which occurs in these ages, may be one of the causes of adult degenerative scoliosis or may cause increased curvature. Osteoporosis is a disease that occurs with low calcium in the bone and is also known among people as bone resorption. Drain-related degenerative scoliosis can occur in any areas of the neck, back, and waist in the spine, however, it is seen mostly in the waist.
In adults who suffer from advanced degenerative scoliosis, spinal stability may be damaged. This disorder can cause the trunk to be sideways with the spine in front and in the background, and the trunk tilts forward with a decrease in the anatomical angle of the lumbar region. These imbalances may increase the severity of the curvature, as well as affect the patient’s movement and cause pain. In adult patients with degenerative scoliosis, it can be observed the pain (radiculopathy) and loss of strength in the muscles that the nerve feeds along the nerve distribution area due to back pain, lower back pain and nerve pressure. In some cases, one of the vertebrae may slip forward, backward or sideways due to excessive malformation of the spine. In addition to adult degenerative scoliosis, these malformations that may occur in the structure of the spine, spondylolysis, retrolisthese, lateral deviation of the spine is called lateral deviation. Bones changes in the structure of the spine may cause pain, as well as leg pain and muscle weakness due to pressure from the nerve or spinal cord.
Symptoms of adult scoliosis
- Difficulty standing after sitting for a long time
- Difficulty in the first steps of walking
- Back spasms and waist muscles
- Gradual discrepancy of walking a long distance
- Feeling tired in the legs
Patients who suffer from severe stress may also experience loss of strength and numbness in the legs, while patients with congenital scoliosis may also experience difficulty breathing and rapid fatigue.
Diagnosis of adult scoliosis
- Direct radiography: front, back, side and side X-rays and permanent scoliosis.
- Magnetic resonance: If the legs become painful, if there is a change in urine functions and defecation, MRI may be necessary.
- Computed tomography
- Electrodiagnostic Testing: These tests may be desirable, especially for patients with leg pain, to determine the level of nerve pressure and determine whether nerve damage is associated with the spine or diabetes with diabetes patients.
Treatment of adult scoliosis
For the treatment of adult scoliosis, the degree of pain and curvature is determined according to whether the curvature is an advanced or not. In general, the first methods of treatment that have been applied to the patient are non-surgical methods. These include exercises to improve physical condition, stabilize and strengthen with the help of a physiotherapist, which may dissolve muscle spasm and relieve pain.
In adult scoliosis patients, corset therapy may be applied with doing exercise, however, short-term corset treatment should be considered as an aid to exercise and physical therapy, long-term corset treatment may cause harm rather than benefit, especially in patients who suffer from adult scoliosis. Pain can be relieved for patients suffering from pain, as well as physical therapy and exercise. In addition, irritation, especially in the facial joints or nerve compression: non-steroidal anti-inflammatory drugs may also be added to the treatment to relieve irritation (inflammation) if the source of pain is a radical pain caused by damaged facial joints or nerve compression, spinal injection may be an alternative treatment for these patients. For patients who suffer from adult scoliosis, non-surgical treatments may be applied individually or together.
In adult scoliosis, pain, loss of function and balance are more pronounced than the degree of curvature and formal malformation problems, however, it may be necessary to have surgery to stop further scoliosis progression, which is clearly determined to progress, although it is painless. Scoliosis surgery may be an important alternative for patients who do not respond to treatment despite all non-surgical methods, which increase in pain during the period (6 weeks to 6 months) and disability occurs. In addition to curvature, if there is urine, fecal smooth or muscle loss due to severe narrowing canal or nervous pressure, scoliosis treatment can be chosen. Adult scoliosis surgery in is more difficult than pediatric and adolescent scoliosis surgery. The duration of the surgical intervention and the number of scoliosis operations may be higher. On the other hand, heart and lung disease, diabetes and osteoporosis are important information that must be reported to your doctor before scoliosis surgery.
The goal of scoliosis surgery is to correct the curvature to ensure balance and fusion of the vertebrae and to eliminate nerve pressure. Long fusion and decompression may be required for some patients and shorter in others.
After adult scoliosis surgery, the patient is kept in hospital for a week to 10 days for recovery and rehabilitation. After surgery, the patient can stay in intensive care for one night. On the first day after scoliosis surgery, the patient is placed on the side of the bed and leg exercises are performed. The patient is transferred on the same day or the next day (the patient must be raised; one or two steps must be performed). After leaving the hospital the patient is given an exercise program, the patient begins to implement this program. The results of the treatment are then evaluated by regular examinations performed by the doctor. In the process, the person is expected to return to normalcy as soon as possible.
Types of scoliosis
The most common type of scoliosis. The curvature of the spine can be in the form of the letter “S” or “C”, that the rotation of the vertebrae around itself, except for the lateral curvature appears also in all idiopathic scoliosis, including lighter forms, this rotation of the vertebrae causes asymmetric protrusions on the back or lower back.
It is the second most common type of scoliosis. The main causes of neuromuscular scoliosis include muscle or nerve diseases. It could be the cause of neurological diseases (brain and spinal cord). Muscle diseases can be seen in childhood and beyond unlike idiopathic scoliosis, respiratory distress and sensory defects are more common in neuromuscular scoliosis. A scoliosis corset should not be used in the treatment process for reasons such as respiratory problems, communication disorders, sensory defects and epileptic seizures. For this type of scoliosis, young ages may be a preferred for surgical intervention.
It is a type of scoliosis resulting from anomalies that occur during the development of the unborn child. Congenital scoliosis shows rapid progress in the early years. Therefore, treatment of congenital scoliosis that occurs in the early stages may require surgical intervention in young ages. Various connective tissue diseases such as neurofibromatosis, various rheumatic diseases, osteoporosis, Marfan syndrome, Ehlers-Danlos, spinal fractures, various metabolic diseases such as Morquio and Gaucher (go-SHAY) disease, and some genetic diseases that cause scoliosis where the term congenital spinal malformation refers to spinal malformations that occur in the mother’s womb and progress with age. The child’s spine’s growth in the mother’s womb is completed in the first three months with the development of the organs. In this period, due to abnormal composition or a combination of spine structure, the growth of the vertebral is asymmetric and the result is curvatures progress.
Congenital scoliosis is not a genetic, however, congenital scoliosis may be associated with a genetic disease with other conditions that may be hereditary so there is no increase in the likelihood of a child suffering from congenital scoliosis only and does not have another genetic disorder with similar brothers or sisters in his family (congenital scoliosis). The cause of congenital scoliosis cannot be fully explained because of a number of events that occur during the stages of fetus development, some cases may occur more frequently with congenital spine malformations, and the most common malformations are
- kidneys and bladder malformations 30%
- Spinal cord malformations 15%
- Congenital heart problems 12%
These malformations may or may not be functionally important. In addition, malformations of the congenital spine may accompany many syndromes.
The extent of the impact of the abnormal vertebrae on the curvature of the spine
It is the most important factor that leads to the curvature of the spine is the uneven expansion of vertebrae which are abnormally formed. The problems that occur in the (uterus, spine) in the form of defects and defects of separation can be more complicated. One of the important points to note is that although there is an abnormal spine at birth, there may not be much curvature at the beginning, the curvature occurs with more growth. However, despite growth, and the spine, many of which are affected in this way, there may be no malformation at all. Even in the case of multiple abnormal vertebrae, these distortions may be balanced to compensate each other, which results in lower trunk growth rather than increased curvature. The curve may increase very slowly until the stage of rapid growth in adolescence. In cases where one side of the vertebrae cannot dissolve and remain connected to it, the connected side cannot grow. The free side continues to grow and scoliosis occurs. If the sides of the vertebrae are connected, there is little or no growth in this area. As a result, scoliosis does not develop, but this area may remain short. If the vertebrae are connected from the front, the humping occurs because the growth will continue from behind. If the vertebrae are connected from the back, Lord’s disease occurs because the congenital growth will continue. Half of the vertebrae or their inadequate shape cause curvature by causing the growth of one side of the spine more than the other.
Symptoms of congenital scoliosis
- Side curvature, abnormal hump, or abnormal internal curvature
- Skin malformations on the back: hair growth, dimples, discolouration
- The arms or legs are abnormally long
- Uneven shoulders, waist or hips
- Disproportionate tightness in the trunk, relative to the legs
- Balance disorders
- Wheel protrusions when the person leans forward.
Diagnosis of congenital scoliosis
Congenital scoliosis is diagnosed primarily through examination. Special X-rays, ultrasound MRI and other tests may be required. The results of these tests provide information about related problems and can be a guide for how to treat malformation in the future.
In this stage of scoliosis, a period called monitoring for insertion of malformation is inserted, this is done at regular intervals with regular x-ray tests. If the curvature increases regularly or if other functional problems occur, appropriate surgical intervention should be performed.
Congenital scoliosis and its treatment with corset
One of the biggest differences between congenital scoliosis and idiopathic scoliosis is that corsets are not effective in congenital anomalies congenital malformation. Sometimes it creates a second curvature to maintain the body balance below or above the curves caused by congenital malformations. These curvatures may increase after a certain period of time and may sometimes more dangerous than congenital curvatures.
In congenital scoliosis, the asymmetric growth of the abnormal vertebrae aims to slow it down or destroy it. For this, the spine fusion process can be applied (freezing the spine, eliminating movement). In order to control increased malformation, surgery may be required when the child is young. Parents are keenly aware that early fusion (because the molten part stops growing) can prevent trunk growth. Although that is quite true, the body size cannot be recovered by correcting a very severe malformation after the growth has ended, and delaying surgical treatment for patients who suffer from this anxiety may lead to serious problems for the patient at a later age. Patients who suffer from congenital scoliosis may undergo early surgery at any age if necessary, but can usually be postponed until one year of age.
After this age, if surgery is necessary for scoliosis, it is recommended to do so without waiting. Although early surgery may be performed, additional scoliosis procedures may be required if the initial surgery does not fully control the curvature. Children who actively grow to control the curvature of scoliosis may need anterior posterior fusion. These techniques can be applied to both scoliosis and kyphosis. To achieve spinal fusion, both the person himself or any other person may need to use bones or many of these sources together. If other related organ problems are revealed, then their treatment should be planned separately. These anomalies, especially spinal cord malformations, must be treated with spinal curvatures. While some spinal cord malformations do not require treatment, others are treated before or at the same time as curvature treatment by surgical intervention.
Other tests for congenital scoliosis:
Regular physical tests and x-rays are performed and continue until the skeleton reaches to maturity without special treatment unless there is an increase in curvature (after surgical treatment as well).
In most surgical treatments used to treat growing pediatric congenital spinal malformation, the curvature is attempted to control by fusion to a limited area or by fusion into a restricted area.
Restricted fusion processes
Resection of half the spine:
In some cases, the curvature can be eliminated by removing the abnormal spine. Body stabilization is applied for 3 to 6 months after the surgical procedure.
Curvature control with growing rods
If the curvature is suitable for very young children, correction can be made by means of rods attached to the screws placed at the top and bottom of the curvature without combination. After that, the curvature is curved every 6 months and the fusion process is applied in adulthood. The reason for this in young children is to prevent the body from staying short by maintaining growth and ensuring the normal growth of the lung and rib cage. Thanks to the newly introduced magnetic rods, the rods can be extended in outpatient clinics without the need for frequent operations.
The treatment for scoliosis varies according to the disease caused by scoliosis, as the response varies depending on the type of scoliosis. Scoliosis progresses with childhood and adolescent development, that is, the curvature of the spine increases, and for these reasons there is no single treatment that can be applied to all cases. The age at which the scoliosis is diagnosed, the location and degree of curvature, the causes of scoliosis, the results of the test and the data obtained from radiological tests are examined, in other words, the treatment for scoliosis is personal and is applied in a manner that varies from patient to patient. Although each treatment option may vary according to the patient, there are generally three alternative methods for diagnosing scoliosis.
The first option: It is to follow the curvatures that are not less than 20-25 degrees, where follow-up is at regular periods. Increased sport exercise and general body condition may be special physical therapy exercises and useful for scoliosis. Exercises that start at a very early age can cause pediatric early boredom. As a result, the child may not want to exercise at an advanced age, and in the case of rapid growth, exercises may be necessary.
The second option is the corset treatment
It is effective for people with a curvature of 20-40 degrees and the potential to grow. A multicenter study conducted in the United States of America and Canada with early results published in 2013 showed that patients who wear a corset have lower surgical rates compared to patients without a corset, in other words, the use of the corset is less prone to surgery. With this early result the study was stopped and was decided to give the corsets to all patients and it was found that the corset can be worn for 20-23 hours a day. If the scoliosis is greater than 20 degrees, the corset treatment may be used for young children as well as older children, however, for very young children (0-5 years) it is difficult to apply the corset under general anesthesia. Corsets may not be used for older children who have a curvature of 40 or more degrees. The situation is a little different from young children. For younger scoliosis, corset treatment can reach 60 degrees. The goal is to slow the progression of spine curvature. Scoliosis surgery is preferred for curvatures over 60 °.
Treatment using the corset method does not stop the pediatric spine curvature. Attempting to correct the curvature without placing fusion with the screws and rods systems placed on the spine is attempted.
The treatment method is known as Quot (extendable rod system), however the growth of the spine will continue.
In order to eliminate the negative effects of this condition, regular scoliosis operations (every 6 months) aim to improve the spine curvature by extending the spine rods. In some systems, rods can be extended using the remote magnetic control every 2-3 months. A treatment method (extendable rods system) should be implemented ideally until the end of the adulthood. The fusion process can start according to the time when a person’s growth decreases or stops.
Another option is the surgical treatment.
Surgery is usually questioned for curvatures in excess of 40-45 degrees. Corrections and freezing (stabilization) are performed for adolescents and adults who are fully developed. Preparation and preoperative planning is important to maximize improvement by performing the lowest possible level of operation in the areas involved in surgery.
The new treatment of scoliosis
For children under 10 years old suffer from scoliosis, freezing operations should be avoided because this will prevent the growth and development of the lung. The pediatric classic surgical method is to lengthen the rods placed in the spine every 6 months without freezing. In this classic method, the rods are placed on the body and elongation is achieved by repeated surgeries at 6-month periods. At the end of these studies, elongation can be performed using a remote control (magnetic rods), which will be invented within 2-3 months.
Neurological monitoring process, which clarifies the functions of the nerves during the operation, and this technology was developed in our country 4-5 years ago and is now widely used. Where the effect of any procedure that may cause nerve injury during surgery is immediately understood and the necessary intervention is made. Neurological monitoring technology has greatly increased the safety of these surgeries. With this technique, complex curvatures can be corrected. One of the most important problems related to scoliosis surgery is fixation of the spine and disappearance of the spine in a specific part. Spinal surgeries gradually began to pay off with a corrective technique that allowed the spine to grow and remain moveable without freezing.
A method called MRI extension method has been developed for patients suffer from scoliosis in the spine who still have growth potential. In this method, endoscopic intervention is applied to the convex side of the back curvature and these screws are connected with a thick rope and extend to provide some improvement and the convex side is prevented from growing, while the concave side continues to grow, the growth of the convex side stops due to the rope attached to the screws, and the curvature improves automatically over time.
The degree of scoliosis
Diagnosis of scoliosis depends on the degree of the spine curvature, according to the spine image, the curvature is measured in degrees as an angle. The angle that measures the degree of scoliosis is called the ” Cobb angle “. Curvatures below 10 degrees are defined as inconsistencies, not scoliosis. To diagnose scoliosis, the curvature must be greater than 10 degrees. If there is more than one curvature of the spine, it should be mentioned about the degree of scoliosis. MRI and other additional tests are used if there is an unusual curvature of the spine (such as curvature on the left side of the chest) or other symptoms.
However, the degree of rotation that accompanies the curve is determined, not the curvature. Measurement of scoliosis is also expressed in degrees, but it differs from the degree of scoliosis. The degree measured in the film indicates the deviation, and the degree that the sclerometer measures indicates the direction.
The patient is closely monitored for curves below 20 degrees, and swimming with back and waist exercises is recommended. There is no intervention (corset treatment or surgery). It may be the preferred corset treatment for people suffering from scoliosis range of 20-40 degrees and possibilities to grow. If scoliosis is more than 40 degrees, scoliosis surgery is required. Treatment for an 8-year-old with a 30-degree curvature differs from a treatment for an 18-year-old with a 30-degree. With a possibility of developing the curvature. In the case of older children, if the back curvature exceeds 40 degrees, and if the waist exceeds 35 degrees, surgery is recommended for these children. If the back curvature is greater than 50 ° and the curvature of the waist is above 40 °, surgery is recommended because it is known that these curves progress over time, although growth stops.
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