In the Spine Health and Surgery Center, scoliosis (spine curvature), kyphosis (humpback), herniated disc, cervical hernia, spine, and spinal cord infections and tumors, spinal fractures, low back, and neck pain are treated with a multidisciplinary approach with technological equipment and experienced physician staff.
You can benefit from the opinions and experiences of a team of experts in the field of determining the source of your pain, early diagnosis, and interventional treatment. If a surgical method is required, the operation is performed by experienced physicians. Instrumental and non-instrumental rehabilitation programs are organized by our physical therapists and physiotherapists.
What is adolescent idiopathic scoliosis?
The most common type of scoliosis disorder (curvature of the spine) is adolescent idiopathic scoliosis. Adolescence is an expression used after childhood, but for the period of adolescence when growth is continuing. Therefore, the skeletal system in adolescents is also not fully mature. This disorder, which is more common in girls and causes more curvature, generally affects 10-year-old children. Idiopathic scoliosis affects 2-3% of children and adolescents aged 10-18 years. The exact cause of idiopathic scoliosis is unknown. However, this disorder is thought to be caused by genetic reasons.
Adolescent idiopathic scoliosis (AIS) is usually first noticed by parents or patients. These ailments sometimes appear at a school screening and sometimes at a doctor’s visit. Most AIS patients do not have many symptoms. However, wider curves manifest themselves with visible distortions such as pain or rib anomalies
What are the symptoms?
Symptoms of scoliosis vary according to the severity of the curvature. Scoliosis discomfort often occurs when the clothes worn by the patient are not as straight as before. For this reason, this discomfort may sometimes not be noticed in children who wear loose clothing. For this reason, parents with a family history of scoliosis should check their children’s backs frequently. In schools, scoliosis can be detected during scoliosis screenings and annual pediatrician visits.
In what situations should scoliosis be suspected?
If your child has a height difference between their shoulders
Difficulty leaning left and right or standing upright
When viewed from behind, inequality between the shoulder blades is noticed
One side of your child’s back appears higher than the other when he/she bends forward
Your child’s hips, underwear lines, or trouser lines are asymmetrical
If you notice an abnormality in your child’s gait, you may have scoliosis
What are the risk factors?
There are some risk factors in the progression of the curvature in adolescent idiopathic scoliosis (AIS). These are the patient’s age, skeletal maturity, gender, and the degree of curvature present. In general, diagnosing girls with scoliosis at a young age increases the likelihood of curvature progression. Diagnosing scoliosis at a young age is riskier in the progression of the curvature. The reason for this is the possibility of the curvature increasing with the growing age. For children under the age of 10, if the curvature is between 5 and 19 degrees, there is a 45% probability, and if the curvature is between 20 and 29 degrees, it progresses with 100% probability. In 11-12-year-old children, if the curvature is between 5 and 19 degrees, it is 61% likely, and if 15 years and older, it is 16% likely to progress.
Skeletal maturity (Maturity)
Skeletal maturity shows how long a child has remained in the growth process. Growth cartilages are closed at certain ages in boys and girls. The Risser sign is a gradation made by looking at the calcification of the pelvis on the scoliosis radiograph. It is made according to a rating of 0-5. According to the Risser classification, curvatures between 2- and 4-degrees progress by 23%, while curves between 0 and 1 progress by 65%.
Diagnosis and treatment
History: Since adolescent idiopathic scoliosis is a genetic disease, the patient’s family history is very important at the time of diagnosis.
Physical testing: Physical testing includes a complete neurological examination and the use of a special measuring device called a scoliometer. This device is used to measure the asymmetry of the spinal cord when the spinal cord is tilted forward.
X-ray: An X-ray of the entire spine should be seen to evaluate the anteroposterior and lateral curvature. In these graphs, the degree of scoliosis is determined by measuring the angle between the most bent vertebrae. Follow-up and treatment of children are planned by measuring the Cobb angle.
Treatment: Many patients with adolescent idiopathic scoliosis have small curves that do not require serious treatment. For patients with small curves of 10-20 degrees, observation is sufficient.
Corset treatment: For patients with curvature above 25 degrees, the progression of the curvature can be prevented by using a corset. For patients who need a brace, a lightweight TLSO corset may be beneficial. The corset made in accordance with the curvature of the patient can be worn under the clothes. In order for the corset to be effective, it must be used 23 hours a day.
Surgery: Adolescent idiopathic scoliosis surgery is generally considered in the patient group where the curvature exceeds 50 degrees. Before deciding for scoliosis in AIS, after a careful evaluation, a detailed consultation with the patient and family should be made and information should be shared accordingly.
Kyphosis, or spinal curvature, popularly known as hunchback, is the curvature of the upper part of the back. Too much or too much kyphosis can cause pain and decrease your ability to function. Treatment varies depending on the severity of the symptoms, how long they last, and whether the pain is relieved by medical treatment.
What are the causes of kyphosis?
Other causes of kyphosis, which may occur during childbirth, are listed as follows.
Causes related to the nervous or muscular system
Arthritis of the spine
Benign or malignant spinal tumors
What are the symptoms?
Symptoms may resemble other diseases of the spinal cord or may be the result of an injury or infection. Except this;
Height difference of shoulders
Tilting the head forward compared to the rest of the body
The upper back appears higher than normal when the body is leaning forward
Tight hamstring (back of thigh) muscles
Mild or moderate symptoms can usually be treated without surgery. Physical therapy and exercises under the supervision of a physiotherapist to strengthen the waist and relieve pain prevent the progression of the disease. Corset is an important treatment option for pediatric patients. In addition, observation and repeated examinations are important to measure the progression of the curvature of pediatric patients.
Minimally invasive interventional treatments:
Epidural steroid injections: Injections are an important method in the treatment of pain caused by pressure on spinal nerves.
Kyphoplasty: Plastic cement is inserted into the vertebra (spine bone) using a needle and balloon. This application stabilizes the spine and reduces pain.
If you have severe kyphosis, other treatments have not helped, or you have severe pain and weakness affecting your mobility, now the surgical treatment option is for you.
Spine and spinal cord tumors
Spinal tumors can be benign or malignant. Benign spinal tumors include meningioma, neurofibroma or schwannomas. The tumor can be located inside the spinal canal or outside of the spinal canal. Removal of the tumor is usually sufficient in the treatment of such tumors. However, in some cases, it may be necessary to give the patient radiotherapy or chemotherapy.
Malignant tumors can arise from the bone itself, as well as tumors that develop due to metastases originating from another organ. (Such as lung, breast, prostate and colon tumors) These types of tumors are diseases that specialist physicians should follow and treat in a multidisciplinary manner.
Spinal cord tumors
Tumors originating from the spinal cord itself include astrocytoma, glioblastoma, and ependymoma. In selected cases, surgical removal of the tumor is required. It is important to follow up malignant tumors by more than one specialist.
What are the symptoms of spine and spinal cord tumors?
The symptoms that occur vary according to the spine or the region where the spinal cord is involved. There may be neck, back or low back pain, pain and numbness in the arms and legs. Apart from this, there may be weakness in arms and legs and problems in urinary control.
Diagnosis and treatment
Computed tomography (CT) and magnetic resonance imaging (MR) are important imaging modalities for diagnosis. Neurosurgery specialist, who evaluates the imaging results and performs a detailed examination of the patient, determines the treatment options in spinal and spinal cord tumors.
Most of the fractures in the spine do not require surgical intervention. However, spinal fractures that occur as a result of major traumas often require surgical intervention. Fractures that occur with high energy often cause slipping in the spine and damage to the spinal cord. There may be pain as a result of fractures and fractures in the bone weakened by osteoporosis. With the developing new techniques, the patient can be injected with cement into the bone by methods called kyphoplasty or vertebroplasty. The patient’s pain is reduced with minimal intervention and the bone is strengthened.
What are the reasons leading to the fracture?
Fractures occur in the spine due to overloads for any reason. There may be a compression fracture in the anterior part of the spine, as well as fractures due to burst fractures in all parts of the spine. The presence of osteoporosis in the patient is one of the main causes of the fracture.
What are the treatment options?
Medical treatment: Rest and use of pain relievers in the treatment of most fractures. The use of corset is an important factor in reducing pain.
Vertebroplasty: It is a method of injecting a segment into the bone by entering into the broken spine through a cannula. In this way, the patient’s pain is reduced and the bone is strengthened.
Kyphoplasty: It is the method of entering the broken spine through the cannula and inflating the balloon in the fractured vertebral body and placing cement into this cavity.
Cervical narrow canal and myelopathy treatment
Your spine is the most important factor in standing and bending, protecting your spinal cord and nerves. Narrowing of the spinal canal occurs due to wear and tear in the cervical vertebrae. Due to the narrowing of the spinal canal, damage to the nerves leading to the spinal cord and arms can occur due to pressure and compression.
What is channel narrowing?
Spinal canal narrowing is more common in people over the age of 50. Diseases such as arthritis and scoliosis can worsen spinal stenosis. There will be no symptoms in the patients, and symptoms that occur gradually or suddenly can be seen. These symptoms are listed as follows:
Pain in the neck or back
Numbness and burning in the arms or legs
Imbalance when walking
Weakness in fingers, hands, arms and legs
Diagnosis and treatment
Additional nonsurgical treatments:
Anti-inflammatory drugs and neuropathy pain relievers are used for burning, tingling and numbness symptoms. The patient is informed to restore balance and prevent falls. It also offers weight loss guidance, healthier eating and exercise advice to relieve pressure on the spine, and Pilates and yoga to strengthen the back muscles.
If there is myelopathy near the cervical stenosis, surgery may be required for treatment. Surgery can prevent further spinal cord damage and recovery can be
achieved with physical therapy. Before surgery, patients may need additional tests, these are;
Electromyography (EMG), which can detect muscle weakness due to nerve problems
Computed tomography (CT)
Magnetic resonance imaging (MR)
After all these procedures, the most appropriate surgical method for the patient is selected. Surgeries are possible to eliminate nerve pressure from both the front and the back of the neck.
Laminectomy is performed at the back of the neck, the compressive part of the vertebra is removed, and if necessary, fixation can be made with metallic plates and screws.
In the anterior spinal cord compression, it can be achieved by removing the bone, disc or both together. It is often necessary to place cages or plates to support the front of the vertebra.
Disc distance and importance
Disc material between the vertebrae has important functions. The disc covers the loads on the waist, keeps the upper part of the body upright and allows the waist to move in all directions. As a result of the rupture of the disc material, the contents coming out affect daily life. The disc material that comes out causes low back pain and leg pain by compressing the spinal cord and nerve roots located in close proximity.
In what cases does the disc rupture causing lumbar hernia?
The disc material is composed of nucleus pulposus, which is waterier inside, and a harder structure called annulus fibrosis on the outside. With aging, the inner nucleus pulposus loses its water structure and causes a decrease in the height of the disc distance, which should be flexible. When the disc is unable to carry the loads, it is exposed to and with the tear on its outer part, the nucleus pulposus inside the disc begins to come out. This process usually takes a long time
Lifting heavy loads or uncontrolled movement can often cause the disc to rupture. The disc may rupture in the face of sudden forces such as traffic accidents or falling from a height.
What are the risk factors?
Lumbar hernia is more common in men than in women. Although it is generally seen in middle ages, it can be seen in all age groups. Obesity, heavy work and smoking are the most important reasons that increase the possibility of herniated disc. The incidence is higher in those with a family history of lumbar hernia.
What are the symptoms of lumbar hernia?
Low back pain and leg pain are the first symptoms that occur with compression of the nerve root in the closes area of the nerve root as a result of the discharge of the disc material or the inflammation that occurs here. Back and leg pains can occur together, or one of the two complaints can be seen alone.
Low back pain: Pain, which usually increases with moving and sitting, usually decreases when resting.
Leg pain: There may be pain spreading to different parts of the leg, depending on the affected nerve root. Pain is generally described by patients as sharp and electric shock.
Numbness- weakness in the leg: Some patients experience numbness and tingling. Due to the compression of the nerve root, weakness or loss of function can be seen in the leg.
Cauda Equina syndrome: Due to the compression of the last part of the spinal cord, problems in the urination function may occur and need to be treated urgently.
Diagnosis and treatment
The treatment of herniated disc should be planned individually as a result of the patient’s complaint, examination findings and imaging methods.
Neck pain and neck hernia
The neck provides the connection between the head and the body. There are 7 vertebrae in the neck area. Neck movements occur thanks to the disc and joints. Neck pain is a very common condition among the adult age group and seriously affects the quality of life.
What are the causes of neck pain?
Neck pain can be caused by tissues of the spine such as bones, joints, muscles, ligaments, and nerves. The most common cause of neck pain is mechanical-type neck pain involving soft tissue strains. Posture disorder is the main cause of this type of pain. It is especially common in people who work in a forward-leaning position at a desk or computer during the day. This pain gradually decreases within 2-3 days and disappears within 1-2 weeks. This pain manifests itself in the form of attacks in some periods. Apart from these, neck hernia, degeneration in the neck bones, narrowing of the spinal canal, rheumatic diseases can also cause neck pain.
What are the symptoms of neck hernia?
Under normal conditions, the disc structure consists of a hard sheath between the two vertebrae and a gel-like soft tissue on the inside. In cervical disc herniation, the outer sheath is weakened or torn, and the inner gel structure shifts outward and this situation compresses the nerves. Arm pain is often more severe than neck pain
because of the compression of the nerve roots. Depending on the level of pressure on the nerve roots, there may be weakness and numbness in the arm and hand muscles. In advanced cases that are not treated, quite serious conditions such as weakness in the legs and urinary incontinence may develop due to the pressure of the spinal cord.
How is the diagnosis of cervical disc hernia made?
In the diagnosis of the disease, direct radiography, computed tomography (CT), magnetic resonance (MRI) examination, and EMG are used, respectively.
How is the diagnosis of cervical disc hernia treated?
Medical treatment is performed by exercise programs that strengthen the neck muscles, injection applications, or surgery.