"Spine surgery" is a surgical specialization that deals with the conservative / interventional / surgical treatments of spinal and spinal cord disorders that occur in children, adolescents, and adults. Physicians who specialize in this medical field are called "spine surgeons".

"Spine centers" are advanced medical units where coordination is done by a spine surgeon and health professionals such as orthopedists, neurosurgeons, neurologists, rheumatologists, physiotherapists, and nurses provide multidisciplinary services with a joint approach All the needs of spine patients can be met under one roof in these centers with the help of current scientific knowledge and advanced technological capabilities.

 

The spine has two main functions: The first important function is to provide both mobility and upright posture for the body. The second function is to protect the "neural highway" that communicates between the brain and organs, i.e., the spinal cord, from traumas. Therefore, disorders that occur in the spine can manifest themselves in a variety of symptoms (pain, postural abnormalities, numbness in arms and legs, tingling, limited mobility or loss of strength, urinary incontinence, paralysis, etc.).

The pathologies that can cause these complaints can be classified into several main categories:

 

• Spinal Deformity

The term deformity can be defined as "the distortion of the normal shape". Sometimes deformity may not be accompanied by functional impairment. However, a spine that deviates from its normal structure can generally cause pain, neurological problems, and functional disorders, as well as disrupt the entire body balance.

Scoliosis, kyphosis, or trauma are significant causes of deformity. Some deformities arise due to congenital defects, while others develop due to acquired defects later on.The severity of the deformities and the complaints they cause also determine the form of treatment. While some deformities can be managed with conservative methods, surgical correction is required for some severe deformities.

 

• Degenerative Diseases of the Spine

Degenerative diseases are conditions that disrupt normal functions by altering the anatomical structure.Examples of degenerative spinal diseases include intervertebral disc injuries, disc herniations, and osteoarthritis of the spine joints.In these types of diseases, compression on the neurological structure can lead to symptoms such as pain, weakness, sensory loss, and urinary incontinence. When conservative treatments are not enough to provide comfort for patients in their daily lives, surgical intervention may be necessary.Before making a surgical decision, the patient's age, socioeconomic status, clinical condition, and expectations should also be taken into account.

 

• Spine Injuries

Minor or major traumas can cause damage, sprains, and fractures in the structure of the spine. Major traumas can cause serious clinical problems and almost always require surgical intervention to restore stabilization.

 

• Tumoral Lesions in the Spine

In addition to tumors that originate in the spine itself, tumors that start in other parts of the body and spread to the spine are also commonly encountered. Tumoral lesions can sometimes have an invasive and destructive character for the spine. In such cases, a multidisciplinary approach is required: in addition to treatment methods such as chemotherapy and radiotherapy, surgical procedures are performed.Surgical procedures can help reduce tumor mass, relieve pressure on affected tissues, and restore stability that has been compromised.

 

• Infections of the Spine

The spine can be the target of various infectious diseases. While most of these diseases can be corrected with corset and medical treatment, surgical intervention is performed in some cases.

 

The main surgical methods used in spinal diseases can be summarized as follows:

• Decompression (Relief of Compression)

It is the process of relieving the structures (neurological, vascular, etc.) under compression in the spine.In recent years, decompression procedures are generally performed with closed, endoscopic "microsurgical" methods. The recovery process is faster with microsurgical methods.

 

• Stabilization (Fixation)
• ​Generally refers to the procedures for restructuring and stabilizing the static balance of the spine, which is disrupted by traumatic, degenerative, and inflammatory diseases to make it balanced and stable again. Stabilization can be achieved with different surgical fixation methods using different materials. Lumbar shift (spondylolisthesis) is a good example of spinal disorders in which stabilization is frequently used.  Spinal fusion surgeries are specialized stabilization methods where two or more bones in the spine are permanently connected to each other. 

 

• Reconstruction

In some advanced cases where correction is not sufficient, reconstruction may be necessary to rebuild the movement of the vertebrae, discs, and spine. In this case, the spinal surgeon can choose one or several different surgical methods that provide reconstruction.

 

There are different surgical techniques available for these surgical purposes.

• Discectomy and Microdiscectomy

It is the partial removal of damaged discs/pads that act as shock absorbers between the vertebrae. It is especially applied to reduce the pressure caused by the discs on the nerve roots coming out of the spinal cord (decompression).

• Disc Prosthesis Applications

It is a reconstruction procedure where an artificial disc is placed in the removed disc's place. It can generally be applied for neck surgeries and in some cases for the lumbar region.

• Laminectomy, Laminoplasty

It is the procedure of removing a portion or all of the bone structure at the back of the spine to increase the diameter of the canal in cases where the spine canal is narrowed.

• Corpectomy

It is the procedure of partially or completely removing one or more vertebrae. It is applied to selected cases where spinal integrity cannot be restored.

• Vertebroplasty

It is a surgical procedure where a cement-like substance is injected into the vertebrae. It is applied in cases where the spine is affected by cancer or fractures.

 

• can be defined as the right or left curvature of the spine when viewed from the front or back. However, it is actually a more complex deformity that affects the entire spine. In addition to moving sideways, the vertebrae also rotate in three dimensions, both upwards and downwards, and inwards and outwards. 

 

While scoliosis can occur in people of all ages, it is more common in childhood and adolescence, especially during periods of rapid growth. Problems originating in the spine itself can cause scoliosis, as well as other health issues that can indirectly affect the spine and lead to scoliosis. When considering childhood and adolescence, scoliosis causes can be examined in four main groups:

 

• Idiopathic Scoliosis   (Cause Unknown Scoliosis)

The most common type of scoliosis among all scoliosis types (approximately 80%). It is 4 times more common in girls. Although there are various opinions on initiating factors, the exact cause has not yet been fully elucidated.

Idiopathic scoliosis, which generally has the potential to worsen over time with growth, has 3 subtypes: infantile (up to 3 years old), juvenile (3-10 years old), and adolescent (10-18 years old) scoliosis.

 

• Congenital Scoliosis  

It occurs due to problems that arise during fetal development in the mother's womb. Malformations such as underdevelopment or partial development of the vertebrae are important causes of scoliosis in this group. Patients may also have accompanying spinal cord, kidney, and heart problems in addition to scoliosis.It can progress rapidly in the first years after birth and may require a more aggressive treatment plan.

 

• Neuromuscular Scoliosis                

Spina bifida, cerebral palsy, muscular dystrophy, and some other neurological disorders can lead to secondary scoliosis. Due to the natural course of these diseases, the spine loses its muscle and nerve support, causing a loss of physiological structure and resulting in scoliosis. In addition to treating the underlying condition, the complications of scoliosis should also be addressed.

 

• Functional Scoliosis                        

Functional scoliosis is a type of scoliosis that does not cause structural damage to the spine, and therefore, the spinal curvature is not permanent (at least initially). Deformity does not develop. Temporary scoliosis can occur due to reasons such as poor posture, psychological factors, muscle strains and pains, and differences in leg lengths. Although it is more easily correctable, it requires proper monitoring and treatment plan, and it is important to distinguish it from other types of scoliosis.

 

In contrast to childhood and adolescent scoliosis, adult scoliosis is generally degenerative in nature. Degeneration in the structures that make up the spine (such as discs, ligaments, joints, and muscles) over the years affects the alignment and leads to scoliosis. It gradually appears from the age of 50, more commonly in women.Osteoporosis can be considered as an important predisposing factor. Pain is at the forefront and is often accompanied by other degenerative spinal symptoms (such as leg pain, numbness, decreased walking distance, etc.).

 

Scoliosis can cause many symptoms and complaints in the clinic. However, in particular, in mild cases, it can progress for a long time without causing any complaints. The location and severity of scoliosis involvement, as well as accompanying diseases, will change the characteristics of the symptoms.

Some of these complaints and symptoms are as follows:

• Curvature and hump of the spine
• Difference in hip and shoulder levels
• Asymmetric appearance of body curves
• Asymmetric appearance between the body and arms
• Disproportionate appearance of the ribs
• Asymmetry of the chest
• Deepening of the lumbar curvature
• One scapula being more protruding than the other
• One shoulder being forward during walking
• One leg feeling longer than the other when walking
• Back and/or waist pain
• Shortness of breath
• Clothes that do not fit the body properly, do not fit properly

 

Scoliosis diagnosis, grading, and monitoring are done using direct radiographs (x-ray radiographs). In direct radiographs, the angle of asymmetry in the spine (Cobb angle) is measured to grade scoliosis. Spine curvatures of less than 10 degrees can be named "asymmetry" rather than scoliosis.

 

As the degree of curvature increases, the severity of scoliosis also increases. According to severity, scoliosis can generally be classified into 3 groups:

 

• Mild scoliosis             (10-20 degrees of curvature)
• Moderate scoliosis    (20-40 degrees of curvature)
• Severe scoliosis                      (>40 degrees of curvature)

 

In addition to x-ray radiographs, advanced tests such as MRI, CT, EMG (nerve conduction studies), respiratory function tests, and bone mineral measurements (DEXA, QCT) may also be requested by the physician if deemed necessary.

 

The treatment and management of scoliosis is carried out through a personalized program with a multidisciplinary approach for each patient. The scope of treatment is determined by the patient's age, the cause of scoliosis, the rate of progression of the deformity, and the degree of curvature of the spine (Cobb angle).

Scoliosis treatment is a long-term process that requires strict monitoring. This already causes great concern and stress for the patient and their family. So it is very important for the physician and healthcare team to provide family support.

In some cases, only monitoring and exercise programs may be sufficient for treatment, while in some patients, up to 24-hour corset use may be required. In advanced cases, surgical intervention becomes inevitable.

 

• usually involves radiological imaging and examination at certain intervals for curvatures smaller than 20-25 degrees. Regular exercise should be performed during this period. During monitoring, treatment options are evaluated based on the progression of scoliosis and are explained to the patient in detail by the physician.

 

Exercise programs for scoliosis are based on stretching and strengthening of muscles through a well-planned program, correcting posture, and increasing mobility. In addition, breathing exercises are included in exercise programs to increase lung capacity and function. It is very important for patients to adhere to the exercise program for treatment success.

 

Schroth exercises are specific scoliosis exercises applied for reorganizing the disrupted balance of the spine with a 3-dimensional approach. It is performed with the guidance of a trained and certified physiotherapist in individual and group therapy sessions and is supported by home programs. 

 

Corset is effective in children with a curvature of 20-40 degrees that is still growing. It is used to prevent the progression of deformity. However, in order for it to be effective, it must be worn all day long (at least 18 hours) until growth is complete. There are specially sized corset available depending on the severity and type of curvature. Its use can be quite challenging and requires patience. Corset treatment during adolescence loses its effectiveness when growth stops, while shorter-term corset use in adult-onset scoliosis can reduce pain by supporting the spine.

 

Non-surgical treatments cannot reverse the degree of scoliosis already present, so early diagnosis in these patients is of great importance to prevent disease progression.

 

Surgical treatments are preferred to prevent further worsening of curvature in the spine and to return the existing deformity as close to normal as possible. However, it is not a suitable treatment method for every patient. It is preferred in aggressive scoliosis where corset use cannot stop the curvature or when the curvature is above 40 degrees. In such cases, the advanced deterioration of the spine and chest can cause complications that threaten life by impairing the functions of the heart and lungs.

For surgical procedures, lung and spine development is generally waited for a certain stage, but in special cases, surgical intervention may be required at earlier stages.

 

Classical scoliosis surgery, known as "spinal fusion," involves straightening and stabilizing the spine by placing metal screws and rods in the vertebrae.  This method has been successfully applied for many years.

 

In recent years, tethering (tensioning) methods such as VBT (vertebral body tethering) and anterior scoliosis correction surgery have been more frequently and successfully applied as an alternative surgical method. Since this method is non-fusion (), it allows the patient to continue growing by utilizing the spine's growth potential. Additionally, compared to fusion surgery, it allows for greater flexibility and comfort in the patient's daily activities.From a surgical technique point of view, it is a very complex and experience-requiring procedure. It is of great importance for the success that the entire team that will undergo the operation is experienced in this regard. The Emsey Hospital Spine Center, the first and only center of excellence in Turkey and Asia, has successfully performed this surgical intervention for many years and has made significant scientific contributions to the world literature on the subject.

 

 

• (also known as gibbosity, hunchback, or round back) is the name given to the spinal deformity where the normal outward curve is excessively increased when viewed from the side of the body.

 

In cases where kyphosis is increased, the most common reason for a patient to seek medical attention is due to the noticeable deformity in the back. In addition, pain in the back, shortness of breath due to chest involvement, fatigue, and secondary signs of underlying disease may also be seen.

A detailed examination after the hyperkyphosis diagnosis is usually sufficient with X-ray radiographic examinations of the spine. However, in some cases, the physician may also need additional tests such as CT, MRI, EMG (nerve conduction studies), bone mineral measurements (DEXA, QCT), and respiratory function tests.

 

The treatment for kyphosis depends on the cause of the condition, the severity of the deformity, and the patient's age. In postural kyphosis, which is caused by poor posture, regular exercise programs and lifestyle modifications (such as correcting sitting position, ergonomic adjustments, regular exercise like swimming or pilates, etc.) to improve posture may be sufficient to correct the condition. Medical and physical therapy treatments can also be helpful for pain relief. This treatment program may be effective for mild Scheuermann kyphosis as well, but corset use and surgical intervention may be necessary in advanced cases. Corset use is ineffective in cases where growth has already stopped.

The classic method that has been successfully used in kyphosis surgery for many years, similar to scoliosis surgery, is spinal fusion surgery, where the spine is fixed with metal rods and screws.

In recent years, there have been significant developments in non-fusion surgeries for kyphosis treatment. Tethering methods, like in scoliosis surgery, can also provide promising results in selected cases of kyphosis. The Emsey Spine Center team has made significant scientific contributions to the medical literature regarding this current surgical procedure and has achieved a prominent position in the world.

 

• First and only "spine excellence center" certification in Asia and Turkey
• An academic team that leads the way in spine surgery in the medical literature
• Innovative and multidisciplinary approach: Scientific council in all fields related to spine health, such as spine surgery, orthopedics and traumatology, brain and neurosurgery, physical therapy and rehabilitation, neurology, rheumatology, and algology.
• Holistic treatment approach: Providing psychological, nutrition and diet, and rehabilitation support for patients under one center during postoperative process.
• Experienced healthcare staff in preoperative and postoperative preparation and care.
• 24/7 uninterrupted service throughout all diagnosis and treatment processes.

Ekleme Tarihi: 5/5/2023
Güncelleme Tarihi: 5/5/2023
Emsey Tıbbı Yayın Kurulu