Scoliosis (Spinal Curvature) Surgery

What is Scoliosis (Spine Curvature)?

Scoliosis is a condition in which the vertebral column, that is, the spine, curves abnormally sideways. This curvature can cause the spine to appear in an “S” or “C” shape. The spine consists of many bones called vertebrae, and when these bones come together, the solid structure of the spine is formed. A normal spine has a slight curvature that increases the body’s mobility.

However, in the case of scoliosis, this slight curvature is greater than normal and the spine bends to the sides more than necessary. This curvature of the spine can affect body posture and sense of balance. Scoliosis most often occurs at a young age, especially during childhood or adolescence, and is often associated with rapid growth phases during this period.

Symptoms of scoliosis include unequal shoulder height, head deviation from center, one side being more protruding than the other, and a curved spine. This condition can occur for a variety of reasons, including genetic factors, neuromuscular problems, or unknown causes during the development of the spine. Early diagnosis and treatment can stop or slow the progression of scoliosis. Treatment options vary depending on the severity of the condition, the patient’s age, and other factors and may include physiotherapy, supportive devices, or surgery.

The normal spinal structure has a certain curvature; but in the case of scoliosis, this curvature is extreme and reaches at least 10 degrees. The technique used to measure this amount of curvature is called the “Cobb angle,” and the severity of the curvature can range from 10 degrees to 90 degrees or more.

Scoliosis can occur in any region of the spine, but it is most commonly seen in the back (thoracic) or waist (lumbar) region. Although this condition may be congenital or appear as the age progresses, the most common group is adolescents between the ages of 10-16, who are experiencing rapid growth phases.

There are various types of scoliosis, one of which is undetermined or idiopathic scoliosis. The vast majority of cases of idiopathic scoliosis occur without a specific cause, and the factors that influence the development of this condition are not fully understood.

The main goal in the treatment of scoliosis is to relieve the symptoms caused by the curvature and control the degree of curvature. The treatment plan is determined by the severity of scoliosis, the patient’s age, and the type of scoliosis and may include various options such as physical therapy, bracing, or surgical intervention.

What Causes Spinal Curvature (Scoliosis)? What are the types?

Spinal curvature (scoliosis) can develop due to a number of factors. Causes of this curvature include congenital spinal abnormalities, neuromuscular diseases and often unknown factors.

1. Congenital Scoliosis: This type of scoliosis is a condition that an individual is born with and is caused by abnormalities of the spine that occur during fetal development.
2. Neuromuscular Scoliosis: This type of scoliosis can be caused by neuromuscular diseases such as cerebral palsy, muscular dystrophy, spina bifida. These diseases can cause the muscles that keep the spine to rest properly on the spine to weaken or work unbalanced.
3. Idiopathic Scoliosis: This is the most common type of scoliosis and its cause is often unknown. Idiopathic scoliosis tends to have a genetic predisposition and occurs mostly in adolescent girls. This type of scoliosis can develop during childhood (0-3 years), middle childhood (4-10 years), and adolescence (11-18 years).

Spinal curvature is not always immediately noticeable. Sometimes, it is diagnosed when symptoms such as lower back pain occur or during routine health checks or school screenings. It should also be understood that factors such as incorrect posture, carrying heavy bags, or constantly sleeping on one’s side do not directly cause scoliosis, but can aggravate the symptoms of existing scoliosis.

What are the Symptoms of Scoliosis?

Scoliosis manifests itself with distinct symptoms, especially when the degree of curvature is above 10. Mild curvatures (around 10 degrees) are often invisible and may not cause any symptoms. However, when the degree of curvature reaches 20 or more, the presence of scoliosis becomes more clearly noticeable.

If you developed scoliosis in your adolescence and did not notice it early, various symptoms may be observed as you get older. Because back pain is rare in children, it is important to pay attention to other symptoms.

Symptoms of Scoliosis in Children:

1. Asymmetric position of the shoulders, one shoulder being higher than the other,
2. Hips not aligning properly,
3. The arms are not symmetrical to the body when the child stands straight,
4. Significant height difference between the two sides of the back when the child bends forward.

In adults, the symptoms of scoliosis are slightly different. In adults, back pain may be the first and most common symptom of scoliosis. Also, as the spine curves, it can put pressure on the spinal nerves, leading to symptoms such as weakness, numbness, or pain.

Symptoms of Scoliosis in Adults:

1. Uneven shoulder alignment,
2. Asymmetrical alignment of the hips,
3. Waist line is irregular,
4. Loss of feeling, weakness or pain in the legs,
5. Difficulty standing upright,
6. Constant feeling of fatigue.

Especially in adults, scoliosis can limit daily living activities and reduce quality of life, so early diagnosis and treatment is extremely important.

How is Spinal Curvature Treated?

Spinal curvature treatment is aimed at relieving symptoms and preventing the progression of the curvature, and the treatment method varies depending on the patient’s age, degree of curvature, location and type of curvature, and the patient’s general health condition. Patients with mild curvatures, usually between 10-20 degrees, may not need treatment as there are no symptoms or complaints. In this case, the doctor monitors whether the curvature progresses with regular check-ups.

When the degree of curvature increases or symptoms such as pain or poor posture occur as the curvature progresses, the following treatment methods can be applied:

1. Corset Treatment: Especially in children and adolescents, corset is used to prevent further curvature of the spine. The corset supports and helps straighten the spine.
2. Physical Therapy and Rehabilitation: Physical therapy aims to improve the patient’s posture, increase muscle strength and reduce pain.
3. Exercise Programs: Spinal curvature exercises include special movements designed to strengthen and support the spine.
4. Schroth Method: This method includes exercises specific to patients with scoliosis to correct breathing and posture.

However, in cases where these conservative treatment methods are ineffective or the curvature continues to progress, surgical intervention may also be an option. Scoliosis surgery aims to correct the degree of curvature in the spine and stabilize the spine. Surgery is usually recommended for patients who have severe curvatures or who experience serious symptoms such as pain and difficulty breathing.

Treatment options and practices may vary from patient to patient, so you should consult your doctor for the most appropriate treatment method. Your doctor will review your treatment plan by regularly monitoring your health condition, response to treatment, and progression of the curve.

Scoliosis Surgery

Scoliosis surgery is considered when non-invasive treatment methods (physical therapy, exercise, corset use) are not effective and the spinal curvature is 45 degrees or more. Surgery for such severe spinal curvatures aims to improve the quality of life for the patient, reduces pain, improves posture and preserves functions such as breathing in the future.

Scoliosis surgery is usually performed in cases of severe curvature, pain or progressive curvature. The surgery is performed to correct the curvature and make the spine more stable. The surgery itself and the recovery process may vary from patient to patient, which is why scoliosis surgery is considered a last resort in most cases.

The main reasons for surgical intervention are:

• Increasing back and leg pain despite treatment,
• Lack of benefit from other treatment methods,
• Curvature of 45 degrees or more and progression of curvature.

The main factors that determine the necessity of surgery:

• degree of curvature,
• curvature type,
• patient’s age,
• General health condition of the patient,
• Symptoms caused by curvature.

Advanced scoliosis can cause not only pain and poor posture, but also breathing difficulties and other health problems. Therefore, the surgical treatment option should be carefully evaluated and decided in line with doctor’s recommendations.

When the decision for surgical treatment is made, your doctor will share with you detailed information about the type of operation, risks, expected results and recovery process. Every operation has risks, so it is important to have open communication with your doctor and share all your concerns before the procedure. The post-operative rehabilitation process is also very critical and helps the patient maintain the success of the operation and return to normal life.

How is Scoliosis Surgery (Spine Curvature) Done?

The techniques applied in scoliosis surgery vary depending on the patient’s age, type and degree of curvature, and the growth status of the spine. Surgeries can be performed with different surgical methods, taking into account the ongoing growth of the spine, especially in children.

1. Extendable Systems: Extendable rods and screws are used to correct spinal curvature. This method helps correct the curvature in parallel with the growth of the spine in children. The surgeon adjusts the length of these rods at regular intervals, usually every 6-12 months, to accommodate the growth of the spine.
2. Spinal Fusion: Spinal fusion is one of the most commonly used techniques in scoliosis surgeries. In this procedure, two or more vertebrae in the area of ​​the curve are brought together and fused (fused). The surgeon uses metal rods, screws, or wire to straighten and stabilize the spine during this procedure. After the correction, a bone graft (usually bone taken from the patient or from a donor) is placed between these vertebrae so that the vertebrae fuse over time and form a single solid bone.

Each of the above-mentioned techniques may be recommended by the surgeon depending on the type of scoliosis and the patient’s general health condition. Immediately after the surgery, a rehabilitation and recovery process begins for the patient. This process helps the patient learn how to move, how to sit, how to stand up, and how to continue his daily life in the postoperative period. As with any surgical intervention, there are certain risks and complications in scoliosis surgeries, so it is critical for patients to stay in close communication with their doctors before and after the operation.

Is Spinal Curvature (Scoliosis) Surgery Risky?

Scoliosis surgery, like any surgical procedure, brings with it certain risks and complications. The risks of scoliosis surgery vary depending on the complexity of the operation, the patient’s age, general health condition and degree of curvature. Since these surgeries are performed on the spine, they carry risks due to their proximity to the nervous system, spinal cord and large blood vessels.

Listed below are the possible risks and complications of scoliosis surgery:

1. Infection: As with any surgical procedure, there is a risk of infection in the surgical area.
2. Excessive Blood Loss: Excessive blood loss may occur during or after surgery.
3. Deep Vein Thrombosis (DVT): DVT is a type of blood clot that can occur after surgery.
4. Breathing Problems: Breathing problems may occur during anesthesia or surgery.
5. Digestive System Problems: The surgery may have effects on the digestive system, stomach or intestinal problems may occur.
6. Nerve Damage: In case of damage to the spinal cord or nerve roots, neurological complications such as loss of sensation or paralysis may develop.
7. Problems with Surgical Materials: Screws, rods, or other devices used in surgery may break or become dislodged.
8. Spinal Instability: The stability of the spine may be affected after surgery.
9. Bone Fusion Problems: A condition in which the bones do not fuse as expected after the fusion process.

Neurological complications are rare but serious risks of scoliosis surgery. These conditions can lead to loss of motor function, loss of sensation, and other nervous system problems. While most neurological complications may be temporary, in some cases they may cause permanent damage.

Preexisting health conditions, age, and general health may increase or decrease risks. If you are concerned about risks and complications, it is important to talk in detail with your surgeon. Your surgeon will inform you about the risks and benefits, as well as discuss which risks are greater in your particular situation. As a patient, understanding all the options, risks, and expectations will help you make an informed decision.