scoliosis Treatment in Turkey.
Scoliosis is an abnormal side curvature of the spine. Scoliosis is often diagnosed in childhood or early adolescence. The normal curvatures of the spine occur in the cervical, thoracic and lumbar regions in the so-called "sagittal" plane.
These natural curves place the head above the pelvis and act as a shock absorber to distribute mechanical stress during movement.
Scoliosis is often defined as curvature of the spine in the "coronal" (anterior) plane. While the degree of curvature is measured at the coronal plane, scoliosis is actually a more complex three-dimensional problem that includes the following levels:
- coronal level
- sagittal plane
- axial level
The coronal plane is a plane vertical from head to toe and parallel to the shoulders, dividing the body into anterior and posterior sections.
The sagittal plane divides the body into right and left halves, the axial plane parallel to the ground plane and at right angles to the coronal and sagittal planes.
Scoliosis and its spread
Scoliosis affects 2-3% of the population, or an estimated six to nine million people in the United States.
Scoliosis can develop in infancy or early childhood. However, the basic age of onset is 10-15 years and scoliosis occurs equally in both sexes. Females are eight times more likely to develop scoliosis to a stage that requires treatment.
Each year scoliosis patients make more than 600,000 visits to physicians' private clinics, an estimated 30,000 children are fitted with a brace and 38,000 patients undergo spinal fusion to treat scoliosis.
Causes of scoliosis:
Scoliosis can be classified according to etiology: idiopathic scoliosis, congenital scoliosis, and neuromuscular scoliosis.
Idiopathic scoliosis: When all other causes of scoliosis are excluded, it is the diagnosis and comprises about 80 percent of all scoliosis cases.
Adolescent idiopathic scoliosis is the most common type of scoliosis and is usually diagnosed during puberty.
Congenital scoliosis results from a fetus deformation of one or more vertebrae and may occur anywhere in the spine.
Spinal deformities cause curvature and other abnormalities in the spine because one region of the spine elongates at a slower rate than the rest of the spine.
The geometry and location of the abnormalities determine the rate at which scoliosis progresses in size as the child grows, because these abnormalities are present at birth. Congenital scoliosis is usually detected at a younger age than idiopathic scoliosis.
Neuromuscular scoliosis includes scoliosis secondary to neurological or muscular diseases. This includes scoliosis associated with cerebral palsy, scoliosis associated with spinal cord injury, scoliosis due to muscular atrophy, scoliosis due to SMA, and scoliosis. This type of scoliosis generally progresses more rapidly. of idiopathic scoliosis and often requires surgical treatment.
Scoliosis symptoms/signs of scoliosis of the spine
There are many signs that you may have scoliosis. If you notice one or more of the following, make an appointment with your doctor.
- Uneven shoulders - one or both shoulder blades may protrude
- When you have scoliosis, the head is not centered directly over the pelvis
- One or both hips is unusually high or high
- Rib cages at different heights due to curvature
- asymmetrical waist
- Changes in the appearance or texture of the skin covering the spine (dimples, hairy spots, color abnormalities)
- The whole body is tilted to one side due to the curvature of the spine
In one study, about 23 percent of patients with idiopathic scoliosis had back pain at the time of initial diagnosis.
Ten percent of these patients were found to have an underlying condition associated with scoliosis such as spondylolisthesis, syringomyelia, tethered cord, herniated disc or spinal tumor.
If a patient with idiopathic scoliosis has more than one mild back pain, a thorough evaluation of another cause of the pain is recommended.
Because of changes in the shape and size of the chest, idiopathic scoliosis may affect lung function.
Recent reports on pulmonary function testing in patients with mild to moderate idiopathic scoliosis have shown impairment of lung function.
Scoliosis diagnosis
Scoliosis is usually confirmed with a physical exam, X-ray, spine radiography, CT scan, or MRI.
Scoliosis is measured in a special way, and the severity of scoliosis is diagnosed by the number of degrees of curvature of the spine.
The diagnosis of scoliosis is made based on a coronal curvature measured on an anterior posterior radiograph greater than 10°, in general scoliosis is considered significant if the curvature is greater than 25 to 30°.
Curves beyond 45 to 50 degrees are considered severe scoliosis and require more aggressive treatment.
The standard test sometimes used by pediatricians and in elementary school examinations is called the Adam's Forward Test. During this test, the patient leans forward with feet together and bends 90 degrees at the waist. From this angle, the examiner can easily detect any asymmetry in the trunk or any Abnormal curvatures of the spine.
This is a simple initial screening test that can detect potential problems, but cannot accurately determine the type or severity of the deformity since radiographic tests are required for an accurate diagnosis.
- X ray: X-rays can clarify the arrangement and consistency of the vertebrae of the spine. X-rays of the spine are done to look for other possible causes of pain such as infections, fractures, deformities, etc.
X-ray image of a patient with scoliosis - computerized tomography (CT) scanCT or CAT): It can show the shape and size of the spinal canal and its contents and surrounding structures, is very good at imaging skeletal structures.
- magnetic resonance imaging (MRI)MRI): It can show the spinal cord, nerve roots and surrounding areas and reveal abnormalities.
Scoliosis in children
Scoliosis in children is classified by age:
1.) Infantile Scoliosis (0 to 3 years old)
2.) Toddler Scoliosis (ages 3 to 10)
3.) Adolescent Scoliosis (11 years and over, or from the onset of puberty to skeletal maturity)
Idiopathic scoliosis includes the vast majority of cases presenting during adolescence. Depending on the severity of the scoliosis and the age of the child, scoliosis is managed by close monitoring, bracing and/or surgery.
In children with congenital scoliosis there is a demonstrated increase in its association with other congenital anomalies most commonly associated with the spinal cord (20 percent), the genitourinary system (20 to 33 percent), and the heart (10 to 15 percent).
An evaluation of the nervous, urogenital, and cardiovascular systems is important when diagnosing congenital scoliosis.
Scoliosis in adults
Scoliosis that occurs or is diagnosed in adulthood is distinct from scoliosis in childhood, in which the underlying causes and treatment goals differ in patients who have already reached skeletal maturity.
Most adults with scoliosis can be divided into the following categories:
1.) Adult scoliosis patients treated surgically as adolescents
2.) Adult scoliosis patients who did not receive treatment when they were younger
3.) Adults with a type of scoliosis called degenerative scoliosis
In one 20-year study, about 40 percent of adult scoliosis patients experienced a severe worsening of their scoliosis. Of these, 10 percent showed very significant progression, and the other 30 percent experienced a moderate worsening of scoliosis, usually less than 1 degree in severity. the year.
Degenerative scoliosis occurs in the lumbar spine (lower back) and this condition most commonly affects people 65 years of age or older.
This type of scoliosis is often accompanied by spinal narrowing, or narrowing of the spinal canal, which puts pressure on the spinal nerves.
Back pain associated with degenerative scoliosis usually begins gradually and is associated with activity. The curvature of the spine in this type of scoliosis is often relatively minor, so surgery may be recommended only when conservative approaches fail to relieve the pain associated with degenerative scoliosis.
Scoliosis treatment
When scoliosis has been diagnosed with certainty, there are several issues that must be evaluated and that can help determine treatment options:
- Spine Maturity - Is the patient's spine still growing and changing?
- Degree of curvature and extent of curvature - how severe is the curvature and how does it affect the patient's lifestyle?
- Location of the curvature - According to some experts, thoracic curves are more likely to be exacerbated than bends in other areas of the spine.
- Possibility of deterioration of scoliosis and progression of curvature – Patients who have significant curvatures of the spine before the age of their adolescent growth spurts are at greater risk of worsening of scoliosis and an increase in curvature of the spine.
After evaluating these variables, the following treatment options for scoliosis may be recommended:
- Scoliosis monitoring
- conservative treatment
- Scoliosis surgery
Scoliosis Monitoring
In many children with scoliosis, the curvature of the spine is too mild to need treatment. However, if the doctor is concerned that the scoliosis may be progressing, he or she may want to see the child every four to six months throughout adolescence.
In adults with scoliosis, a repeat X-ray is usually recommended every five years to monitor for scoliosis and curvature of the spine, unless symptoms gradually get worse.
Conservative treatment of scoliosis
Braces are only effective if patients have not reached skeletal maturity If the child is still growing and the spinal curvature is between 25° and 40°, a brace may be recommended to prevent the progression of scoliosis.
There have been improvements in brace design and many newer models under the arm, rather than around the neck, and while there is some disagreement among experts about which type of brace is most effective, studies show that spinal braces, when used with full compliance, successfully halt the progression of curvature in About 80 percent of children have scoliosis. For optimal effectiveness, the brace should be checked regularly to ensure it is suitable for scoliosis and may need to be worn 16 to 23 hours each day until growth stops.
Scoliosis surgery andThe latest treatment methods in Turkey
In children, the two primary goals of scoliosis surgery are to halt the progression of curvature through adulthood and reduce spinal deformity. Most experts recommend surgery only when the curvature of the spine (scoliosis) is greater than 40 degrees and there are signs that scoliosis is progressing. This scoliosis surgery can be performed using an anterior (through the front) or a posterior (through the back) approach depending on the particular case.
Some adults treated for childhood scoliosis may need a second surgery, especially if they were treated 20 to 30 years ago, before major advances in spinal surgery procedures and surgical treatments for scoliosis can be implemented. At the time, it was common to fuse a long portion of the spine. When the many vertebral segments of the spine are fused together, the remaining moving parts bear a much greater amount of load and pressure during movements. Para-fusion disease is the process in which degenerative changes occur over time in the moving parts above and below the place of spinal fusion. This can lead to painful arthritis of the discs, joints, and ligaments.
In general, adult scoliosis surgery may be recommended when the curvature of the spine is greater than 50 degrees and the patient has nerve damage to the feet and/or has bowel or bladder symptoms. Adults with degenerative scoliosis and spinal stenosis may need decompression surgery with spinal fusion.
A number of factors can increase the risks associated with scoliosis surgery in older adults with degenerative scoliosis. These factors include: being older, smoking, being overweight, and having other health/medical problems. In general, the surgery and recovery time is expected to be longer in older adults with scoliosis.
Posterior approach to scoliosis surgery
The posterior approach has been the gold standard for years and is now considered a surgical procedure applicable to most scoliosis patients.
The most common surgery for idiopathic scoliosis in adolescents is posterior spinal fusion using devices and bone grafting. It is performed through the back while the patient lies on his stomach. During this surgery, the spine is straightened with rigid rods, followed by spinal fusion. Spinal fusion involves adding a bone graft to the curved area of the spine, creating a strong union between two or more vertebrae. Metal rods attached to the spine ensure that the spine remains straight while the spinal fusion is in effect.
This procedure to treat scoliosis usually takes several hours in children and teens, but generally takes longer in older adults. With recent advances in technology, most people with idiopathic scoliosis can return to life within a week of surgery and do not need a brace after surgery. Most patients are able to return to school or work within two to four weeks after surgery and can resume all preoperative activities within four to six months.
A posterior approach is usually required in patients with double or triple scoliosis associated with significant kyphosis.
In younger, adult patients with good bone density and strength, a brace is not used after surgery.
Posterior devices (eg, rods, screws) may be placed without fusion or "growth rods" in patients with scoliosis under 10 years of age. The merging process is performed.
The average hospital stay for most operations is four to seven days.
Anterior approach to scoliosis surgery
Many thoracolumbar (thoracolumbar) curves are treated in this way. Devices (rods) are implanted along the side of the spine.
The patient lies sideways during surgery. The surgeon makes incisions in the patient's side, deflates the lung, and removes the rib to access the spine. Video-assisted thoracoscopic surgery (VAT) provides an improved view of the spine and is a less invasive procedure than open surgery. The anterior spine approach has many potential advantages: better deformity correction, faster rehabilitation of patients, improved spinal mobility, and fewer segments fusion. The potential drawbacks are that many patients require bracing for several months after surgery, and this approach carries a higher risk of disease.
The advantages of this surgical approach include:
- better correction
- Less blood loss
- Lower levels of the spine fuse in many cases.
The anterior approach is often done using modern techniques and is called Video-Assisted Thoracoscopy or VATS for short. Patients are hospitalized for three to six days.
anteroposterior approach
The anteroposterior approach is performed in patients with severely rigid tilts and in young, skeletally immature patients as well. This procedure can be performed in one day or divided into two procedures on different days.
In general, one curve is treated from the front and back. If there is a second curve, it is only treated from the back. Sometimes, if there are two severe curves, the surgical procedure is done in a double anteroposterior approach.
The anterior approach is the standard procedure performed to treat lumbar curves. Despite its name, it is actually performed through the patient's side to reach the front of the spine. Anterior surgery can be performed using an endoscope inserted into the thoracic spine. It is also called thoracoscopic surgery.
The anteroposterior approach is more involved than a single anterior or posterior procedure. The surgery may take six to 10 hours, the average hospital stay ranges from five days to two weeks, and recovery takes longer.
Laminectomy
The lamina (the back part) of the vertebrae is removed to make more room for the nerves. Various devices (such as screws or rods) may be used to promote fusion and support unstable areas of the spine.
osteotomy
The term osteotomy means cutting and removing bone. An osteotomy is performed in the front or back of the spine.
In the treatment of scoliosis, osteotomy is used to improve the correction of spinal deformity. Osteotomy is used to treat adults with rigid scoliotic curvatures, children with large curvatures that cause deformity, to correct flat back, and in spinal reconstructions where realignment is required after prior spinal fusion.
Spine excision (removal)
If the scoliosis or kyphosis is advanced, and the patient is out of balance, the abnormally shaped vertebra causing the scoliosis can be surgically removed. The surgery is performed using the anteroposterior approach, more commonly today, only than the posterior approach. Devices (eg, rods, screws) are implanted in the back and patients are often prepared for several months after surgery.
Minimally invasive surgery (MIS) for scoliosis in Turkey
It is a technique applicable to thoracic spine surgery. Not every patient with thoracic curvature is a candidate for VATS. The procedure requires temporarily emptying one lung; Some patients, for anatomical reasons, cannot undergo this. Also, some curves do not allow easy access to the spine with VATS.
Small incisions called portals are made in the side of the chest. The surgeon uses endoscopes, cameras, and video monitors to see the spine. These devices help make spine surgery less invasive for the patient while providing equal or better results. There is little effect on lung function using VATS as some studies have shown.
After surgery, small incisions are hidden under the patient's arm. The scars are cosmetically much smaller than standard open procedures.
Spinal fusion can sometimes be done through smaller incisions with this technique. The use of advanced fluoroscopy (X-ray imaging during surgery) and endoscopy (camera technology) has reduced the size of the incisions and the placement of devices, which reduces tissue trauma. It is important to keep in mind that not all cases can be treated in this way and that a number of factors contribute to the surgical method used.
The benefits and risks of surgery must always be carefully weighed. Although a large percentage of scoliosis patients benefit from surgery, there is no guarantee that surgery will stop the progression of curvature of the spine and symptoms in each individual.
Scoliosis risks
As with any surgery, there are risks associated with scoliosis surgery. Your surgeon will discuss the potential risks with you before asking you to sign a surgical consent form. Possible complications include, but are not limited to:
- Lack of bone fusion (pseudoarthrosis)
- Failed to improve scoliosis
- Broken/Failed Hardware
- Infection and/or pain at the bone graft site
- blood clots in the lungs
- Spinal cord and/or nerve injury
- Healing from scoliosis surgery
After scoliosis surgery, your child won't get better right away. The patient will likely be able to get out of bed within 24 hours on pain relievers for 2 to 4 weeks. The incision should heal in at least 7 to 14 days, and the fusion should heal completely in at least 6 to 9 months.
In the meantime, the situation may worsen slightly until the fusion and spinal realignment have stabilized. In about 6 months, you will notice an improvement. While the fusion is occurring, your child should avoid any heavy lifting, bending or twisting. Exercise is fine as long as the spine remains stable; This means no contact sports until the fusion is completely healed. After your child recovers and the surgeon says he's fine, he'll likely be able to play again.
How do you deal with scoliosis and live with it?
For children, in particular, it can be frightening to learn that they have scoliosis. They may not like the idea of wearing a brace, either. But scoliosis is not something to fear or be ashamed of. With the right treatment, scoliosis doesn't have to define your life.
The challenges of living with scoliosis vary with the individual, the age and severity of their condition. Scoliosis is not just a physical weakness; It can also have mental health effects and can affect your ability to participate in activities. However, there are many resources available to help you or your child deal with scoliosis and live a full life.
For many people, especially teenage girls with adolescent idiopathic scoliosis (IAS), a diagnosis comes with body image concerns. Scoliosis can make some teens more self-aware than usual. For younger people, even a mild disfigurement with little or no pain can have serious mental health effects.
Surgery is the best way to enhance a teen's self-image.
Although scoliosis can affect your health and quality of life, it doesn't have to happen. With the help of trained professionals and a range of non-invasive, non-invasive methods to help manage your condition, finding relief can be much easier than you think. If you have scoliosis or are concerned about the possibility, seek treatment today.
Bimaristan Medical Center remains your first choice for treatment in Turkey.
We direct you to the best specialists who are experts in all fields, we break the language barrier, Arab specialist doctors will help you in communicating with your doctor, we help you book an appointment in the most important and modern hospitals in Turkey, we offer our services to secure hotel reservations for you and your companions, in addition to transportation, we help you secure a travel visa for you for free.
We provide our services throughout Turkey, the best place to provide you with treatment is our destination.
We will be with you step by step towards recovery.
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don't hesitate tocontact us, Bimaristan Family Center in Turkey. You can also read on our website more aboutRobotic surgery and its uses in Turkey.