Scoliosis Surgery

What Is Scoliosis?

Scoliosis is a spinal disorder characterized by the curvature of the spine to the side on the vertical axis, which should normally be straight. A healthy spine looks flat when viewed from behind, while a spine with scoliosis “S” or “C” shows abnormal folds in shape. Curvature usually occurs during the growth spurt in adolescence, and girls are more likely to develop pronounced curvature than boys (about 4:1 in severe scoliosis). The cause of most cases of scoliosis is idiopathic (i.e. no specific underlying cause is known); however, a combination of genetic predisposition and environmental factors may play a role. In addition, congenital spinal abnormalities (congenital scoliosis), neuromuscular diseases (e.g. cerebral palsy as) or due to degenerative changes (deterioration of the vertebrae and discs with advancing age), scoliosis can also develop.

Symptoms of scoliosis are often mild and may not cause pain, especially in children. The family or doctor usually notices scoliosis with signs such as inequality at shoulder levels, dislocation of one scapula more than the other, asymmetry in the lumbar triangles, or higher ribs on one side of the back during the forward bending test. Mild grade scoliosis (< 20° curvature) usually does not cause a pronounced complaint. But as the curvature increases, the deterioration in the structure of the trunk becomes noticeable, and severe cases of scoliosis can lead to difficulty breathing or restriction of movement . Adult Back or lower back pain is also a common symptom in patients with scoliosis at age, and pain can worsen with age. This is due to the fact that the muscles and discs around the spine in adults wear out over the years, under additional load, nervous stresses and balance disorders.

Scoliosis is not uncommon in society — about 3 out of every 100 people have scoliosis (most are slightly graded and non-interventional curvatures). But severely progressive scoliosis affects fewer people. Diagnosis is usually a physical examination and X-ray imaging is put with. Curvature with X-ray Cobb angle The so-called degree is measured; this measurement is critical in determining the treatment plan. While mild curvatures are followed regularly, treatment may be required for curvatures that are progressive or above certain thresholds.

Figure: X-ray image of a case of scoliosis before surgery. Pronounced in the thoracic (thoracic) and lumbar (lumbar) areas of the spine S-shaped curvature is present and the vertebrae make abnormal angles to the right and left.

Figure: X-ray image of the same patient after scoliosis surgery. Placed on the spine metal screws and rods With its help, the curvature is greatly corrected and the spine is aligned. With the boiling (fusion) of the vertebrae in the process of recovery, the spine is fixed in this new position.

Treatment of scoliosis depends on the degree of curvature, the age of the patient and the type of scoliosis. In most mild cases it is only observed if the curvature progresses with regular checks. Moderate curvatures (usually 20°—40° curvatures in the growing age) orthose/corset treatment is recommended; properly used corsets can help prevent increased curvature until growth is complete. In addition, exercise programs and physical therapy specific to the patient's condition can be used to support the spine by strengthening the back muscles, especially in children and adolescents. But exercise alone does not correct large curvatures, it is more aimed at slowing progress and improving overall posture.

Surgical treatment is on the agenda if, despite these conservative methods, scoliosis progresses and reaches serious dimensions. Below are the details of when scoliosis requires surgery and the details of the surgical process.

When Should Scoliosis Be Treated With Surgery?

Scoliosis surgery is considered in cases where the curvature of the spine is severe or progresses, threatening the patient's health and quality of life. Not every scoliosis patient needs surgery; usually surgery is practiced as a last resort when other treatments are inadequate or when the curvature rises above a certain threshold. alright In what cases does the decision to undergo surgery come up?

• Magnitude of Curvature Angle (Cobb Angle): Orthopedics and spine surgery specialists usually Recommends surgical treatment for spinal curvatures above 45°—50° . In particular, it has not completed its growth when the Cobb angle in adolescent patients exceeds 45 degreesthere is a very high risk that the curvature will continue to increase rapidly throughout puberty. This threshold is also in line with the recommendations of two important organizations recognized worldwide: SRS (Scoliosis Research Association) and SOSORT (Society for Orthopedic and Rehabilitative Treatment of Scoliosis)states that surgery should be considered in curvatures above about 45—50 degrees. Because curvatures at this level can also progress after growth is complete and can cause serious problems in older ages.
  
  
• Progressive Curvature: If, even if the angle of curvature is still below 45 degrees, it is seen that the curvature progresses rapidly during the follow-up (for example, a marked increase within a year), surgical intervention may be on the agenda. If moderate curvatures of 25—40 degrees, especially in children and adolescents of growing age, progress can be made despite the corset and physical therapy, surgery can be planned before the growth ends. Because there is a high potential for curvatures to increase in the pubertal growth attack. After achieving skeletal maturity (~2 years after menstruation in girls, end of puberty in boys), although the rate of progression of idiopathic scoliosis slows down large curvatures can continue to progress ~1° per year in adulthood. As a matter of fact, the observations made, there may be progression over time in untreated large-angle scoliosis in adulthood shows. specifically Curvature over 50° in adulthood there is a tendency to continue to increase, albeit slowly. Therefore, if the curvature has exceeded a certain level at a young age, surgery may be recommended in time so as not to require larger surgeries in the future.
  
  
• Clinical Manifestations and Cosmetic Concerns: The degree of curvature created in the patient signs and symptoms is also important. For example, in severe cases of scoliosis, rotation (rotation) occurs in the rib cage due to the curvature of the spine, which forms a humpous protrusion (gibozite, colloquially “costal hump”) on the back. This appearance can cause serious cosmetic discomfort, especially in young patients. As the curvature increases, the asymmetry between the shoulder and hip levels becomes noticeable, the fit of clothes is disturbed. If scoliosis greatly affects the appearance of the patient, leading to psychological problems, which can also be a factor favoring the indication for surgery. Of course, the primary goal of surgery is not cosmetic; however, the removal of severe deformity significantly improves the patient's self-confidence and quality of life.
  
  
• Pain and Neurological Symptoms: Adolescent (adolescent) idiopathic scoliosis usually proceeds painlessly, but Most adult scoliosis patients may have chronic back or lower back pain . Abnormal loading of the intervertebral discs and facet joints due to curvature accelerates degenerative changes, leading to pain. In addition, the curvature in the waist can put pressure on the nerves that hit the leg, causing pain, numbness, or loss of strength in the legs (e.g. sciatic-like complaints). If scoliosis pain control to chronic pains that are difficult or Neurological manifestations Surgery is considered if it leads to difficulty walking (eg, impaired sensation in the legs). In adult degenerative (age-related) scoliosis, nerve compression is frequent as a result of the development of a narrow canal (spinal stenosis), and in such cases it is necessary not only to correct the curvature, but also to expand the spinal canal (decompression). Surgical treatment in such complex cases can significantly improve the patient's quality of life.
  
  
• Impact on Organ Functions: Very severe (usually exceeding 70—100°) thoracic spine curvatures, distorting the shape of the rib cage may restrict the expansion of the lungs. Although rare, very severe cases of scoliosis that occur in childhood and are not treated can lead to a decrease in respiratory capacity in adulthood and a weakening of heart function. Fortunately, today scoliosis of this degree is rarely found. Nevertheless, If scoliosis has begun to affect the patient's breathing, cardiac circulation or other systemic functions, surgery is definitely on the agenda . In addition, in children with congenital scoliosis, it may be necessary to perform surgery at an early age if the curvature is at a level that prevents lung development (using special extendable rod systems that allow growth if necessary).
  
  

In summary, the treatment of scoliosis by surgery; degree of curvature, potential for progression, age of the patient, current symptoms and risks that may arise in the future It is decided by taking into account. Doctors usually recommend surgery “last resort” evaluates and recommends only when necessary. This is due to the fact that spinal surgery is a comprehensive undertaking and carries certain risks. The family and patient should discuss these risks and benefits in detail with the surgeon when making the surgical decision. It should be remembered that with the right indication, scoliosis surgery performed by an experienced team can greatly correct the curvature of the spine of patients, preventing serious health problems that may occur in the future and improve the quality of life.

Scoliosis Surgery Process: Preparation, Operation and Hospital Process

Scoliosis surgery (with the name often used in medicine spine fusion surgery), requires detailed preparation and a meticulous surgical process. Under this heading we will talk about the preparations before surgery, how the operation is performed and the early recovery process that goes through in the hospital.

Pre-Operative Preparation

In order for a patient whose scoliosis surgery is planned to optimally prepare for the operation, the following steps are followed:

• Detailed Assessment: The surgeon performs full-size spine x-rays to fully understand the degree of scoliosis and the condition of the spine before surgery, sideways bending graphs to see the flexibility of curvature if necessary, and MRI It uses imaging methods such as. MRI is especially desirable if there is a suspicion of nerve compression or spinal cord anomaly. These images help plan the surgical strategy (such as which vertebrae to cover the fusion, where to put the screws).
  
  
• Medical Checks: The general state of health of the patient is assessed. Blood tests, lung function tests (especially if the curvature is in the chest area), and heart examinations can be done. If there is a chronic disease (such as diabetes, hypertension), consultation with the relevant branch doctors is tried to minimize the risks of surgery. In young patients usually there are no major health problems, but in patients who will undergo surgery for scoliosis at an advanced age It is important to control other existing health problems.
  
  
• Blood Preparation: Scoliosis surgeries take a long time and there may be significant blood loss during surgery. Therefore, in some centers, in the preoperative period, the patient is asked to donate one or two units of his own blood for use as needed. During surgery, blood transfusions are also available if necessary. Today, blood recovery devices (systems that collect and return the patient's own blood) and drugs that control bleeding are used during surgery to reduce bleeding.
  
  
• Anesthesia Assessment: Before surgery, the anesthesiologist team interviews the patient and evaluates for general anesthesia. Drug allergies, previous anesthesia experiences, and current health problems are reviewed. The patient is given information about the process of surgery and anesthesia. Especially in patients with severe scoliosis with limited respiratory function, the anesthesia plan is carefully prepared.
  
  
• Psychological Preparation and Information: It is very important that the patient and his family are informed in detail about the operation process. The surgeon provides explanations to the patient about the purpose of the surgery, chances of success, risks and alternatives. Especially young patients need to be given confidence and their questions answered in order to adapt to the idea of surgery. Contact with other patients who have undergone surgery or psychological support services can be useful if necessary.
  
  
• Last Day Before Surgery: Admission to the hospital is usually made one day before surgery. During this process, the necessary final examinations are completed. An antiseptic shower is taken to clean the operating area and, if necessary, the hairs on the surgical site are properly cleaned. The patient stops eating and drinking from midnight before surgery (he remains hungry for the safety of anesthesia). In addition, a relaxing premedication can be done on the morning of surgery.
  
  

Operation (Surgical Technique)

Scoliosis surgeryis a comprehensive surgery performed to correct and fix (fuse with fusion) curved segments of the spine. The operation is performed under general anesthesia and lasts several hours. The most commonly used method in modern scoliosis surgery, posterior instrumentation and fusion It is called a technique. In this method, the surgeon lays the patient in the prone position, making an incision from the back (posterior) and reaching the spine. The basic surgical steps are:

• Installation of Screws and Bars (Instrumentation): Surgeon to the levels of the vertebrae, where the curvature will be corrected pedicle screws inserts special screw implants, which are called. These screws are inserted into the right and left posterior projections (pedicle) of each vertebra and firmly attached to the vertebra. Then through these screws, the metal that will ensure the alignment of the spine root (rod) systems are installed. The rods are made of strong alloys such as titanium or stainless steel. The curved spine is slowly guided to the right axis with the help of these rods, which are attached to the screws. The surgeon acts extremely carefully when correcting the spine so that there is no pressure on the spinal cord or nerves; during the operation neuromonitoring The so-called neural monitoring method is used. Neuromonitoring stimulates the surgeon in the possibility of any strain or damage by constantly monitoring nerve transmissions in the patient's legs and body, thereby minimizing the risk of nerve damage.
  
  
• Fusing of the Spines (Fusion): It is not enough just to fix and fix the spine with screws and rods, because these metals may not carry the entire load for life. Therefore, after the correction is provided fusion the process is carried out. Fusion is the process of ensuring that the targeted vertebral bones fuse with each other and become a single bone mass. For this, small bone grafts are placed on the back of the vertebrae. A bone graft can be a small piece of bone taken from the patient's own hip (autograft), as well as cadaver bone taken under sterile conditions (allograft). New bone grafts are placed on the roof structures (lamina) in the posterior part of the spine and around the screws. Over time, the vertebrae with these grafts boil together to form a strong bone fusion creates. When this boiling occurs, the residual curvature is permanently corrected.
  
  
• Other Techniques: In some special cases, the surgeon may use different approaches and techniques. For example, if the curvature is too hard and does not stretch, to be able to provide adequate correction osteotomy through so-called processes, some bone structures can be cut and reshaped. In addition, in cases where the growth potential persists and requires intervention at a very early stage, especially in the children's age group, without complete boiling of the spine rod systems that allow growth can be used. These can be magnetic rods that can be extended at certain intervals or rods that are surgically extended at certain intervals. It has also been developed in recent years and applied in some eligible patients anterior spinal trunk rope (vertebral body tethering) There is also a method. In this method, in order to correct the sideways curvature of the spine, screws are placed on the side of the vertebra and a flexible polymer rope is stretched between them; the spine is fixed by clamping with this rope and controlled guided in the growth process. This technique is still in its infancy and is being practiced as an alternative to fusion in adolescent patients with more growth potential. Nevertheless, scoliosis surgery today gold standardis posterior instrumentation and fusion.
  
  
• Duration: Scoliosis surgery is average depending on the length of the spinal segment to be corrected and the difficulty of the curvature 4 to 8 hours It can take as long as. In some complex cases, surgery can be performed in two stages on different days (for example, correcting the upper and lower parts in separate sessions with very long curvatures). During the operation, the patient's vital signs (heartbeat, blood pressure, oxygen level, etc.) are constantly monitored by the anesthesia team. In addition, the lost fluids are replenished from the vascular route and, if necessary, a blood transfusion is performed.
  
  
• End of Operation: One or several pieces to the operating site when the surgical correction and fusion process is complete drain is placed. These drains collect blood and fluids that may accumulate in the first days after surgery, transporting them outside the body. Once the bleeding has been checked and the stability of all implants is checked, the adele and skin layers are sealed. The patient will have a surgical incision line (surgical scar) running along the spine on the back; this scar is usually midline and closed with aesthetic sutures.
  
  

Hospital Process (Early Recovery)

As soon as the operation is over, the patient is awakened from the effect of anesthesia and taken to the intensive care room or higher care unit. Since scoliosis surgery is a major surgical intervention, close monitoring is important in the early stages:

• Intensive Care and Pain Control: On the first night, the patient is usually followed up in intensive care or in a room with a monitor. As soon as the process of awakening from anesthesia is completed and the vital signs are stabilized, the breathing tube is removed. The patient's postoperative pain control is critical to the comfortable progression of recovery. For this purpose, several methods are used: strong painkillers can be administered intravenously, or in some centers continuous infusion of painkillers can be performed with an epidural catheter. In most hospitals, patient-controlled pain relief devices (PCA pumps) can take certain doses of medication by pressing the button as the patient feels pain himself. Epidural analgesia is a commonly used method of reducing pain after spinal surgeries. Studies have compared the effectiveness of different pain control methods, but there has been no clear superiority in which technique works best. In practice, doctors provide pain control in the most convenient way according to the patient's condition and their own experience.
  
  
• Respiratory and Circulatory Support: After the operation, the patient is fully awakened, deep breathing exercises and coughing are encouraged. This is the cleansing of secretions accumulated in the lungs and postoperative pneumonia (pneumonia) It is important to reduce the risk. If necessary, respiratory physiotherapists support the patient, practicing deep breathing with devices called “inspirimeters”. Also so that no clots form in the legs that remain motionless after a long operation Pneumatic Compression Devices with a calf massage is applied and blood-thinning needles (a derivative of heparin) can be used. These measures, deep vein thrombosis (DVT) and Pulmonary embolism It is aimed at preventing complications such as
  
  
• Mobilization (Mobilisation): The day after the operation, if the general condition is favorable, the patient is seated in his bed and raised to the feet, and carried out for a short time. This early mobilization helps both regulate blood circulation and prevent lung problems. In the first takeoffs, the patient may experience weakness or dizziness himself, which is normal and is carried out step by step with the help of a physiotherapist or nurse. Most patients after surgery Can get up and take a few steps on the 1st or 2nd day. Surgeons initially have different approaches to the use of corsets: while some surgeons do not use a postoperative corset, considering that modern instrumentation systems are sufficiently robust, some recommend corsets for several months, especially for long corrections or in patients with poor bone quality. If it is necessary to wear a corset, the patient is mobilized by putting on a corset before the first takeoff.
  
  
• Hospital Admission Time: A patient who has undergone scoliosis surgery, usually after surgery 4—7 days stays in the hospital. The first 2-3 days are the most difficult period; the pain can be intense but is quickly controlled, the amounts of drainage are monitored. Drains are usually pulled out in 2-3 days. Since the patient's bowel movements may slow down due to anesthesia, oral feeding is started as soon as possible, and walking also speeds up the work of the intestines. If the urinary probe is installed, the probe is withdrawn after the patient begins to stand up. During this period of stay in the hospital, the patient is carried out a little more every day and is encouraged to do his daily activities (going to the sink, eating by himself, etc.).
  
  
• Before Discharge: Before the patient goes home, the surgical suture line is checked and dressings are made. If absorbable suture is used, there is no need to buy stitches, if not, an outpatient appointment is usually given to remove stitches after 10-14 days. The patient and his family are trained in home care: care of the wound, the rules for showering (usually the bathing is restricted until the stitches are removed or the shower can be taken with waterproof covers), the limits of daily activity are explained. Also during discharge, the patient is prescribed painkillers suitable for him and, if necessary, muscle relaxants. Doctor check An appointment is usually scheduled for 6 weeks after surgery. In this check, new x-rays are taken and the condition of the spine and bone boil are evaluated.
  
  

Recovery and Rehabilitation After Surgery

The recovery process after scoliosis surgery is a period that spans time, requiring patience and attention. After discharge from the hospital, rehabilitation continues, and both medical follow-up and the patient's own efforts are important to achieve complete recovery. In this section, we consider the stages of the postoperative recovery process and the points to be considered in rehabilitation.

1. Early Period (First 6 Weeks): The first few weeks after surgery are a critical period for the body to recover itself and heal the surgical site. After discharge, the patient is usually withdrawn to home rest. During this period:

• Pain Management: Pain and muscle spasms in the area of surgery in the first weeks are normal. Painkillers prescribed by the doctor should be used regularly. Usually, strong non-opioid analgesics (e.g. paracetamol, NSAIDs) are given at discharge and, if necessary, mild opioids. The first 1-2 weeks the pain is more pronounced, while from the 3-4th weeks it begins to subside. The patient should know that the need for painkillers will gradually decrease, but should not hesitate to take medication to the point where he can not tolerate pain — well-controlled pain, accelerates healing.
  
  
• Movement and Daily Life: In the early postoperative period, the patient is encouraged to engage in light activities in the home. Is bed rest relativeIt is not recommended to lie down constantly; a balanced activity plan is followed in the form of getting up several times a day and taking short walks around the house, sitting and resting, going to bed again. However, prolonged sitting should also be avoided (initially it may be recommended not to sit for more than 30 minutes). The patient must necessarily rest when he is tired by listening to his body. In this period it is forbidden to lift heavily, bend over, make sudden movements. In order to reduce the load on the spine, certain restrictions must be observed in everyday activities: for example, squatting by breaking the knees instead of bending the waist if you are going to take something from the floor, such as using an auxiliary tool if possible. If the doctor recommended wearing a corset, the patient should wear a corset when he stands up, he can remove it while lying down (according to the surgeon's instructions).
  
  
• Wound Care: The surgical incision is usually a line 10-15 cm or longer. It is important to keep the operating area clean and dry after leaving the house. A full shower should not be taken until the doctor allows it (usually after the stitches are removed), but instead cleaning in the form of a regional wipe should be carried out. If signs of infection develop at the wound site, such as redness, excessive swelling, discharge or elevation of fever, a doctor should be consulted without time. The risk of infection in scoliosis surgeries has been reported to be around 1%, but this low probability should be taken seriously early on and follow up on findings.
  
  
• Nutrition and General Care: A balanced diet rich in protein and calcium is recommended to support the recovery process of the body after surgery. Protein intake is essential, especially to support bone boiling. If smoking is smoked, it should definitely be abandoned, because nicotine seriously disrupts bone boiling and increases the risk of infection. No supplements (vitamins, herbal products, etc.) should be used without physician approval, but support can be given with a doctor's recommendation if vitamin D and calcium levels are low.
  
  

2. Mid-Term (6 Weeks — 6 Months): The 6-week control after surgery is the milestone. If everything is in order on the X-ray taken at this check, the patient can usually transition to a more active life. During this period:

• Physical Therapy and Exercise: When your surgeon allows it (usually ranges from 6 weeks to 3 months), physiotherapy The program can start. Exercises are performed to strengthen the muscles of the back and trunk, increase flexibility, accompanied by a professional physiotherapist. The goal is to strengthen the muscles that support the spine and allow the patient to perform their daily movements more comfortably. First, it starts with light stretching and walking exercises, over time, movements aimed at the central muscles called the core are added. Swimmingis one of the best sports recommended after spinal surgery; thanks to the lifting force of the water, it works the muscles without putting a load on the spine. With the approval of the doctor, swimming can usually be started after the 3rd month.
  
  
• Return to Daily Life: Adult patients who work desk or light work can make a gradual return to work after about 4-6 weeks. School-age children are also able to return to school in 4-6 weeks, but they should be careful not to sit in the same position for a long time and move between. At this stage, the patient is still not able to fully perform heavy activities, but he feels much better than in the previous period. Bending forward is carried out within the limits specified by the doctor regarding twisting movements. Many surgeons, during the first 3 months of patients Not to lift loads heavier than 5 kg recommends. Restrictions are gradually reduced as the boil in the spine progresses after the 3rd month.
  
  
• Corset Usage: If the corset was given after surgery, usually after the 3rd month control, the use of the corset is no longer necessary. If the bone boil looks satisfactory on the X-ray, the patient can leave the corset and begin to work his muscles freely. Initially, after leaving the corset, the patient can feel himself in the gap, but in a short time the back muscles adapt to the new situation.
  
  
• Follow-up of Bone Decay: In order for the fusion process to be successful, the vertebrae need to boil (i.e., spaced bone grafts produce new bone). This process is slow; typically, full boiling is expected between 6 months and 1 year. Signs of boil are monitored with x-rays taken at the 3rd month and 6th month controls. If it is noticed that there is no boil at any level (pseudarthrosis develops), the healing process is modified (for example, activities are restricted, devices that enhance bone healing or additional supportive therapies are applied). In most young patients, boiling occurs without problems; in patients with advanced age or osteoporosis, the risk of pseudarthrosis is somewhat higher.
  
  

3. Late Period (6 Months — 1 Year and Beyond): After 6 months of surgery, the majority of patients become able to do a significant part of their daily lives again. If everything is in order at the 6th month control:

• Transition to Full Physical Activity: From 9-12 months it is assumed that the fusion of the spine is largely completed. At the end of the one-year process, patients can usually return to full physical activity with the permission of their doctor. This means that almost any kind of sport can be practiced, except for contact sports. Many patients can do exercises that they could not do before surgery (such as running, light weight training, pilates) in the postoperative period. But especially to patients who have undergone a long-term fusion heavy contact sports Some permanent restrictions may be imposed on (wrestling, American football, etc.). Nevertheless, many young scoliosis patients, athletes, are able to return to professional sports life after surgery.
  
  
• Work and Power: Those who work in jobs that require physical strength can return to their profession after about 6 months to 1 year. At this point, the important thing is to have learned and applied spinal protective techniques (correct lifting techniques, proper posture, etc.). If the work requires heavy lifting, the person may need a longer rehabilitation or need to make some adjustments to their work.
  
  
• Follow-up: A patient undergoing surgery for scoliosis is monitored at regular intervals for some time. During the first year, checks are usually carried out in the 3rd, 6th and 12th months. After that, a 2nd year and a 5th year check-up may be recommended. Once the curvature has been seen to improve and fusion is achieved, a check once a year or a few years is sufficient in the long run. Adolescent patients are checked every year until growth is complete (girls ~16, boys ~18). Because, albeit rarely, there may be small changes in the remaining levels that are not involved in fusion, or problems due to overload may develop in adjacent segments. Adult patients are also called for an annual check-up for up to 5 years, unless necessary, if they are without problems.
  
  

The rehabilitation process can proceed differently in each individual; age of the patient, general state of health, scope of surgery factors such as affect the speed of recovery. Patients who are young and without other health problems often show a surprisingly rapid recovery. For example, a teenage scoliosis patient can return to school 3 months after surgery, and after 6 months he can start playing sports. On the other hand, an adult patient of advanced age and having undergone a long-level fusion can find a year to fully recover. To be patientCompliance with the doctor's instructions to the letter and maintaining a positive attitude are the keys to successful rehabilitation.

Possible Risks and Complications

As with any surgical intervention, scoliosis surgery has some risks and the possibility of unwanted complications. Although serious complications are rare today thanks to experienced surgeons and advanced techniques, Know these risks before surgery important. Here are the possible risks and complications that can be encountered in scoliosis surgery:

• Infection: The risk of developing infection in the surgical area after spinal surgery is generally low (about 1% in young patients with idiopathic scoliosis). The risk may increase slightly in cases such as neuromuscular scoliosis or advanced age. The infection can be superficial (skin and dermal), as well as deep (at the level of the spine and implant). Symptoms are usually increased pain, redness, swelling, discharge, and fever that occur days or weeks after surgery. Infections are usually controlled by antibiotic treatment and, if necessary, surgically cleaning the wound (debridement). Rarely, screws inserted in stubborn infections may need to be removed.
  
  
• Bleeding and Transfusion Need: During scoliosis surgeries, there may be an average of several hundred milliliters to several liters of blood loss. With a good surgical team and modern techniques, minimal blood loss is usually achieved. However, a significant proportion of patients still suffer during or after surgery blood transfusion may be required. Excessive bleeding is a very rare complication; surgeons use microsurgical techniques, blood-retaining drugs (such as tranexamic acid) to reduce bleeding. Large vein injuries during surgery are rare and if they occur, they are repaired by vascular surgery.
  
  
• Nerve Damage (Neurological Complications): One of the most serious risks in spinal surgery is injury to the spinal cord or nerve roots. As a result of such an injury, the patient may develop loss of strength, loss of sensation or, very rarely, paralysis. Fortunately, in experienced hands, this risk is extremely low (less than 1% in large series). In particular, in idiopathic scoliosis surgery, the rate of neurological complications has been reported with figures such as 0.3—0.5%. The practice of neuromonitoring and careful surgical technique minimize the risk of nerve damage. Although the most feared consequence of spinal cord injury is paraplegia (paralysis of the legs), this possibility is extremely rare. Nerve root damage can often have weakness or a sensory defect in a single area, and some of these may resolve over time. Surgeons are constantly alert during surgery to maintain the patient's neurological integrity and modify the intervention when necessary.
  
  
• Problems with Screws or Rods (Implant Complications): Screws, rods and other implants inserted into the spine during surgery can sometimes change position or loosen unintentionally. For example, if a screw does not hold sufficiently in the bone, it can loosen or very rarely a rod break can occur. This usually indicates that either the fusion is incomplete (if bone boiling cannot be achieved, the implants are overloaded) or that the patient has an inappropriate load early on. Some of the implant related problems can be corrected with minor surgical revisions. After fusion is achieved, it is unlikely that the screws will break or loosen, since the spine itself is boiled and fixed.
  
  
• Pseudoarthrosis (Boiling): In the process of fusion (boiling) into the spine, in some cases the bone grafts do not boil well, and a fibrous pseudoarticulation remains between the two targeted vertebrae. To this situation pseudarthrosis is called. The absence of a boil means that movement continues in that segment of the spine, which can lead to pain or the return of deformity over time. The risk of pseudarthrosis is especially higher in patients who smoke, the elderly or those with osteoporosis. According to studies, up to 15% of patients undergoing adult scoliosis surgery may need a second surgery due to a boil problem. In such a situation, the surgeon can re-operate and put additional grafts in the area that does not boil, supplement it with stronger implants. The likelihood of developing pseudarthrosis in young patients is quite low.
  
  
• Neighboring Segment Problem: A long-term effect of fusion surgery is also an increased load on the moving segments that remain above or below the boiled parts of the spine. This adjacent segment degeneration in the so-called case, after many years premature wear, hernias or new curvatures may form on neighboring discs. For example, after a fusion extending to the lumbar region, degenerative changes can be observed in the later years at the sacrum-lower lumbar junction or in places near the neck area. There is no rule that this will happen to every patient, but it is recommended that patients after spinal surgery minimize these effects with regular exercise, weight control and the right biomechanics.
  
  
• Posture and Movement Restriction: Technically it is not considered a complication, but it is a condition that should be known: in the parts of the spine included in the fusion after scoliosis surgery restriction of movement happens. So those segments don't stretch front-to-back or sideways like they used to. For example, if only the back (thoracic) area has been fused, the patient can lean from the waist as before, but the back remains more immobile. If the lumbar vertebrae were also involved in the fusion, the patient's bending from the waist can be permanently limited. Therefore, the patient must adapt the movements of daily life to this (such as bending the knees by bending). This condition is not a complication, but an inevitable consequence of surgery, but most patients note that they do not experience a serious loss of flexibility and are able to do their daily work comfortably. Movement lost, especially when only the upper parts of the spine are fixed, is a small fraction of total spine movement.
  
  
• General Anesthesia and Other Risks: Major complications due to general anesthesia and surgical stress, such as heart attack, pulmonary embolism, stroke, and rarely with prolonged major surgery, can develop. However, when scoliosis surgery is performed in young people, such risks are low enough to be neglected. In advanced surgery, the anesthesiologist team minimizes the risk by taking all necessary precautions. In large series, mortality after scoliosis surgery has been reported at a very low rate of 0.2% (usually seen in patients with serious underlying heart problems). Other complications that may also be rarely seen include general surgical risks such as a clot in the lung (pulmonary embolism), fat embolism, laziness in bowel movements (ileus), urinary tract infection, bedsores.
  
  

As a result, Scoliosis surgery is a serious, but generally safe, intervention. Complication rates are low in young patientsInfection ~ 1%, neurological damage < 1%, serious complications < 5% are reported in experienced centers. The risk of complications may be slightly higher in adult and advanced deformity surgeries (may approach 20-30%, including all minor and major complications), but in this group of patients the benefits of the procedure (reduced pain, improved quality of life) are mostly outweighed. As with any surgery, your surgeon will clearly tell you about the risks and take the necessary preventive measures. Although complications are unlikely to develop, the patient and his family should be prepared for these possibilities and should contact the medical team at the slightest adverse reaction after surgery.

Differences in Surgery in Adolescent Scoliosis and Adult Scoliosis

Scoliosis can occur both in adolescence (such as Adolescent Idiopathic Scoliosis) and in adulthood (such as degenerative scoliosis or untreated old scoliosis). In these two groups there are significant differences in the nature of scoliosis, the expectations of patients and the specifics of surgical treatment. In this title adolescent (adolescent) scoliosis with adult scoliosis We will examine the differences in surgery between:

• Cause and Type of Scoliosis: The vast majority of cases of scoliosis in adolescence Idiopathic Scoliosis (cause unknown). In these young patients, the curvature of the spine usually occurs during the period of rapid growth and there are no other underlying spinal diseases. Adult scoliosis, on the other hand, can take two forms: 1) Continuation of idiopathic scoliosis in adolescence (i.e. individuals who have scoliosis when they are young and remain or have a curvature after growing up) or 2) Degenerative (age-related) scoliosis. Degenerative scoliosis is lateral curvatures that occur in mid-to-late age as a result of wear of the disc and facet joints of the spine with aging, unilateral collapse. In addition, osteoporosis, spinal fractures or many years of unilateral loads can also lead to scoliosis in an adult. So, adult scoliosis patients are a more heterogeneous group: Some may have idiopathic scoliosis at the age of 50, others may have developed curvature due to lumbar shifts and calcification at the age of 65. This, in turn, makes the treatment individual.
  
  
• Indication for Surgery (Justification): The main reason for the decision to operate in adolescent patients prevention of problems that may occur in the future and correct severe cosmetic deformity. In young people, curvature usually does not cause pain; surgery is done more to prevent the curvature from progressing and affecting lung capacity, creating a serious deformity. Whereas indication for surgery in adult scoliosis are most often the symptoms present: Complaints that complicate the patient's daily life are in the foreground, such as persistent back/back pain, leg pain due to nerve pressure, decrease in walking distance, impaired balance. Of course, surgery can also be considered in adults, since curvatures exceeding 50-60 degrees have the potential to progress (especially with osteoporosis in postmenopausal women); but the main motivation is to improve the patient's quality of life. Cosmetic concerns can also occur in adults, but are usually not as pronounced as in younger patients.
  
  
• Scope of Surgery and Technical Details: Since the spine in adolescents is still relatively flexible, surgical correction is usually easier and more effective. Since the spine of young patients is more elastic responds very well to correction with screws and rods; even severe curvatures can be greatly corrected. In adult patients decreased flexibility of the spine (due to calcifications, disc losses, etc.) over the years. Therefore, it can be more difficult to correct the curvature of the same degree in an adult. In adults when a surgeon is needed osteotomy performs additional bone loosening procedures such as. In adolescents, a single (posterior) surgery is usually sufficient, while in adults in some cases combined approach (both front and back surgery) may be required. For example, in advanced degenerative scoliosis, it can be planned to support the spine both from the front (insert a cage) and fix it with screws from behind. Again, in adults narrow channel If accompanied, the surgeon first removes the bone/connective tissue pressure on the nerves (decompression), then corrects the curvature, which means extra processing.
  
  
• Fusion Levels: In adolescent patients, it is the principle to involve as few vertebrae as possible in the fusion. Because a young individual has a long life ahead and the prospect of being able to remain mobile; therefore, only the necessary vertebrae are boiled, trying to maintain healthy segments of movement. For example, only if there is scoliosis in the area of the upper back, the lumbar vertebrae are preserved. In adults Since the curvature is often associated with degenerative processes, the surgeon may sometimes have to fix longer levels. Especially in scoliosis of the lumbar region, it may often be necessary to lower the fusion down to the hip bone (pelvis) if the curvature extends to the hip (sacrum). Because in the degenerative case, the sacrum is included to obtain a solid foundation, since the lower levels may already be impaired. This, in turn, increases the restriction of movement somewhat. In adolescents, on the other hand, it is mostly not necessary to descend to the pelvis, the curvature is almost always limited to the chest and upper lumbar region. Also in adolescent scoliosis surgery selective fusion There is a concept called: if there is a double curvature and the curvature at the waist is at a tolerable level in terms of body balance, only the upper curvature can be corrected (selective thoracic fusion). In adults, such selective approaches are less applicable, because over time, lumbar curvatures also harden and, if left untreated, can be a source of pain.
  
  
• Complication Profile: Adult scoliosis surgery carries higher risks of complications than adolescent scoliosis surgery. There are several reasons for this: Adult patients may have additional risk factors such as diabetes, osteoporosis, cardiovascular disease because they are older, and corrections with surgery can be more extensive. Researches, that complication rates in adult deformity surgery are markedly higher compared to youth has shown. For example, in one review, the overall complication rate in adolescent idiopathic scoliosis surgeries was around 8%, while in adult deformity surgeries the rate increased to 30%. In particular, infection, implant problems and pseudarthrosis are more common in adults. As mentioned above, the need for reoperation due to a boil problem in an adult patient can reach 15%, while in younger patients this rate is very low. On the other hand, the risk of neurological complications in young patients is considered somewhat higher than in adults, in practice it is quite low in both groups (< 1%). As a result, in adult surgery, the surgeon and the team should be more prepared for the management of complications and the patient should also be informed about this.
  
  
• Recovery Time: Young patients usually recover faster after surgery. Cell regeneration and bone resorption are stronger at a young age, in addition, rehabilitation goes faster, since there are no concomitant diseases. An adolescent patient can become quite active in 3-4 months, while an adult patient can find 6 months to reach the same level. Since muscles and connective tissues are stiffer in adults, the response to physiotherapy may also be somewhat slower. For example, a 14-year-old patient will be able to play sports after 6 months, while a 60-year-old patient may only be able to do their daily work comfortably after 6 months. Postoperative pain management in adults may also be more difficult than in adolescents; pain threshold and chronic pain problems differ in adults. For this reason, adult patients may often need a more intensive pain protocol.
  
  
• Results and Expectations: The success rate in adolescent scoliosis surgery is very high; the curvature is largely corrected, a cosmetically satisfactory result is achieved, and this correction is permanent for life. After the young have completed their growth age, they usually continue their lives with a normal spine structure. In adults, success is greater. relief of pain and functional recovery is measured by. Even if the curvature is corrected, the existing degenerative changes may not disappear completely. Nevertheless, the majority of patients after adult scoliosis surgery report marked improvement in their daily activities and a significant reduction in pain. From a cosmetic point of view, a more balanced, flat spine is also achieved in adults, but expectations should be realistic; the spine of a patient with degenerative scoliosis at the age of 70 may not be as perfect as that of a teenager. However, in the literature, that adult deformity surgery provides a significant increase in the quality of life of patients It has been revealed by many studies.
  
  

To summarize, Although adolescent and adult scoliosis surgeries are based on the same principles (straightening and fixing the spine) has quite different dynamics in practice. Your surgeon will determine the most appropriate surgical strategy for your age group and type of scoliosis. In adolescent patients, the goal is to prevent future risks and ensure a normal adulthood, while in adult patients the goal is to fix existing problems and stop progression. In both cases, Experienced spine surgeons achieve very successful results with appropriate techniques, patients can return to their normal lives.

Life After Scoliosis Surgery: What to Consider

The operation was successfully completed and you have largely survived the recovery process... So what happens now? The life of an individual who has undergone scoliosis surgery involves some changes compared to before surgery. Since there are metal implants and a boiled segment in the spine, it is necessary to pay attention to certain issues in everyday life. But with proper precautions, most people who have undergone surgery can continue to lead a healthy, active and productive life . Here are the things to consider about life after scoliosis surgery:

• Posture and Spine Protection: It is important to maintain the correct posture habits acquired in the postoperative period for life. Basic spine-friendly behaviors should be adopted when working at the computer, such as paying attention to ergonomics, not staying in the same position for a long time, lifting heavy loads by bending the knees and not at the waist. Since the fusion-fixed region of the spine does not move much, excessively forceful movements should be avoided, especially in the first years, in order to protect adjacent segments. This not to overdo it in a certain sportmeans not repeating movements that require sudden turn/twisting. But there is no need to worry about normal daily movements; the body will already give a feeling of a limit that will protect itself.
  
  
• Exercise and Physical Activity: Those who have undergone scoliosis surgery does not have to lead a sedentary lifeRegular exercise, on the contrary, is very beneficial for the health of the spine. After complete recovery, sports such as swimming, walking, pilates, yoga (except for positions that require excessive stretching), running can be practiced with the approval of the doctor. Exercising regularly is critical to both overall health and keeping the muscles around the spine strong. Weight lifting sports Caution should be taken: With very heavy weights, preference should be given to lighter and controlled weight exercises instead of sports such as powerlifting and weightlifting. Whether contact sports (football, basketball, wrestling, etc.) can be done depends on the patient's level of fusion and the doctor's recommendation; in most cases it can be done at an amateur level but should be discussed with the surgeon if professional continuation is contemplated.
  
  
• Heavy Loads and Exhausting Works: Lifting loads above a certain weight can put excessive stress on the surgical site. As a general rule, the first year after surgery is as much as possible Not to lift more than 20-25 kg care must be taken. After a year, if the spine has boiled completely intact, the patient can do heavier work so as not to strain himself. Nevertheless, a profession that requires constant heavy lifting, such as transport, for example, may need to make a choice of profession or work arrangement, as it can wear out other parts of the spine. Also in the house, attention should be paid to principles such as distributing the weight balanced on two arms, so as not to push or pull heavy furniture, to prevent it from being overloaded on one side when shopping for groceries.
  
  
• Checks and Health Follow-up: Even if everything is fine when the first few years have passed after the operation, going to regular check-ups prescribed by your spine surgeon It is necessary. In the long term, a check is usually sufficient every year or every few years. In these checks, your doctor will assess the condition of your spine with X-rays or MRI if needed. For postmenopausal women or men of advanced age bone density follow-up is also important, because if osteoporosis develops, problems can occur in adjacent areas, even if there are no fractures in the areas of the boiled spine. Therefore, taking measures against bone resorption in advanced years (supplementation with calcium/vitamin D, osteoporosis drugs if necessary), maintaining overall health is also relevant for people who have undergone scoliosis surgery.
  
  
• Pregnancy and Birth: One of the topics that women who have undergone scoliosis surgery are most curious about in the future whether they can get pregnant and whether pregnancy will bring additional load on the spine. Conducted research and clinical experience, that having undergone scoliosis surgery does not adversely affect the chances of getting pregnant and giving birth healthy shows. Even if there is fixation in the spine (screws/rods), the alignment of the spine usually occurs without problems as the uterus grows. During pregnancy, the expectant mother's lower back pain may increase slightly, especially if the fusion extends to the lumbar region, but in most cases it is tolerable and a normal pregnancy process can be experienced. When it comes to childbirth, not only a history of scoliosis surgery is an indication for cesarean section; many women successfully give birth normally. If epidural anesthesia (birth analgesia) is required, prior information should be given as the anesthesiologist may experience technical difficulties due to the structure of the spine. However, in general pregnancy and childbirth rarely negatively affect patients with operated scoliosis . Still, patients planning a pregnancy are advised to check the final condition of their spine and get their advice by consulting their doctor before becoming pregnant.
  
  
• Living with Metal Implants: Surgically installed screws and rods are designed to stay in the body for life. The body does not usually reject these implants as foreign matter; materials such as titanium coexist seamlessly with implants because materials such as titanium are biocompatible. Airport security devices Magnetic field detectors such as magnetic field are often not a problem; titanium alloy implants usually do not trigger an alarm. Even so, your doctor may give you a card stating the details of your implants. You can pass this card without problems by presenting this card at airport security. There are patient experiences that implants can sometimes give a slight sensitivity in cold weather, but this is not a scientifically proven case. Removal of metals in the spine is considered only in special cases, such as infection or serious implant problem. Otherwise, the metals are left in place by the logic of “corrected as soon as they deteriorate”. In the years after surgery, if MRI imaging of the spine is required for any reason (e.g. disc problem at another level, etc.), modern MRI devices can take images without being too affected by titanium implants, meaning that the screws do not interfere with MRI.
  
  
• Psychosocial Status: In addition to physical change after scoliosis surgery, it can also be a process of adaptation psychologically. Especially for adolescent patients, as the hump or asymmetry will be corrected before surgery increase in self-esteem is a frequent occurrence. Patients feel happier with their upright posture. But some patients can also be emotionally affected because they go through a long process. Therefore, in the postoperative period join support groupsIt can be helpful to keep in touch with people who have had similar experiences. Family and friend support is also an important part of rehabilitation. It should be remembered that the healing experience of each individual is different; it is necessary to continue the progress of your own body, without comparing it with others, celebrating small achievements.
  
  

In summary, although life after scoliosis surgery requires some new habits, The vast majority of patients are able to live without significant restrictions in their daily lives. . A surgically corrected spine usually functions much better compared to severe scoliosis before surgery. Thanks to surgery, many patients become able to perform physical activities that they could not do before. For example, a teenager who is an introvert due to his preoperative hump can confidently return to his social life after surgery; an adult who has difficulty walking due to chronic low back pain can enjoy long walks painlessly after surgery. Follow doctor's recommendations, exercise regularly and maintain overall healthwill be the best friend of your spine in the postoperative years.

As a result, we gave comprehensive information about scoliosis surgery. What is scoliosis, when surgery is needed, what is the process of surgery and after it, what are the risks, how the situation changes in adolescents and adults and what life after surgery entails We covered such questions in detail. Remember that the condition of each patient is individual. This guide provides an overview; the recommendations of your own doctor should always be taken into account as a priority. Scoliosis surgery is a treatment that has high success rates in correcting spinal deformity, which can positively change the lives of patients. When done at the right time and in the right hands, smiling results are obtained, both from a health point of view, from a cosmetic and psychological point of view. If you or a loved one has scoliosis and you are considering surgery options, you can have a productive dialogue with your doctor in light of this information and approach the process more prepared and informed. Wishing you healthy days...