Prof. Dr. Nurullah Ermiş
Scoliosis & Kyphosis Surgery
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WHAT IS SCOLIOSIS?
Scoliosis is a condition characterized by a lateral curvature of the spine, typically forming "S" or "C" shaped curves. While a healthy spine appears straight when viewed from the front, scoliosis disrupts this alignment and creates visible curvatures. This condition most commonly develops during childhood and adolescence, and early diagnosis in growing individuals is critical to preventing the progression of the curve.
The symptoms of scoliosis are not always obvious. The most common signs include:
• Uneven shoulders or hips • Back or lower back pain • Slight curvature of the rib cage • Poor posture
For this reason, regular spinal check-ups are essential, particularly for children and adolescents. Scoliosis detected early is crucial for preventing progression and maintaining quality of life.
The causes of scoliosis vary:
• Idiopathic scoliosis: The most common type, usually with no known cause, most often appearing during adolescence. • Congenital scoliosis: Caused by structural defects of the spine present from birth. • Neuromuscular scoliosis: Results from diseases affecting the muscles or nervous system, and tends to progress more rapidly. • Other causes: Trauma, infection, or metabolic disorders can also lead to spinal curvature.
Scoliosis is most commonly seen in children between the ages of 10 and 16. In Turkey, clinically significant spinal curvature is detected in 2–3 out of every 100 children. Diagnosis typically begins with a physical examination and is confirmed with a full-spine X-ray; MRI or CT may be used when necessary.
HOW IS SCOLIOSIS TREATED?
Scoliosis treatment is determined based on the degree of the curve and the patient's age. In mild cases, regular exercise and medical follow-up may be sufficient. Moderate to severe cases may require brace treatment. If the curve is progressing rapidly or a significant deformity has developed, surgical intervention may be necessary.
Prof. Dr. Nurullah Ermiş performs all current minimally invasive and open surgical techniques in scoliosis surgery, including Vertebral Body Tethering (VBT). VBT is a "growth-friendly" method that gradually corrects the spine without fusion in adolescent patients with remaining growth potential, preserving spinal mobility. For patients who have completed growth or have larger curve angles, posterior spinal fusion (PSF) with 3D navigation and neuromonitoring support provides safe and lasting correction.
WHAT IS KYPHOSIS?
Kyphosis, commonly known as hunchback, is a spinal curvature affecting the thoracic (upper back) region. When viewed from the side, the head appears slightly forward and a noticeable rounding is seen in the upper back. The degree of kyphosis matters significantly; curvature between 20–55 degrees is generally considered normal, but treatment is required when it exceeds 55 degrees. Kyphosis in children may affect lung and heart health; in later life, it can reduce breathing capacity and create serious health risks.
Kyphosis may be congenital or may develop over time. Leading causes include spinal damage or fractures, osteoporosis, spinal inflammation, tuberculosis, postural disorders, and nutritional deficiencies.
Kyphosis presents in several forms:
• Congenital kyphosis: Curvature caused by structural defects in the vertebrae, which may progress as the child grows. Deformity can worsen rapidly, particularly during the first year of life. • Developmental kyphosis: Typically appears between ages 12–15; the curve becomes permanent as the spine stiffens. Poor posture and back pain are common in affected children. • Traumatic kyphosis: Results from accidents or impacts, causing pain, muscle weakness, and sometimes nerve compression-related problems.
The most prominent symptom of kyphosis is rounding of the upper back. Other symptoms include:
• Forward head posture • Neck, back, and lower back pain • Spinal stiffness • Shortness of breath • Weakness, numbness, or tingling in the legs • Muscle tension • Increased hunchback appearance when bending the neck forward • Difficulty standing upright
Treatment is determined based on the degree of kyphosis:
• 50–55 degrees: Exercise and correct posture are sufficient. • 55–70 degrees: A kyphosis brace is used. • Above 70 degrees: Surgical intervention is required.
Surgery involves stabilizing the vertebrae and correcting the spinal alignment. In children, rods placed in the spine following surgery are extended at regular intervals as the child grows.
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- Visible asymmetry and curvature in the back or waist region
- Shoulders or hips positioned at noticeably different heights
- Prominent rib hump when bending forward (positive Adam's forward-bend test)
- Difficulty standing or walking for extended periods, tiring quickly
- Back and lower back pain with muscle spasms as the curve progresses
- Shortness of breath, easy fatigue, and palpitations in severe cases
- Clothing not fitting symmetrically; perceived loss of height
Tedavi Yöntemleri
VBT (Vertebral Body Tethering)
Vertebral Body Tethering (VBT) is a growth-friendly technique indicated for adolescents between 10 and 16 years of age who still have growth potential, when the Cobb angle falls between 40 and 65 degrees. The procedure is performed thoracoscopically — through a closed, camera-guided approach on the side of the chest — so no large incision is required and tissue trauma is kept to a minimum. Titanium screws are placed into the vertebrae at the apex of the curve, and a high-tension flexible polyethylene cord (the tether) is secured between the screws to compress the convex side of the curve. As the patient continues to grow, spinal asymmetric loading under the tether's tension gradually corrects the curve; because no fusion is performed, full spinal mobility and flexibility are preserved. Postoperative hospital stay is typically 3 to 5 days, and most patients return to school and daily activities within 4 to 6 weeks. Long-term follow-up studies show primary correction rates exceeding 80% in appropriately selected patients.
Posterior Spinal Fusion (PSF)
Posterior spinal fusion (PSF) is the gold-standard surgical technique for patients who have completed skeletal growth, those with Cobb angles exceeding 65 degrees, and advanced cases such as neuromuscular or congenital scoliosis. Through a posterior midline approach, pedicle screws are placed into each involved vertebra under continuous intraoperative neuromonitoring (IOM) and 3D computer-assisted navigation. The screws are linked with titanium rods, and the curvature is corrected simultaneously in both the coronal (front-back) and sagittal (lateral) planes. In select advanced cases, an anterior release may be added to complement the posterior construct. Postoperative hospital stay is generally 3 to 5 days; with an appropriate rehabilitation program, patients return to normal daily activities within 3 to 6 months and are able to perform virtually all routine tasks outside of heavy manual labor.
Preoperative Planning and Surgical Safety
A successful scoliosis operation depends heavily on meticulous preoperative planning. Curve type, vertebral levels, global spinal balance, neurological risk, pulmonary reserve, and bone quality are all reviewed in detail before surgery. During the procedure, intraoperative neuromonitoring, three-dimensional guidance, modern implant systems, and blood-management protocols when necessary help improve both safety and correction quality. This comprehensive approach helps protect the spinal cord while allowing the deformity to be corrected in a controlled and balanced way.
Recovery and Long-Term Follow-Up
Pain control, breathing exercises, early mobilization, and walking training are essential parts of recovery after scoliosis surgery. Most patients are helped out of bed within the first few days, and after discharge they follow a gradual walking and rehabilitation program. Return to school is often possible within 4 to 6 weeks, while return to sports may range from 4 months to 12 months depending on the surgical technique and fusion-healing process. Long-term follow-up includes regular radiographic evaluation, assessment of spinal balance, implant integrity, and the patient's functional recovery over time.
Sıkça Sorulan Sorular
Can scoliosis improve without surgery?
Mild curves below 25 degrees may stabilize once growth is complete, and a proportion show partial spontaneous improvement. In curves between 25 and 45 degrees, a spinal brace (orthosis) can slow progression during active growth, but cannot permanently correct the curve. Curves above 45 degrees typically continue to worsen throughout the growth period and may even progress in adulthood, making surgery the only effective and lasting treatment option in these cases.
Can patients return to sports after scoliosis surgery?
After VBT, a gradual return to sports is usually possible within 6 to 9 months; swimming and cycling are among the earliest activities that can be resumed, while contact sports and heavy loading activities require up to 12 months. After fusion, the process is somewhat longer: light to moderate activities are generally possible within 6 to 12 months, while contact sports and intense physical activities typically require a waiting period of 12 to 18 months.
At what age is scoliosis surgery performed?
VBT is preferred for patients aged 10 to 16 with open growth plates and a Risser grade of 0 to 2. Posterior spinal fusion can be performed at any age — including in adults with degenerative scoliosis who have significant pain or functional decline. An individualized treatment plan is created for each patient, taking into account curve magnitude, skeletal maturity, and overall health profile.
Is kyphosis surgery different from scoliosis surgery?
Kyphosis, particularly Scheuermann's disease or post-traumatic cases, may require surgery when the kyphotic angle exceeds 70 to 75 degrees. Posterior instrumentation and fusion form the basis of treatment; an anterior release may be added in select cases. In both scoliosis and kyphosis surgery, the goals are to correct the deformity within safe limits, protect neurological structures, and improve the patient's long-term quality of life.
Is scoliosis surgery risky?
Scoliosis surgery is a major spine operation, so risks such as bleeding, infection, neurological injury, implant-related problems, nonunion, or under-correction are theoretically present. However, with modern neuromonitoring, navigation systems, contemporary implants, experienced anesthesia teams, and standardized postoperative care pathways, these risks are significantly lower than they were in the past. Even so, each patient's risk profile must be assessed individually according to curve type, age, associated medical conditions, and the number of spinal levels involved in surgery.
When can patients return to school and daily life after scoliosis surgery?
Most patients are able to walk within the first few days after surgery, and many are discharged within 3 to 5 days. Return to school or desk-based daily routines is often possible within 4 to 6 weeks, although carrying heavy bags, remaining seated for prolonged periods, and sudden twisting or bending movements are restricted early in recovery. The speed of return to normal life depends on the extent of the operation, pain control, muscle recovery, and adherence to rehabilitation.
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