Scoliosis treatment in Turkey

Scoliosis is judged on a series of measurements over time, not on one. A curve that has not changed across repeated x-rays in someone who has stopped growing is a different situation from the same measurement in a twelve year old with years of growth ahead. That is why the first honest answer to most enquiries is monitoring rather than treatment.

So before agreeing to anything, ask what your own previous measurements were and over what period, and how much growth remains. A clinic that proposes an operation without asking for the earlier films is not managing scoliosis, it is quoting for it.

• Mild curve, growth finished

  Usually observation. Progression after growth is slow in most people, and the honest answer is often that nothing needs doing now.

• Growing child, curve progressing

  The situation where bracing has a role. The aim is to hold the curve while growth completes, and wearing it as prescribed is what makes it work.

• Large or clearly worsening curve

  Where surgery is discussed. Fusion straightens the spine partially and stiffens the fused levels permanently, which is a trade rather than a fix.

• Adult with pain and imbalance

  A different problem from adolescent scoliosis. Surgery here is aimed at pain, balance and nerve symptoms rather than at appearance, and it is bigger surgery in an older spine.

For a herniated disc rather than a curve, see microdiscectomy; for canal narrowing, laminectomy. For the wider orthopaedic offering, see orthopedics in Turkey.

1. 1

   Assessment with the whole history

   Previous x-rays, when they were taken, growth stage, and a clinical examination including a neurological check. A single new film is not enough to decide on surgery.
2. 2

   Deciding the levels

   How much of the spine is included is the decision that determines how much movement is lost. Ask which levels and why, and what would be different with one level fewer.
3. 3

   Anaesthetic and monitoring

   A long general anaesthetic with continuous spinal cord monitoring. Ask explicitly whether neuromonitoring is used and who runs it.
4. 4

   The correction

   Screws and rods correct and hold the curve while bone graft fuses the segments. The correction is partial by design, because forcing more is how nerves get injured.
5. 5

   The first days

   Pain control, getting up, and checking neurological function. Ask what happens if a monitoring change occurs during surgery, because there is a protocol for that.
6. 6

   Years, not weeks

   Radiographs at intervals, return to sport in stages, and long term awareness of the levels next to the fusion. Agree who does this before you fly.

• Send the previous x-rays, not just the latest. Progression over time is the whole argument for or against surgery, and a clinic that does not ask for them has not assessed the case.
• Ask about neuromonitoring by name. Whether it is used routinely, who operates it, and what the protocol is if the signal changes.
• Ask who the surgeon is and what they are trained in. Deformity surgery is a subspecialty, and in a child it is a paediatric one.
• Ask how long you must stay. And what happens with wound checks, pain control and the first radiograph before you travel.
• Agree the five year follow up. In writing, naming who does it and where. This is the part that a package abroad does not usually contain.
• Take the implant record home. Manufacturer, model, levels and dates. Nobody can manage a late problem without it.

• Bracing holds, it does not correct. And it works only while a child is growing, and only if it is actually worn for the hours prescribed.
• Specific scoliosis physiotherapy has a role. Schroth and similar approaches are used alongside bracing and observation. They are not a substitute for either.
• General exercise is good for you and does not change the curve. Both things are true, and a good clinician will say both.
• Manipulation does not straighten a structural curve. Be wary of any programme sold on before and after photographs taken in different postures.
• Pain and curve size are not the same thing. Plenty of large curves cause no pain and plenty of small ones hurt. Treating the number rather than the person is a mistake.
• Watching is a treatment. When growth is finished and the curve is stable, doing nothing is a considered decision rather than a fobbing off.

• NHS, information on scoliosis in children and adults.
• British Scoliosis Society, patient information on assessment, bracing and surgery.
• Scoliosis Research Society, patient resources on scoliosis management.
• National Institute for Health and Care Excellence, guidance on spinal conditions.
• Turkish Ministry of Health, register of facilities authorised for health tourism.