Spine Health

Accurate solutions for all spinal disorders:

At Hisar Spine Health, congenital and acquired spinal curvatures and hunchback (scoliosis, kyphosis), spondylolisthesis (slipped vertebra), spinal fractures and dislocations, and spinal infections and tumors are successfully treated at our center.

Treatment of spinal tumors

Spinal tumors include tumors originating from bone, nerve and soft tissue.

Safe lower back surgery

Our operations offer safe surgery backed by experience, knowledge and modern technology (spinal cord monitoring). During surgery, the spinal cord and nerves are monitored with a special device, reducing the risk of paralysis during the operation to zero.

Slippage of the lumbar vertebrae in young people and degenerative narrowing of the canals containing the spinal cord and nerves (spinal stenosis) in older people can cause severe pain and neurological damage. Surgical treatment is unavoidable for patients whose pain does not respond to conservative methods and for those who develop neurological problems such as numbness and loss of strength. It should also be remembered that lower back pain can be caused by tumors and spinal infections. All of these conditions that cause lower back pain are successfully treated at our center.

Vertebroplasty and Balloon Kyphoplasty for Fractures Caused by Bone Loss (Osteoporotic Fractures)

Vertebroplasty and balloon kyphoplasty, introduced in recent years to relieve pain in postmenopausal and age-related osteoporosis and especially in certain spinal tumors, are performed at our center under local anesthesia as day surgery.

Traumatology

Traumatology can be described as the subspecialty that treats musculoskeletal disorders arising after blows, impacts, falls and traffic accidents, which are very common, especially in our country. Although fractures naturally come to mind first, fractures involving the head are handled by different specialties. Fractures of the facial bones are managed by the Plastic, Reconstructive and Aesthetic Surgery department and the Ear, Nose and Throat Surgery department. Fractures of the other bones forming the skull are treated by the Neurosurgery department. Rib fractures, although among the most common fractures, are primarily the concern of the Thoracic Surgery department. Trauma does not always result in fractures. Injuries to structures such as muscles, tendons and ligaments, generally referred to as soft tissue injuries, also fall within the scope of traumatology. And since ours is a surgical discipline, when surgery is required, surgical procedures are successfully performed by our team.

Arthroscopic Surgery

Arthroscopic surgery can be briefly described as confirming the diagnosis of and treating joint disorders using a closed (minimally invasive) surgical technique. Closed surgery means entering the joint with a pen-shaped camera and performing the procedure with pen-shaped instruments through another small entry point. Its greatest advantage is that no large surgical incision is made. Patients can return to work sooner than after open surgery. Another advantage is that the structures forming the joint, above all the joint lining, as well as the ligaments, cartilage, tendons and bones in the area, can be evaluated in detail and functionally. Although the knee and shoulder joints are treated most often, arthroscopic procedures can also be performed on the elbow, wrist, hip and ankle joints. All arthroscopic procedures are performed successfully at our clinic.

Arthroplasty

Arthroplasty can be briefly described as joint replacement surgery. The word prosthesis can be thought of in the same way as the prostheses used in dentistry. Dental prostheses fitted for people who have lost their teeth or whose teeth are severely damaged replace the teeth and take over their function. Similarly, prostheses are used for cartilage degeneration that begins after an average age of 40 or develops as a result of previous injuries. The prostheses we use replace the damaged joints. Although knee and hip replacements are performed most often, there are also shoulder, elbow, ankle, wrist and finger prostheses. Joint prostheses should not be confused with the prostheses used after limb loss (amputation) to restore appearance and function. For example, after a leg amputation, the external devices used to enable walking are also called prostheses. After arthroplasty, patients are relieved of joint pain and their mobility increases. Prostheses can last up to 15-20 years. These operations are performed successfully at our hospital.

Musculoskeletal Tumors

The diagnosis, treatment and follow-up of musculoskeletal tumors are also carried out successfully at our clinic. The word tumor refers to any kind of growth of cells in the body. The terms benign and malignant, on the other hand, are used depending on whether the tumor is able to spread and damage the affected structure. Musculoskeletal tumors can essentially be divided into two groups: soft tissue tumors and bone tumors. In addition to surgical treatment, drug therapy and radiotherapy are sometimes added to the treatment.

Pediatric Orthopedics

The subspecialty known as Pediatric Orthopedics or Children's Orthopedics, as the name suggests, deals mainly with musculoskeletal disorders in children. However, it should be remembered that children are not miniature adults. Their diagnosis, treatment and follow-up are very different from those of adults. Of course, there are also overlapping topics that pediatric orthopedics manages together with traumatology, spine surgery and other subspecialties. However, pediatric orthopedics mostly brings to mind congenital disorders of the walking system, such as hip dislocation, especially in our country. Even though the incidence of hip dislocation has been steadily decreasing in recent years, it continues to be a problem. Hip ultrasonography has revolutionized this field. With an early diagnosis, very successful results can be achieved with non-surgical treatments. At our hospital, hip ultrasonography is performed as standard screening for all newborns.

Hand Surgery - Microsurgery

Although hand surgery and microsurgery first bring to mind the reattachment of severed limbs using microsurgical techniques, the scope of hand surgery can be said to cover the area from the fingertips to the shoulder. Microsurgery means repairing blood vessels and nerves, which are impossible to suture with the naked eye, under a microscope using very fine sutures and very fine special instruments. Although this field has become more popular in recent years and receives a lot of media attention, contrary to popular belief, it is not a method that can be applied to every limb amputation. Successful results can only be achieved when it is performed in suitable patients. In patients whose blood vessels and nerves are severely damaged, achieving successful results is quite difficult. Hand surgery should not be understood only as the reattachment of severed limbs. All musculoskeletal injuries of the region between the hand and the shoulder fall within its scope. Many examples can be given, from bone fractures in this region to nerve compressions and tendon and muscle ruptures. In our department, it is possible to benefit successfully from all the possibilities of hand surgery and microsurgery.

Sports Medicine

Sports medicine, as the name suggests, can be described as the subspecialty that deals with musculoskeletal injuries in athletes. Athletes can return to sport only with an accurate diagnosis, treatment and a fast rehabilitation program. The most critical issue here is shortening the time needed to return to sport. Some musculoskeletal disorders require surgical treatment only in athletes. Only in this way can a return to sport be achieved.

Spondylolisthesis (Slipped Vertebra)

The spine consists of a series of interconnected bones called vertebrae. In about 5% of adults, a developmental fracture may occur in the bony part connecting the upper and lower joints of the lowest vertebrae of the lower back. This fracture may occur on one or both sides of the vertebra. These are usually “stress fractures” caused by excessive loading of the lower vertebrae of the highly mobile lower back. These fractures are called “spondylolysis”. Because this region is very mobile, these fractures often may not heal. However, while these fractures usually cause pain in adolescence, they may not cause serious problems in adulthood. In some patients, the fracture allows the upper vertebra to slip forward over the one below. This condition is called “slipped vertebra” or “spondylolisthesis”. Depending on the degree of slippage, spondylolisthesis can cause more serious problems. Slipped vertebrae caused by this type of fracture are medically called “isthmic spondylolisthesis” and usually present as slippage of the L5 vertebra over the S1 vertebra. Spondylolisthesis has been found in 5 to 10% of patients who see a doctor because of lower back pain.

Spinal Canal Narrowing

Spinal stenosis (narrowing) is a certain degree of narrowing of the sagittal diameter of the spinal canal, the lateral recesses and the foramina (nerve root canals), either along the entire spinal canal or at one or two vertebrae. It may be congenital or develop later in life.

The normal sagittal diameter of the lumbar spinal canal is 15-25 mm. The basic problem in spinal stenosis is an insufficient canal diameter. If the sagittal diameter is less than 10 mm, this is referred to as absolute stenosis; if it is between 10 and 13 mm, as relative stenosis. A special area called the lateral recess is bounded in front by the back of the vertebral body, on the side by the pedicle and behind by the superior articular facet, and opens medially into the spinal canal. In the lower lumbar region, the distance from the back of the vertebral body to the most ventral part of the superior articular facet should not be less than 3-4 mm. A lateral recess height of less than 3 mm suggests lateral recess stenosis, while a height of less than 2 mm is diagnostic.

Stenosis may remain asymptomatic unless structural changes such as age, trauma, thickening of the ligaments, joint changes and the development of spondylotic bars compress the neural elements below a critical level.
Stenosis can affect both the cervical and lumbar regions at the same time. However, it is not common for stenosis in both regions to be symptomatic at the same time. Symptoms that appear in older individuals are due to myelopathy.

Although spinal stenosis can generally occur at any age, it most often begins to cause symptoms after the age of 50. It is more common in men. The L3, L4 and L5 levels are affected more often. Patients often complain of insidious back, hip, leg and calf pain. How far the pain spreads to the legs and arms varies depending on the level of narrowing. The spread is usually on both sides. Walking and standing for long periods trigger the pain. Patients tend to walk with a forward-bent posture. They find relief from the pain by sitting down. This picture is a special condition called neurogenic claudication. In this way, neurogenic claudication can be distinguished from disc pain, which is not relieved by sitting. As the condition progresses, sitting and lying down no longer relieve the pain either. In advanced cases, persistent pain and urinary problems may develop. Therefore, in cases where spinal narrowing is suspected, urinary urgency and frequent urination are considered an important sign for surgery, and urgent surgery is recommended for these patients. Patients with spinal stenosis report a very long history of pain and can manage for a while with medication. As the stenosis progresses, the patient's pain hardly responds to any treatment. Surgery is recommended for these patients.

Spondylolysis and Spondylolisthesis

The spine consists of a series of interconnected bones called vertebrae. In about 5% of adults, a developmental fracture may occur in the bony part connecting the upper and lower joints of the lowest vertebrae of the lower back. This fracture may occur on one or both sides of the vertebra. These are usually “stress fractures” caused by excessive loading of the lower vertebrae of the highly mobile lower back. These fractures are called “spondylolysis”. Because this region is very mobile, these fractures often may not heal. However, while these fractures usually cause pain in adolescence, they may not cause serious problems in adulthood. In some patients, the fracture allows the upper vertebra to slip forward over the one below. This condition is called “slipped vertebra” or “spondylolisthesis”. Depending on the degree of slippage, spondylolisthesis can cause more serious problems. Slipped vertebrae caused by this type of fracture are medically called “isthmic spondylolisthesis” and usually present as slippage of the L5 vertebra over the S1 vertebra. Spondylolisthesis has been found in 5 to 10% of patients who see a doctor because of lower back pain.

Another type of slipped vertebra is the one usually seen over the age of 40 as a result of age-related wear of the spine and its surrounding connective tissues. This problem is medically called “degenerative spondylolisthesis”. Slippage caused by ageing and wear is usually a forward slip of the L4 vertebra over L5. Slipped vertebra is often accompanied by a “narrow canal” (spinal stenosis).

What are the symptoms?

Stress fractures (spondylolysis) may not always cause clinical symptoms. Sometimes they are discovered by chance on lower back X-rays taken for other reasons. If there are clinical signs, they may appear as lower back pain, pain in the buttocks, tightness in the lower back muscles and, less often, numbness and pain in the legs (sciatica) and weakness in the feet. The pain usually increases with standing, walking and other activities, and decreases with rest.

How is it diagnosed?

If, after listening to your complaints and examining you, your doctor suspects spondylolysis or isthmic spondylolisthesis, he or she will request X-rays. However, a stress fracture (spondylolysis) may not be visible on plain X-rays. In this case, if your doctor still suspects a fracture, a bone scan and/or CT may be requested. If a fracture is detected with these tests, an MRI may be considered necessary for treatment planning. An MRI may also be necessary to evaluate the spinal cord and nerves in patients with slippage and leg pain and/or numbness. If you have isthmic spondylolisthesis, its severity will be graded from 1 to 4 according to the degree of slippage.

For the diagnosis of degenerative spondylolisthesis, evaluation will also be made with plain X-rays and an MRI scan. In this type of slipped vertebra, a bone scan and CT are usually not needed.

What are the treatment options?

If your only complaint is lower back pain, the degree of slippage is not severe, and your doctor has not found serious nerve compression or involvement on examination and tests, the first treatment to be chosen is non-surgical treatment. This may include one or more of rest, painkillers and anti-inflammatory drugs, temporary use of a brace, and physical therapy.
If your pain continues, another option may be steroid and local anesthetic injections into the fracture area and the joints connecting the vertebrae (facet joints). If lower back pain is accompanied by leg pain and numbness due to nerve compression, epidural or foraminal injections may be added.
Pain from stress fractures (spondylolysis) usually improves with these treatments. However, the fracture may not always heal completely in these patients. Once the pain has resolved, a fracture that has not healed does not pose a danger. Severe slippage in later life is generally not expected in these patients. Nevertheless, these patients may need to be followed up with X-ray examinations from time to time.

When might surgery be necessary?

Surgical treatment may be necessary for patients whose complaints do not resolve with non-surgical treatment methods. In addition, if the slippage causes spinal cord compression that leads to a serious neurological deficit (foot drop, urinary incontinence), early surgical intervention may also be required.

Two types of surgical treatment can be applied in spondylolysis. The first is repair of the fractured area. The other method is spinal fusion.
In isthmic spondylolisthesis, the preferred surgical method is spinal fusion. If there is also spinal cord compression, the compressing structures are removed to relieve it. The operation can be performed from the front, from the back or from both sides. Fixation materials may be used. Recovery is achieved with a good rehabilitation program after the operation.

Facet Arthropathy

The facet joints connect the posterior elements of the vertebral bodies to each other. Facet joints have features similar to joints in other parts of the body. Like the bones that form the other joints of the body, the joint surface of the facet joint is covered with smooth cartilage, surrounded by a capsule made of strong ligaments and contains synovial fluid that provides lubrication. Like the hip and knee joints, the facet joint can become arthritic and painful and can cause lower back pain. Pain and discomfort due to degeneration and arthritis of this part of the spine is called facet arthropathy.

Symptoms

Most people with facet arthropathy complain of lower back pain that occurs when twisting and bending backwards. Facet arthropathy pain is usually localized to a specific area of the lower back and, unlike the pain and numbness caused by a herniated disc, does not radiate down the leg. However, if arthritis develops in the facet joint, bone spurs (osteophytes) form in the joint, and these can press on the nerve roots. This can contribute to the development of a narrow canal, which can cause numbness and pain radiating to the leg and weakness in the leg.

Diagnosis

Facet arthropathy alone is usually not the cause of significant lower back pain; it is accompanied by other conditions that contribute to these symptoms, such as degenerative disc disease, arthritis of other parts of the spine and, frequently, a narrow canal. Even people with mild to moderate lumbar (lower back) spinal arthritis show signs of facet joint degeneration on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). A bone scan showing active inflammation is a test that can be used to determine whether facet arthropathy contributes to lower back pain. If the pain decreases significantly when a mixture of steroid and local anesthetic is injected into the facet joints, and the tests performed (bone scan, CT, MRI) show signs of facet joint arthritis, facet arthropathy can be diagnosed with a certain degree of confidence.

Treatment

There are many options for treating the pain and other symptoms caused by facet arthropathy. Initial treatment for facet joint disease includes avoiding the movements that cause facet pain, using anti-inflammatory drugs, and doing stretching and strengthening exercises.

Injections can be used to relieve the pain and discomfort caused by inflammation and synovitis in facet arthropathy. Unfortunately, this is not a permanent solution, and the pain may recur after a few months. In a recently developed treatment method called sinuvertebral nerve ablation, a needle is inserted through the skin and the nerve supplying the facet joint is permanently ablated with electric current, reducing the pain.

If nerve root compression has developed due to enlargement of the facet joints, or if conditions such as degenerative disc disease, spinal instability or a narrow canal (spinal stenosis) are also present, surgical treatment is necessary to relieve the pain.