Scoliosis, cervical and lumbar disc herniations, fractures and dislocations, infections, tumors, cervical and lumbar, spondylolisthesis, and spinal degenerative problems in adults and children are treated using the latest scientific findings at the Istanbul Spine Center-Group Florence Nightingale in Turkey.

The clinic is the first in Turkey to start applying “endoscopic treatment of herniated disc” in 2002 and “total disc arthroplasty” in 2003, and these are successfully performed. The clinic is considered a reference center for spinal diseases worldwide.

It is one of the most experienced centers in the world for vertebral resections and scoliosis operations, which can be used especially for various conditions, from fractures to spinal tumors. All patient investigations are reviewed by specialists, physiotherapy and pain therapy clinics, and radiologists; Appropriate treatment methods, including treatment options such as conservative treatment (physiotherapy and medication applications), blockage of nerve roots and facet joints, endoscopic or open surgery, are scientifically established for each patient.


The EOS method, applied to patients with spinal disorders, allows the use of a radiation dose up to 10 times lower than in the case of conventional radiography.


National and international meetings are held every year, with many researchers from around the world visiting the Spine Center and participating in scientific studies.



Scoliosis is a significant deviation of the spine to one side and / or a three-dimensional rotational deviation that can be identified in the upper and / or lower back. In a normal and healthy person, the vertebrae are placed in a straight vertical line. In the case of scoliosis, the spine is curved to the right or left and is also rotated around its axis. Such curves can exist at a single point in the column, but they can also be in multiple places and in different directions.

Scoliosis is more common in adolescence. This can lead to unrecoverable damage to the heart and respiratory system if not treated early. To identify the disease, it is important for patients to analyze their body shape for signs.


These signs include:

  • Difference in shoulders
  • Waist asymmetry
  • The protrusion of a part of the spine
  • Deviation to the right or left of the body balance

The method of treatment is determined by the size of the curvature and the stage of development of the bones. The earlier the treatment is started, the higher the success rate.


Surgery: is the only option when the curve is greater than 40 degrees and in patients who are still developing. Surgical treatment is performed successfully using implants (screws-rods) located in the cervical and lumbar spine. Monitoring (neuromonitoring) of spinal cord function during surgery is a method that increases the safety of the operation for both the patient and the doctor and is commonly used at the Spine Center, a reference center in the field of scoliosis surgery.

The surgical process is organized in an extremely professional manner for the comfort of the patients. The surgical method to be applied is determined by your doctor based on the type of scoliosis, and the patient is given all the details of the operation. Only one operation is enough for 90% of patients to get a favorable result. Patients get up and go a day after surgery. The duration of hospitalization is about 5 days. Usually, patients can resume their daily activity 3 weeks after surgery.



In a normal spine, the upper back has a curve called “kyphosis,” and the lumbar area has a curvature called “lumbar lordosis.”

The normal thoracic spine has a slight kyphosis between vertebrae 1 and 12, with an angle of 20 to 45 degrees. When this curve is greater than 45 degrees it is called “hyper-kyphosis”.


Congenital kyphosis: Treatment depends on the type and severity of the disease. Observation is the first method of treatment in children with spinal deformities. Progressive and severe deformities due to congenital kyphosis, which are greater than 45 degrees, or cases of kyphosis accompanied by a neurological weakness often require surgical treatment. Usually, the early surgical approach gives the best results and prevents the evolution of the curve. The procedure of the surgery that will take place might change depending on the nature of the deformity, such as sieve fusion, instrumental fusion and osteotomy (rods, staples and screws).

The surgeon may recommend an osteotomy to realign the spine.


Developmental kyphosis: Also known as “Scheuremann’s kyphosis“, it is defined as a rigid (structural) kyphosis. It is most common in young people between the ages of 12 and 15. Abnormal kyphosis is best seen from the side, in the forward bending position. Patients with Scheuremann’s disease often have poor posture and complain of back pain.

It is recommended to observe the patient in the following cases:

  • Postural hyper-kyphosis
  • Bending less than 60 degrees in adolescents
  • Curvature of 60-80 degrees in incomplete adolescence

Corset treatment, accompanied by an exercise program, may be recommended if the deformity is moderately severe (60-80) and if the patient is still developing skeletal development.

Surgical treatment: Spinal fusion may be recommended if the deformity of the kyphosis is severe (above 80 degrees) and if the patient suffers from increasing back pain. The spine is corrected and lengthened by fixing rods to the vertebrae with screws. Patients can resume normal daily activities in 4-6 months. The change made by the surgical correction is visible.

Traumatic kyphosis: The treatment of kyphosis is intended to correct and stabilize the deformity, reduce pain and improve neurological function. Flexible deformations can be treated by fusion and posterior instrumentation (connecting the vertebrae through rods and screws). Fixed deformities often require more serious operations, such as removal or resection of the vertebrae. All these operations are performed by experienced surgeons.

Cervical disc herniation

The discs are made of strong binding tissue and act as a buffer or shock absorber between the vertebrae. A disc herniation in the neck area, called a “cervical disc herniation,” occurs when the contents of the discs between the vertebrae move to the location of the spinal cord or nerve roots. Cervical disc herniation often results in pain in the cervical region, pain radiating down to the arm, numbness of the arm accompanied by changes in sensation.

Treatment: Cervical hernia usually behaves well in conservative therapy. Patients should first receive this therapy, which involves rest, neck support, painkillers and muscle relaxants, as well as physiotherapy exercises. In some patients, transforaminal injections of steroids to relax the nerve roots may be helpful. Surgical treatment can be considered in patients with severe neurological signs such as loss of sensation and movement and especially in patients with symptoms of myelopathy and who have not achieved any improvement after the application of conservative therapy. The purpose of the surgery is to remove the part of the disc that presses on the nerve. After removing the disc causing the compression, the procedure of fusing (connecting) the vertebrae is usually used. Another treatment option offered by the Spine Center is the disc prosthesis which is preferred to maintain movement, especially in young patients.


Degenerative cervical diseases

Spinal degeneration begins in the intervertebral discs, resulting in secondary changes in other adjacent joints. This process that takes place in the spinal cord is called “spondylosis”. In the case of spondylosis, small bony protrusions called osteophytes develop around the spinal canal and the nerve root canal. Factors that cause cervical disease may include aging, overload and trauma, prolonged work in an abnormal position, genetic causes, smoking, vascular disease and diabetes, or chronic rheumatic diseases. Cervical spondylosis results in pain in the neck, shoulders and arms by compressing the nerve roots. Pain can radiate to the arm and palm by specifically distributing the nerve root under compression. If the cervical disc herniation presses on the spinal cord, gait problems, spasticity (increased muscle tone) and urinary incontinence may occur.

Treatment: The initial treatment is usually conservative, the most common methods being patient education, cervical support, physiotherapy and painkillers. If the patient still complains of pain, if there are certain neurological findings or if these results have worsened despite conservative treatment, surgery will be considered. The surgery depends on the pathology that caused the patient’s current condition.

Surgical methods used:

Method performed before (front) – The cervical vertebrae are accessed by entering through the front of the neck. The disc herniation between the vertebrae and the bony protrusions that cause compression of the spinal cord are removed. This is called a corpectomy. The resulting space can be supported by an implant or bone from the patient or by an artificial bone transplant.

Posterior (back) method – This is based on removing the posterior membranes of the vertebrae (laminectomy) and releasing the spinal canal. This is done for spinal canal stenosis with zero or more levels. If necessary, the posterior fixation will be performed with titanium screws to maintain the stability of the spine after removal of the posterior membranes.

Chest disc herniation


Approximately 0.25-0.75% of all herniated discs are located in this area. The nerve roots between the vertebrae extend to the chest area and cause pain and burning sensation between the ribs due to the pressure on the nerve roots caused by the herniated disc. The most common signs of patients are pain and changes in sensation accompanied by loss of sensation of movement in the lower extremities.

Treatment: Physiotherapy may help, but if the condition persists and worsens, then the disc should be removed by surgery. It is possible to remove the material causing the pressure using microscopic or endoscopic methods.



Lumbar disc herniation

The lumbar spine consists of 5 vertebrae. There is a disc-shaped connective tissue that facilitates movement between the vertebrae, allows the spine to be strong and functional as a protection against impacts. This disc consists of two sectors, the inner layer and the outer layer. The soft inner layer protrudes when the outer layer is deformed. This herniated section secretes chemicals that result in pain. These are all called lumbar disc herniations. Lumbar disc herniation in young people is rather associated with lifting heavy objects or forced lumbar movements. In the elderly, minor but repeated forced lumbar movements over the years can lead to herniated lumbar discs over time. The most common ailment of patients with a herniated disc is pain in the lower back that radiates down to the legs and toes. In more advanced cases, problems such as numbness and weakness may occur, in addition to low back pain or leg pain. In untreated patients, there may be loss of mobility when the ankle is raised, called “foot drop” and urinary incontinence.

Treatment: The main purpose of herniated disc treatment is to eliminate the pain and help the patient to return to daily life. The first thing to do is bed rest, medication and patient education.

The structures around the spine are strengthened and the body mass is distributed more evenly through physiotherapy exercises, so that the load on the disc can be partially reduced and the ailments reduced to a minimum. Epidural injections or epidural blockages are other methods used to relieve patients’ pain.

In case of loss of strength and sensation in the legs and feet, or if conservative methods of treatment fail to eliminate the discomfort of patients, the herniated material of the disc is surgically removed to release the nerves. In addition to open surgery, microscopic or endoscopic surgical methods may be applied in lumbar disc surgery, depending on the clinical and radiological results. Another method of treatment used includes the application of the disc prosthesis which will maintain the normal movements of the spine and allow the elimination of pain.

Degenerative diseases of the lumbar disc and spinal stenosis

The discs between the vertebrae lose their spongy nature and begin to contain less water with age. This causes a decrease in the height of the disc and calcification of the disc that bends towards the spinal canal, and the bony protuberances called osteophytes that the body forms to limit the movement of the spine press the nerves. All of these changes result in spinal cord stenosis, which is called either “spinal stenosis” or “narrowed canal.”

The most common ailment of patients with spinal stenosis is back pain. Typically, the pain worsens once the patient sits, walks, coughs, and exerts effort, and relieves pain when the patient is resting.

Neurogenic claudication, which is a typical symptom of stenosis, is characterized by pain, numbness, tingling in the legs, especially in the calves, which occur while walking and are reduced when the patient is resting. To facilitate diagnosis, all vertebrae can be visualized on the same image and body balance disorders can be explored by EOS imaging.

Treatment: Treatment begins with bed rest accompanied by analgesics and relaxants and continues with physiotherapy. Epidural steroid injections may also be considered.

In the case of severe pain that does not respond to conservative methods and that significantly restricts the patient’s daily activities, surgical treatment is necessary. The main goal of surgical treatment is to remove the compression of the spinal cord. Decompression is achieved by removing the bone structures (laminectomy) that form the posterior wall of the spinal canal by intervention through the lower back. Another stage of decompression is the removal of the discs that cause compression, the resulting space between the vertebrae after the removal of the discs is strengthened by inserting some titanium carcasses filled with bone grafts.

This operation can be performed from the front (ALIF), from the side (XLIF) or with incisions in the lower back (TLIF). It is essential to achieve balance and stability of the spine by fixing with screws which is also performed through the back (posterior instrumentation), to provide comfort to the operated patient and to prevent recurrence of the disease. After surgical treatment the patient should regain normal physiological curves of the spine (spinal balance).

Spondylosis and spondylolisthesis

Spondylolisthesis is the anterior sliding of a vertebra over the lower vertebra. With this slipping, the spinal cord compresses into the spine, resulting in pain, numbness, and burning sensation in the legs.

There are 5 types of spondylolisthesis, the most common being post-operative slipping and slipping caused by congenital vertebral problems in childhood.

5% of people have a developmental fracture in the bone section that connects the upper joints to the lower ones (joint facets) of the vertebrae located in the lumbar area. It is almost impossible to weld these fractures because this area moves a lot. In some patients, an upper vertebra slips anteriorly over the lower vertebrae due to a fracture, called a “lumbar slip” or “spondylolisthesis.”


Treatment: In case of slight slipping, the ailments will be removed by rest, analgesics, temporary use of a corset and physiotherapy. Epidural or foraminal injections may be considered. If fractures in adolescents result in pain and restrict activity, they should be treated surgically.

The preferred method is usually fresh bone graft consolidation to fuse the fractured area and fix it with screws and hooks.

In the case of slipping in old age, if the disease causes ailments that cannot be reduced by medication and produces signs of nerve compression (flexion of the foot, urinary incontinence) and progresses, surgical treatment is necessary. The nerves in the slippery region are released by surgical treatment and the vertebrae are pulled together to prevent the slipping from progressing. The operation can be performed from the front or back, or from any side. The recovery process is supported by postoperative rehabilitation programs.

Spinal tumors

Tumors of the spine occur in the bones that make up the spine and spinal canal or in nerves or other soft tissues. Depending on the origin of the tumor, there are two types: primary tumors, which result from cells in the spine and spinal cord, and metastatic tumors, which develop in other parts of the body (breasts, prostate, lungs, etc.) and which then spread to the spine. Most of the time, the patient complains of back pain.

The pain worsens at night and usually does not go away after the rest periods. Chronic symptoms of the disease may occur, for example: fever, weight loss and fatigue. Depending on the location of the tumor and whether it causes compressive weakness, numbness and tingling in the arms and legs, inability to walk, urinary incontinence, uncontrolled defecation, sexual dysfunction, poor reflexes, bed rest is required. Loss of strength, collapse and scoliosis occur in children.

Treatment: Depending on the type and location of the tumor, methods such as:

  • Surgery
  • Radiotherapy and immunotherapy

Simple monitoring may be an option for some patients. Such decisions usually require the cooperation of a neurosurgeon, radiologist, and medical oncologist.

Benign tumors that do not reside in compression can be monitored periodically.

In particular, tumors that show neurological symptoms or cause fractures or that are at risk of causing fractures should be removed by surgical procedures.