Problems that cannot be solved in good hands are not plenty nowadays. As long as you can find the right person, in the right place, at the right time; as the second surgery is more difficult than the first one and less likely to succeed, third operations are much more difficult, and the chances of success are much lower. So, it is very important that you must get correct treatment in the first operation, because no surgeon likes to operate upon someone else’s failed surgery. If a doctor tells you have to be operated on; the right time and place is exactly right here, right now.

Unfortunately in medicine, there is no guarantee for any cure; but only success rates can be mentioned. The risk is a ratio that can be reduced with the use of contemporary methods and with experience. First of all, ask the doctors who tell you not to have surgery, whether they are able to do that surgery; and then reassess what they say. Of course, do the same for doctors who advise you to undergo surgery; especially the experience and skill of the surgeon you choose is very important. This is because, unfortunately, the number of surgeons who can perform some surgeries without a risk is not plenty in our country. Try to find someone very experienced.

I would like to remind you that in order to arrive at a decision that a patient should undergo surgery, the surgeon should be sure that the explanations are understood by the patient, following a detailed history and a thorough examination of the patient together with all necessary radiological examinations and analyses.

Thanks to the modern techniques used in contemporary medicine, the duration of surgery is not important for you anymore. The important thing is the experience of your surgeon, and the quality of the surgical techniques applied during this time.

After a failed surgery, this is your last chance to finally recover. I do not know where and when your previous surgery was done, but I wish you had had the first surgery in a good center, by an experienced surgeon. I hope you are aware that this second operation is a difficult job and you shouldn’t spend your last chance just anywhere.

Before you decide that you had an unsuccessful surgery, or that there is an issue related to an erroneous operation, consider:

Did any of your doctors who recommended surgery not give you half an hour and not give you this opinion, written?

Did your surgeon who decided on surgery just wanted the MR images and did not want other examinations such as your dynamic x-rays – blood tests – electrical nerve measurements – computerized tomography (CT)?

Did you choose your surgeon who did your surgery with peer-friendly advice?

Was it the most important factor in your choice, the amount of money to be withdrawn from your budget?

The surgeon who did your surgery did not spare you half an hour to let you know what you will do, or not do, after the operation, right?

If your answer to the first 3 questions is that ‘no, he didn’t’; and for the last 2 it is ‘yes’; then beware. It is still not too late but the surgeon you will choose this time will be your last chance. Think again…

I hope we are not too late but if I can examine the patient in detail and have a chance to get a new MR, we may see whether there is a clinical picture seen in 7% of people with these type of disorders; called Adams Hakim Syndrome or normal pressure hydrocephalus. If you’re in luck and we find such a disorder, then we will do whatever it takes to help with the damage.

Within the scope of the emergency health service that has developed in our country in recent years; many ambulances, ambulance aircrafts, ambulance helicopters and sea ambulances have made it possible for patients to be transferred between hospital intensive care units and even cities. When the patient is being transported in this way, all medical treatment that must be done in intensive care should be uninterrupted. Many tools which are available in the most advanced intensive care units are also present in these ambulances. Of course, an experienced emergency technician, even better, an emergency specialist physician should be in the vehicle. Thus, while the patient sleeps in an intensive care unit, they may open their eyes in a better, more equipped intensive care center.

When a patient in coma due to diseases such as “cerebral hemorrhage”, “cerebral vascular obstruction” or due to a trauma or accident enters the emergency service, both the doctors and relatives of the patient begin looking for a hospital with an intensive care center. They of course want to reach the best. In fact, among the hospitals with an intensive care center; we can count all the education and research hospitals affiliated with the Ministry of Health together with university hospitals. Of course, it is important to remember that there are very good centers in private hospitals in which the services are certified according to European or American standards. However, the emergency intensive care bed search systems used in emergency departments do not always see vacancies in these private hospitals. Thus I would like to remind that patients can only reach these with their own resources. I would also like to draw your attention to the fact that some private hospitals will charge an extra fee for some intensive care services.

Coma is graded by doctors and treated in intensive care units, which are rated by the health authority. Here, the patient is seen by specialists from all the medical branches required, about the disease leading to coma, and the treatment is planned. The patient may never come out of the coma or, even if relieved from coma, may remain in the so-called vegetative state. Some lucky patients will have to live with some sequels after months and sometimes years of rehabilitation. Those who are more fortunate may return to their completely normal lives as before the coma.

It is possible nowadays to reduce the level of risk to neglectable levels after a decision is made by the correct evaluation, and through operations done in experienced hands and equipped institutions.

Syringomyelia is a cyst in the spinal cord. Another name for this is “hydromyelia” and is sometimes seen coincidentally in MR images and is only followed up to see whether it will grow over time. This is because these cysts may be associated with a spinal tumor that can appear only over time.

Sometimes it may be necessary to treat them surgically due to the presence of severe complaints, such as marked numbness in the arms and shoulders. Although the surgical treatment of these cysts consists of opening the cyst and evacuating it with the help of a thin tube called a shunt, there is a great benefit in choosing experienced surgeons; considering paralysis and other serious problems that may arise after the surgery.

In fact, the spinal cord tumor is not a form of cancer. In other words, the tumor in the spinal cord does not spread to other organs or grow very fast like cancers. These are actually benign tumors. However, by compressing the spinal cord in a small closed bony canal; they can lead to very severe consequences. Due to the compression of spinal cord and nerves going to arms and legs; paralysis may occur, the muscles in arms and legs may stiffen, movements may be restricted and even worse, the patient may leak both stool and urine.  When these tumors are diagnosed, they need to be operated upon immediately. There is also no chance of radiotherapy or drug treatment, i.e. chemotherapy with these tumors. Once the paralysis has developed over time, the paralyzed condition cannot be reversed even with surgery.

This event, “spinal stenosis” or “lumbar stenosis” is the result of the narrowing of the canal in the middle of the mentioned spinal bones and results in complaints due to the collective squeezing of the nerves originating from the spinal cord passing just through there. Other than pain in the waist and legs, the main complaint of the patient is the contraction type of ache in the legs when walking for a short distance that prevents the patient from walking; and the patient has to constantly walk leaning forward from the waist. There is no other treatment for this problem except surgery. However, the patient may have “minimally invasive surgery” as the doctors say, or “closed surgery”, “bloodless surgery” through a needle at a very low risk; “microsurgery” or low-risk surgical interventions made through a small cut; or if these are not a solution, it may be necessary to do “fusion surgery”, “instrumentation”.

If there is a spinal curvature, be a scoliosis or a kyphosis; corset is the first step of treatment. These are often custom-made corsets, i.e. corsets specially designed for the patient to be worn all day long; which need to be renewed over time according to the changes that occur in the patient’s curvature and body height. As the second step, it is necessary to perform a fusion surgery or spinal instrumentation. Here, the purpose of the operation is either to fix the spine to the corrected state in some adult patients or to correct the spine while allowing it to grow using movable instruments and adjustable rods, especially in small children.

In some patients, especially in the elderly; these surgeries may be complicated and dangerous surgeries that require the removal of spinal bones totally or partially. In this type of surgery, an experienced neurosurgeon – as well as orthopedists – must also be present in the operation. I would also like to emphasize that, if a congenital anomaly which accompanies the curvature is detected; only treatment of this problem surgically by an experienced pediatric neurosurgeon may be sufficient to correct the curvature.

If these complaints are seen within a few days after the head trauma, your patient should be be evaluated by a neurosurgeon; but if present one week later on, by a neurologist.

When congenital skull deformities are corrected by an experienced pediatric neurosurgeon with an experienced plastic surgeon – especially if the surgery is performed before the child’s first age – the result may be so that no deformity is present. Of course, such an excellent result must not be anticipated after surgery performed after the first year of age. It is better to have surgery performed by a similar team in other diseases that can disrupt the shape of the skull. Artificial bone, bone cement, cadaveric bone, titanium screws and plaques can sometimes be used in these operations, but patient’s own bone is preferred.

As you may know, in decompressive surgery for brain edema; part of the skull is removed to make room for the swollen brain. This opening in the skull is later on closed occasionally with the patient’s own bone, and sometimes with an artificial bone. The most appropriate time for this correction will be decided by the neurosurgeon who performs the decompressive surgery. Sometimes shunting may not be necessary when the bone is replaced.

Maybe your patient does not need any surgery, or a very complicated operation may be necessary. The surgery to be performed is decided according to the age, weight, discomfort, examination findings and results of the medical tests of the patient. Of course, many types of surgeries may be considered in this case; and the cost of the operation is determined according to the risk, duration, chance of success, duration of recovery, etc. Thus, it is unfortunately not possible to tell you a price range. In addition, the hospital comfort that you want is another factor that affects the cost. However, if we are sure about the kind of surgery that is necessary, then we can choose among various price options that best suits you.

We do not normally recommend surgery for arachnoid cysts, surgery is recommended only if they cause a major problem; and it is not a very risky operation regardless.

We do not normally recommend surgery for pineal cysts, but surgery is recommended only if they grow during follow-up; as it is a very risky operation.

It will be better for a neurologist to answer these questions, but we aim to remove the pressure on the brainstem immediately with a proper operation. We can generalize the same situation; if it is possible to surgically treat the condition that increases the intracranial pressure, we plan an operation immediately.

I hope it wasn’t like what you’ve said, that is, it is indicated by angiography that it is such a vascular malformation – not just thought so. I also hope that your surgeon who recommended this treatment is a surgeon who has the experience to do the appropriate surgery; instead of saying “surgery is very dangerous” for a surgery that he can’t do. Otherwise cavernoma in fact can be surgically removed at low risk.

In such cases, that is, if a benign tumor is found in your brain; and if an experienced neurosurgeon suggests surgery for you, get the operation done immediately so that the tumor can be completely removed before the tumor turns into a malignant tumor. Other treatment options will be applied as a last resort, if the tumor cannot be completely removed and changes its temperament. In the meantime, do not forget to investigate whether doctors telling you that you should not be operated are really capable of performing this operation in the first place.

Metastases from the tumors of other parts of the body to the brain and within the brain can be successfully removed using contemporary surgical techniques and thus the life of the patient can be extended, and quality of life can be preserved.

If a disc hernia is in the form of extrusion or protrusion, especially if it has fallen into the spinal canal; the only treatment all over the world  is surgery. If weakness and cord compression is accompanying this, it is a much more dangerous situation; and the only solution is an emergency surgery. However, I would like to remind that in order to reach this decision; a surgeon must listen and examine the patient in detail, make electrical measurements from his nerves, obtain a CT as well as MR and dynamic x-rays of the spine. Success rates in neck surgery is higher than in waist surgery.

Of course, however, myelomalacia refers to spinal cord injury and whether a prosthesis or cage will be placed when the disc is removed during surgery will be decided on the basis of the age of the patient and results of radiological examinations.

We call your back pain an axial pain or mechanical back pain. In other words, the pain is due to the problems of the structures in your back. These can usually be treated with simple methods, such as weight reduction and muscle-strengthening exercises to be initiated after the pain is reduced by bed rest treatment. It is then appropriate to apply to a physiotherapist.

I do not know where and by whom your previous surgery was done, but I wish that you’d undergone the first surgery in a good center and by an experienced surgeon. I hope you are aware that this reoperation is a difficult task and that it cannot be done everywhere. I can of course perform all the motion preserving lumbar surgery alternatives, against all possible costs. This has no disadvantage compared to conventional screwing methods; but has many advantages for the future, if your age is not too old. It would be much healthier to tell you about all these face to face.

Especially young people working seated should make sure their seats and desks are of ideal ergonomic dimensions and shapes. They must also have a spring-loaded mattress that is maximum eight years old. Then they should pay attention to their diets so as to ensure that their weight is within normal limits, and also they must exercise regularly to maintain optimum muscle strength. Otherwise, it is inevitable that the surgeries to be performed will also fail.

There is no type of surgical procedure that I can’t perform, and no spine disease that can’t be solved with surgical procedures nowadays; but I always prefer surgery as the last resort. Have you depleted all the other options so that having surgery is definitely being considered? You appreciate that I cannot guide you with with only this much knowledge. If you wish my help; come to an examination and of course I will try to help you as much as I can.

Today, every age, every disease and every patient have an operation that can be done. However, surgery should always be considered as a last resort, especially in patients who are very young and very old. This is because each surgical method has its own risks and unfortunately the healing rate of the patient is directly proportional to the risk level of the surgery.

When these hemangiomas lead to pain in the area, they can be treated by filling them with bone cement in a closed operation.

I’m a private practice physician and I do not work in any hospital. I see my patients at my office and if I am going to do surgery, I hire various private hospitals in Ankara. Unfortunately, using the government reimbursement or the SGK channel; you do not have a chance to reach me. But of course I can direct you to experienced surgeons in big cities.

Everything seen in the examination should be written while reporting radiological tests. Sometimes there may be some phrases about the normal structural differences between people. If your doctor tells you that there are no problems with the report and the examinations, or if the report is saying normal in the conclusion section; chasing after the words in the text will only help you to lose your serenity.

Without patiently listening, making a thorough examination and completing some tests; it would not make sense to suggest anything about how to really treat the patient. I am sorry.