The most severe spinal deformity that has progressed to the last degree is considered scoliosis of the fourth degree. There are not very many patients with this diagnosis, since, bypassing the initial, second and third stages, you can get to the fourth only if you ignore any treatment and refuse medical help. In addition to visible significant deformations, the patient experiences severe pain, which becomes permanent and leads to depression and depression. Therefore, when treating diagnosed scoliosis in the fourth stage, attention is paid not only to straightening the curvatures, but also to psycho-emotional restoration.
Scoliosis 4 degrees
Why does scoliosis develop to degree 4?
Despite the prevalence of such a disease as scoliosis, curvature of the spinal arch by more than 50 degrees, which is typical for the fourth degree of the disease, is not as common as the previous three.
The degrees of development of the disease in medical practice are classified according to the angle of deviation of the vertebral arch from the vertical to the side.
- The first is that the deviation relative to the norm reaches 10 degrees.
- The second is the deviation value in the range of 11-25.
- Third - the angle can reach a value from the range of 26-50 degrees.
- The fourth is an angle of 50 degrees or more.
Scoliosis degrees
It is necessary to treat the disease from the second stage. Only in the first, initial stage, can corrective measures be taken. Moreover, the greater the angle of deviation, the more complex and lengthy the treatment should be.
Important! With the fourth degree of pathology, vertebral changes can be not just severe, but irreversible. Therefore, in almost all cases, surgery is used, followed by a long recovery period.
Scoliosis grade 4 is treated surgically
Very often, already at the third degree, the patient is assigned, if he does not receive proper treatment, a third group of disability. And with the fourth degree - the second. This is due to the fact that the mobility of the arms or legs is limited (depending on the location of the curvatures), or dysfunction of the digestive, excretory, respiratory, or reproductive systems occurs.
By the way. If, with diagnosed scoliosis of grade four, the patient simultaneously experiences excessive stooping, he is diagnosed with grade 4 kyphoscoliosis.
Kyphoscoliosis 4 degrees
Curvatures are subject to classification and are divided into types in accordance with various parameters. In their form, for example, they are designated by letter equivalents, of which there are three types.
Table. Types of curvature.
| Type and shape | Peculiarities |
| The spine takes on a shape similar to the letter C | In this case, there is only one vertex of curvature. The first type can be determined visually, after examining the patient’s back in a straightened and bent state. |
| The shape of the vertebral arch resembles the letter S | There are two vertices of curvature. This species is also recognized visually, by two visible deviations from the vertical axis opposite to each other. |
| The spine is curved in a Z shape | This type, characterized by three distortions, is also determined visually, but is clarified using fluoroscopy. The latter type is diagnosed extremely rarely. |
Forms of scoliosis
Examples of surgical treatment of scoliosis in our clinic
The patient is 13 years old. Diagnosis: Idiopathic right thoracolumbar scoliosis 95°. Surgical treatment was performed: Posterior corrective transpediculocorporeal screw spondylodesis Th2-L4 using a transpedicular system.
The patient is 15 years old. Diagnosis: Idiopathic left-sided thoracolumbar scoliosis 98°. Surgical treatment was performed: Posterior corrective transpediculocorporeal screw spondylodesis Th2-L4 with transpedicular system + Universal Clamp system.
Patient 12 years old. Diagnosis: Neurofibromatosis type 1, right-sided thoracic scoliosis 90°. Surgical treatment was performed: Posterior corrective multi-rod transpediculocorporeal screw spondylodesis Th1-L4 with transpedicular system + Universal Clamp system.
Causes
It would seem that modern medicine has answers to many questions. But in most cases, doctors are unable to explain the cause of scoliosis. It is believed (in 80% of a hundred) that the disease has an unspecified cause and is idiopathic.
Causes and distribution of idiopathic scoliosis
Along with this, there are several factors that can provoke the development of scoliosis, their effect is especially important in childhood and in relation to adolescents.
Cost of surgery for scoliosis
We have come to one of the burning questions: how much does intervention to correct scoliosis arches cost? Within Russia, the cost for it, taking into account implantable devices, is 100-330 thousand rubles. The surgery offered by leading clinics in St. Petersburg and Moscow is the most expensive. However, it is worth considering that the cost of treatment is determined by factors such as the severity of the clinical problem, the type of scoliosis deformity, the type of endocorrector and the manufacturer of this product.
Abroad, surgical correction of scoliosis costs approximately from 40 thousand to 250 thousand US dollars. But this is exactly the case when a high price corresponds to impeccable quality, which cannot be said about domestic medicine. The lowest price threshold among countries leading in the field of orthopedics and neurosurgery was recorded in the Czech Republic - from 20 thousand euros. The most expensive treatment in the USA and Israel is from 50 thousand dollars or more, in Germany an average of 34 thousand euros.
Symptoms of pathology in degree 4
It should be noted that this degree of pathology is diagnosed most often in adults, but can also occur in children. If the disease is advanced and has entered the fourth stage, the following symptoms are observed.
- One shoulder is significantly higher than the other.
- Asymmetry in the shoulder blades.
- The pelvic line and waist line are skewed.
- The costal hump protrudes at the place(s) of curvature.
- After even light physical activity, persistent pain occurs in the back.
- The patient constantly feels tired and physically weak, and his ability to work becomes zero.
- Breathing problems begin with shortness of breath.
- There is a difference in leg length.
Adams test
Scoliosis in the last degree not only causes global deformations of the spine, but also changes the location of internal organs, disrupting their activity. As a result of pathological changes, the body loses its functioning of the immune system, various dysfunctions begin, colds become more frequent, various pains intensify, blood pressure begins to “jump,” arms and legs become numb, mobility and physical activity are limited.
By the way. At the same time, sooner or later, almost everyone experiences neuropsychiatric symptoms, which can only be dealt with with the help of a neurologist.
Prevention
Swimming is one of the best means of preventing spinal curvature. Prevention of scoliosis begins with maintaining correct posture. If your job requires you to sit at your desk for long periods of time, try not to hunch over, change your position regularly, and take breaks as often as possible.
During rest, you can walk or do simple physical exercises. It is also important to adjust the chair: it should support your back in the lumbar region and shoulder blades, removing excessive stress from the muscles located in these areas of the body.
To strengthen your spine and back, you should lead an active lifestyle : visit the pool, train on the horizontal bar. Proper organization of night sleep should also be part of the prevention of scoliosis. Avoid too soft mattresses and large pillows.
Place a bolster pillow under your head, supporting the cervical vertebrae, filling the cavity between the shoulder blades and the back of the head and preventing the spine from bending. The optimal position for sleeping is considered to be the fetal position (lying on your right side with your knees slightly bent). Sleeping on your stomach or back is not recommended.
Diagnostics
The deformation phenomena are so pronounced that they cannot be ignored; even compared to the third degree, they differ strikingly. But at this stage of the disease, diagnosis is carried out not only visually, but always with the use of radiography and even, possibly, MRI.
Radiography
Photos in standing, lying and traction positions
By the way. It is on the radiograph that the degree of scoliosis is determined, the exact angle of deformation is calculated, and the possibility of damage and deformation of internal organs is analyzed.
Cobb method
When studying X-rays taken in different positions of the body, the angle of curvature is measured using a special Cobb technique. Parallel lines along the vertebral endplates are drawn on the image. Then the resulting angle is measured between these lines.
Free surgery for scoliosis: how long to wait for the quota?
Surgical intervention for severe childhood and adult scoliosis is approved by order of the Ministry of Health of the Russian Federation and is subject to quotas. That is, the state, taking into account that you are disabled, undertakes to fully cover the costs of treatment. Therefore, you can have the operation completely free of charge, if the severity of your diagnosis does not contradict the established standards of the Ministry of Health: 3-4 degrees of scoliosis-type disorders.
But you should be aware that the process of obtaining a quota is quite lengthy. It may take a very long time until all the medical documentation you have prepared is verified, the relevant authorities give the go-ahead, and until you receive a long-awaited invitation to one of the clinics in Russia where similar treatment is practiced under the VMP program. The wait will last from 3 months to 1 year. In special cases, when a person needs immediate hospitalization, health authorities decide to provide the patient with VMP according to the quota without waiting in line.
Scoliosis: reviews of surgery and rehabilitation
Studying the scoliosis correction forum, a large audience speaks positively about the Czech Republic. Perhaps this is the only country that can be safely recommended to our citizens as the most advantageous place for Russian medical tourists: in terms of reasonable prices, ideal quality of medical services provided according to modern standards, and first-class organization of rehabilitation care.
Scar after surgery.
And finally, we will orient you regarding the features of postoperative rehabilitation. In the first two days you need to remain completely calm while lying in bed. You cannot move, roll over, or even turn your head. From the third day, very gentle therapeutic exercises are indicated, which are performed without leaving the hospital bed. On the third day, the exercise therapy methodologist prescribes gentle therapeutic exercises, which are first performed while lying in bed with the help of a specialist. Gradually, the exercise therapy complex is expanded and complicated. The main goal of the exercises is to increase the endurance of the ligamentous-muscular system.
Sitting is not allowed for at least 2 weeks. To protect the operated spine from unwanted stress and alleviate the person’s condition, from the moment you begin to move independently, it is recommended to wear a special removable orthopedic corset. At certain stages of recovery, massage and physiotherapy treatments are included. The discharge is issued approximately 14 days after surgery, but the begun course of recovery must be continued in a rehabilitation center. Before final recovery, you will need 6-12 months to conscientiously fulfill all the requirements of your treating doctor.
Rehabilitation period
What appearance your back will have after surgical treatment of scoliosis largely depends on the correct course of the rehabilitation period. After spinal surgery, patients must remain in a horizontal position for at least 2 days. During this time it is forbidden to turn your head or move. On day 3, the first exercise therapy session is held. A rehabilitation specialist shows light breathing exercises that are performed while lying down. Every movement of the patient is strictly controlled, the doctor helps him carry out the exercises correctly and gradually complicates the exercises as he recovers.
Subsequently, patients are discharged from the hospital, receiving comprehensive recommendations. Their nature is determined individually and depends on the treatment method for grade 3.4 spinal scoliosis.
Everyone, without exception, needs to avoid heavy lifting, heavy physical work and sudden movements. Sitting is allowed immediately after the intervention. Any activity can be carried out without wearing an orthopedic corset.
At a certain stage of rehabilitation, in the absence of complications, it is recommended to include massage sessions and physiotherapeutic procedures. Their nature and duration are individual parameters.
Children and adolescents recover faster after treatment for grade 3 scoliosis. But that is why they must follow the recommendations as accurately as possible in the postoperative period. On average, full recovery takes 6 to 12 months.
Reviews about surgery to remove stenosis and treat scoliotic deformity are easy to find. Almost every one of them talks about the difficulties of the recovery period. Indeed, it is not easy and involves many restrictions, but this is a small price to pay for restoring health. And the specialists at SL Clinic will do everything possible to make rehabilitation as easy and quick as possible.
Features of preparation
Regardless of which surgical method of scoliosis treatment is chosen, patients should undergo a comprehensive preoperative examination, including:
- CT;
- spirography;
- ECG;
- OAM and UAC.
Since surgery to correct grade 3 or 4 scoliosis is performed under general anesthesia, patients are hospitalized one day before the scheduled date. You must stop eating and drinking 12 hours before. Immediately 2 hours before the procedure, the medical staff measures blood pressure and assesses the condition of the lungs and cardiovascular system. If the indicators are normal, the patient is transferred to the operating room and a venous catheter is installed to administer medications and maintain an unconscious state for the entire required period.
Consequences of ignoring
Ignoring severe spinal curvature is difficult and in many ways unnatural. Lifelong disability is complicated by profound disorders of vital organs and systems: respiratory, cardiovascular, digestive, genitourinary. An imbalance in at least one of them leads to significant discomfort for a person. All this is often complicated by a disorder of the neuropsychic sphere - the patient develops severe depression, nervous breakdowns associated with the awareness of the ugliness and worthlessness of his body. The situation can get out of control to such an extent that a person decides to die without permission, just so as not to suffer.