Problem of surgical priority choice at combined pathology of lumbar spine and hip joint (literature review)

Abstract

Pathological processes that affect the hip joint and the lumbar spine often coexist, leading to a significant loss of quality of life. Therefore, the problem of surgical treatment of degenerative diseases of the lumbar spine with conditions of hip joint arthritis is actual. Objective. To analyze the available scientific information regarding the priority of choosing a surgical intervention under the conditions of a combined pathology of the lumbar spine and hip joint. Methods. The research material was an analysis of relevant literature in specialized sources over the past 10 years. Results. The opinion of specialists about the possibility of direct influence of instability and sagittal spine balance on the functional orientation of acetabulum and, therefore, on the risk of impingement and dislocation of the hip joint was found. Conversely, flexion contracture in the hip joint can affect the sagittal balance of the spine and cause back pain. The indication for priority surgical treatment of the spine, in addition to acute or rapidly progressive neurological deficits, is the loss of sagittal balance, in particular, lumbar lordosis with subsequent changes in the sagittal profile. When, under the conditions of the hip joint arthritis, the pelvic tilt and the lordosis of the lumbar spine increase combined with the stenosis, spinal surgery is preferred. The combination of lumbar stenosis with hip joint arthritis may be a factor in increasing the risk of neurological deficits after hip arthroplasty. However, some authors in the case of combined pathology in any case recommend performing total joint arthroplasty in the first place because of its obvious excellent results, others did not find the best variant of the sequence of intervention based on the assessment of quality of life. Conclusions. Despite the long history of the study, the practical issues of treatment of the combined pathology of the lumbar spine and hip joint, the choice of optimal treatment tactics remain debatable and require further study