Surgical Correction of Trunk Balance in Spinal Deformities and in Instability of Hip Joints

Abstract

Introduction. Restoration of trunk balance is the basic task in surgical correction of spinal deformities and in hip joint instability of various etiology. Purpose. To analyze and to define the relevance of roentgen-anatomical parameters of spine-pelvis relationships for surgical correction of deformities in the thoracolumbar spine and of hip joint instability of dysplastic and neurogenic etiology. Material and methods. An X-ray analysis of parameters of the frontal and sagittal spine-pelvis balance was performed in 220 patients with dysplastic and neurogenic deformities of the thoracic and lumbar spine (n = 98) and with instability of hip joints (n = 122) but who were able to walk. They were operated in the neuro-orthopedic department with orthopedics in National Medical Research Center for Children’s Health. The reference group included 60 relatively healthy children without any scoliotic deformities of the spine and with stable hip joints. Dynamics of changes in X-ray parameters was analyzed using findings of orthostatic spondylograms from the indicated groups of children. The obtained data were compared with reference values. Results. The trial performed has revealed typical changes in spine-pelvis relationship parameters in patients with hip joint instability and spine deformities and in the reference group . The researchers also found out relations between various parameters of the trunk balance before and after surgical correction. Conclusion. While planning a surgical correction of trunk balance in spinal deformities, one should take into account parameters of spine-pelvis relationships, such as PI, SS, PT, SVA deviation and the mid-sacral line; and in case of hip joint instability - local roentgen-angulometric parameters of the femoral and acetabular components of instability. This is due to the fact that the lower the level of reconstructive surgical manipulation is located, the greater effect it has at the frontal and sagittal balance of the trunk.