Surgical strategy for degenerative scoliosis combined with hip disorder

English Keywords:Degenerative scoliosis  Hip disorder  Spinal surgery  Hip replacement

English Abstract:

  【Abstract】 Objectives: To investigate the surgical strategy for degenerative scoliosis combined with hip disorder. Methods: Data of 180 patients treated with the posterior fixation of lumbar spinal fusion from June 2012 to June 2015 in Chinese PLA General Hospital and The General Hospital of Northern Theater Command were retrospectively reviewed. Among which, 26 patients undergone the spinal surgery and total hip replacement were divided into group A and group B. Group A consisted of 11 patients who underwent the total hip replacement first, and group B consisted of 15 patients who underwent the lumbar spinal surgery first. The average follow-up period was 1.5 years(range, 1-3 years). The general conditions were compared, including age, gender, operative time, blood loss, and hospitalization period. Then the shoulder balance, Cobb angle, sagittal vertical axis(SVA), lumbar lordosis(LL), thoracic kyphosis(TK), pelvic tilt(PT), sacral slope(SS), anteversion of acetabulum(AA), the Oswestry disability index(ODI) score, VAS score and Harris score were compared between the 2 groups before operation and at the last follow-up. Results: For group A and group B, the mean ages were 64.2±3.4 years(58-69) and 64.3±2.5 years(60-68) respectively; in THA, the blood loss were 420.9±2.6ml and 331.3±26.7ml, the operative time were 2.3±0.2 hours and 1.6±0.2 hours, and the hospitalization time were 6.8±0.6 days and 5.9±0.8 days respectively; in spinal surgery, the blood loss were 873.6±37.8ml and 812.0±19.7ml, the operative time were 6.6±0.3 hours and 6.4±0.3 hours, and the hospitalization time were 14.7±0.6 days and 17.4±0.7 days respectively in the two groups. The blood loss and operative time of THA, the hospitalization time in group A were more than that in group B(P<0.01). But the hospitalization time of the spinal surgery in group A was less than that in group B(P<0.01). The Cobb angle, LL, PT, SS, SVA, TK, AA, ODI score, leg pain VAS score and hip joint Harris score between the two groups before operation were not statistically different(P＞0.05), and were comparable. At the final follow-up, in group A and group B the Cobb angle were 2.8°±1.7° and 3.0°±1.3°, LL were 43.7°±1.7° and 44.9°±1.8°, PT were 23.3°±0.9° and 23.8°±1.4°, SS were 39.9°±1.3° and 39.9°±0.8°, SVA were 5.7±0.4cm and 5.7±0.2cm, TK were 28.4°±2.1° and 27.9°±2.7°, and VAS scores were 2.8±0.8 and 2.9±1.0 respectively, and all these were with no significant differences(P>0.05) between the two groups. Whereas, the AA were 26.8°±1.0° and 20.5°±1.5°, ODI were 25.8±1.0 and 17.5±2.0, and Harris scores were 81.3±1.8 and 88.0±1.2 respectively in group A and group B. The AA and ODI score of group A were more than that of group B(P<0.01), and Harris scores of group A were less than that of group B(P<0.01). At postoperative follow-up, 5 patients in group A showed imbalance shoulders and inclined trunk; and after spinal surgery and before THA, 8 patients in group B were unable to walk due to limited motion of the hip joint, which were more severe than that before the spinal surgery. Conclusion: To perform spinal surgery before THA can solve the lumbar nerve symptoms and correct the sagittal imbalance of the spine in the treatment of the coexisting of degenerative scoliosis and hip disease, which simplifies the difficulty of the joint replacement and correct the sagittal imbalance left by spinal surgery. However, at the same time there was the risk of severe limitation of walking during the period after spinal surgery and before THA.