Results of diagnostics and treatment in patients with hip-spine syndrome

   Objective: to improve diagnostics and results of treatment in patients with hip-spine syndrome (HSS).

   Materials and methods. This study is prospective, and in it we included 100 patients with coexisting hip OA and lumbar spine stenosis with problems in right surgery tactics. All patients underwent clinical examination. We performed needle EMG and intraaticular injections under ultrasound control with ropivocaini 7,5 mg – 3,0. We divided our patients into two groups, in main group (55 patients) surgeries were based on needle EMG and on VAS after injections. In the second group (45 patients) we chose surgery depending only on VAS dynamic after injections. The clinical results before and after surgeries were rated depending on Oswestry, Harris and VAS scores.

   Results. In the main group depending on results of needle EMG and VAS after ultrasound-guided injections we formed patients into 4 subgroups. In subgroups 1.1-1.3 THA, spinal surgery or both were chosen as surgery treatment, the resuts in 3 moths were good. In subgroup 1.4 we discovered a neuro-muscular disease due to needle EMG results, no surgery was performed. In the control group we formed two subgroups – K1 and K2. In K1 subgroup there was a pain reduction (VAS 40 mm and more) and we performed a THA with bad results in 6 (of 29) patients. In K2 subgroup there were no pain reduction after intraarticular injections, neurosurgeons performed spinal surgeries witn bad results in 3 pateients (of 16).

   Discussion. Our examination algorithm in patients with HSS In control group, where the surgery type was based only on intraarticular anesthetic injection, 9 of 45 patients had bad results after surgery (THA or spinal surgery), and that is same as descrided in literature.

   Conclusion. Our examination algorithm in patients with coexisting hip and lumbar spine pathology is based on performing needle EMG and ultrasound-guided hip injections with local anesthetics. If there are denervation sings in paraspinal and low limbs` muscles we recommend spinal surgery first, THA then only if needed. If there are no signs of denervation – we recommend THA only. This algorithm helps to improve the diagnostics and surgical treatment results.

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