Федеральное государственное бюджетное учреждение «Российский научный центр «Восстановительная травматология и ортопедия» им. акад.

No abstract

1240% of people with low back pain have spinal instability in degenerative-dystrophic diseases of the spine. The paper highlights the biomechanical basis for the development of segmental instability and discusses various hypotheses for the development of this condition. The authors describe the modern methods of neuroimaging used in the diagnosis of segmental instability, such as radiography, functional spondylography, CT, functional CT, MRI. Further, the paper presents provocative tests used in the diagnosis of instability: passive extension of the lumbar spine, standing, sitting, pron-instability, "scissors", compression of spinous processes, forward lean in standing position, and some others. The authors shared their experience in diagnosing segmental instability. However, the discrepancy between the data of instrumental examinations and patient complaints, poorly studied rotational and lateral instability in osteochondrosis indicate the need for a more detailed study of the instability of the spine as a whole.

Relevance Compensatory mechanisms of the lumbar spine-pelvis complex in concurrent degenerative changes remain a poorly understood problem. Numerous publications report data either from the point of view of spinal pathology or from the point of hip joint damage. Objective To evaluate changes in the parameters of the spine-pelvis sagittal balance in patients with the hip-spine syndrome. Materials and methods Two groups of patients with hip-spine syndrome were analysed: 1) "Hipspine" group (n = 54) and 2) "Spine-hip" group (n = 66). All patients underwent radiographic examination. Radiographs of the spine with the capture of the head and hip joints in the anteroposterior and lateral projections in the standing position were taken. Results In the first group, the position of the pelvis was within normal anteversion or pelvic hyperanteversion. In the second group, pelvic retroversion was revealed; normal position of the pelvis (without its compensatory deviation) was present only in several cases. Discussion Regularities in the compensatory mechanisms in the hip-spine syndrome variants have been identified. However, cases with pelvic retroversion require further study and assessment of the balance after surgery. Conclusion Compensatory mechanisms in hip-spine syndrome depend on the dominance of the pathological process (joints or spine), which must be considered in evaluation of the parameters of the sagittal balance in these patients.