What imaging is best to diagnose the source of hip-spine pathology symptoms?

摘要

There has been recent interest in joint arthroplasty in terms of how spinal motion might influencecomponent position in patients undergoing total hip arthroplasty. In fact, recent studies have shownan increased risk of dislocation in patients with prior spinal fusions. The risk increases with themore levels fused or if the fusion extends to the sacrum. The fusion leads to a stiff spine, andpatients are unable to go through the normal pelvic motion that occurs when going from a standingto a sitting position or vice versa, and, as a result, may increase their risk of THA dislocation. Thisresearch has prompted a number of surgeons to recommend that patients with underlying spinalpathology, such as lumbar stenosis or lumbar spondylosis, or previous spine surgery obtain certainimaging prior to THA to assess pelvic motion to determine their potential risk of postoperativeinstability. The most commonly used imaging is a standing and a sitting lateral of the pelvis and spine. This could bedone with standard radiographic techniques or with advanced 2-D or 3-D imaging techniques, such as thoseavailable with EOS Imaging equipment. Additional information may be gotten by having the patient obtain a thirdradiograph that is done while the patient is leaning forward. Finally, some companies offer patient-specific planningfor THA with information obtained from CT.