Spinal Pelvic Disorder

Emerging Advances on the Horizon

March 22, 2023 – OrthoSpineNews –

What is Spinal Pelvic Disorder?
Spinal pelvic disorder, or SPD, is a condition that negatively affects the spine and pelvis. It is caused by a misalignment in the spine and pelvis that can cause pain, discomfort, and other symptoms. It can also affect the quality of life, making everyday tasks more difficult. The condition is often caused by an imbalance between the muscles in the back, pelvis, and hips. This imbalance can cause the spine and pelvis to be out of alignment, leading to the symptoms of SPD. The condition can affect people of all ages, and it is more common in women.

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Symptoms of Spinal Pelvic Disorder
The symptoms of spinal pelvic disorder can vary from person to person, and they can range from mild to severe. Some of the most common symptoms include:

• Pain and discomfort in the lower back, pelvis, hips, and legs
• Pain when standing or walking
• Difficulty standing for long periods of time
• Difficulty sitting for extended periods of time
• Difficulty sleeping
• Numbness or tingling in the legs and feet
• Muscle spasms
• Limited range of motion
• Weakness in the legs and feet
• Fatigue

Causes of Spinal Pelvic Disorder
Unfortunately, the incidence rate of SPD seems to be increasing as the population ages and becomes more sedentary.  Other factors contributing to spinal disorders include:

• Excess weight or obesity.
• Improper lifting techniques.
• Nutrition and lifestyle habits such as sedentary lifestyle, low calcium intake, or smoking.
• Other conditions such as osteoarthritis, rheumatoid arthritis, or thyroid disease.
• Overuse from exercise or occupational movement.
• Weak core muscles
• Poor posture.

Diagnosis of Spinal Pelvic Disorder
Patient assessment usually includes a series of tests to assess range of motion and muscle strength. This can help definitively determine risk and validate the need for additional diagnostic tools.  Three of the most common diagnostic tools include:

• X-rays. X-rays can reveal vertebral (spinal column) problems, tumors, fractures or degenerative changes in the spine.
• CT scan. A CT scan can provide a clearer image of abnormalities seen on X-ray. This scan uses computers to form a series of cross-sectional images that can define bone, disk and other problems.
• MRI. MRI uses a strong magnetic field and radio waves to produce computer-generated images. This test is helpful for looking at the spinal cord and identifying herniated disks, blood clots or other masses that might compress the spinal cord.

Treatment Options for Spinal Pelvic Disorder
The treatment for spinal pelvic disorder will depend on the underlying cause of the condition. Some of the most common treatments include:

• Physical therapy and exercises to strengthen the core muscles and improve range of motion
• Stretching and massage to help relax the muscles
• Orthotics or braces to provide support to the spine and pelvis
• Medication to reduce pain and inflammation
• Surgery to repair any structural damage.  Factors such as advanced spinal degeneration, deformity, and prior fusion alter the biomechanics of the spinopelvic unit. Attention should be paid to recognizing these issues during the work-up for a total hip arthroplasty as they can result in an increased risk of dislocation.¹

Emerging Treatment Strategies – Reverse Hip Replacement System (Reverse HRS)
A major problem with SPD is the version and position of the acetabular component changes when the patient is sitting versus laying down because of the stiffness of the spine. This can substantially increase the risk of dislocation, impingement and instability after traditional hip replacement surgery.

In patients with concurrent spine and hip degeneration, the surgeon must pay close attention to appropriate implant positioning and have consideration for implants with enhanced stability to minimize the risk of dislocation.  The functional motion of the hip has been emphasized recently and several publications have pointed to the position of both the acetabular and femoral components, as well as the arc of motion of the femur coupled with pelvic rotation, as important contributors to hip stability.¹

Our institution, Shore Medical Center, Somers Point, NJ, has enrolled the first patient into a pivotal clinical study to further evaluate the Reverse HRS for use in primary total hip arthroplasty (THA).  One of the advantages of the Reverse HRS is the ability of the implant to stay stable and not have impingement even as the cup changes position in patients with SPD.

Tips for Managing Spinal Pelvic Disorder
There are a few things you can do to manage your spinal pelvic disorder and reduce your symptoms. Here are some tips to get you started:

• Practice good posture: Good posture can help reduce the strain on your spine and pelvis and minimize the symptoms of SPD.
• Exercise regularly: Regular exercise can help strengthen your core muscles and improve your range of motion.
• Take frequent breaks: Taking frequent breaks from activities that put strain on your spine and pelvis can help reduce the symptoms of SPD.
• Wear supportive footwear: Wearing supportive footwear can help reduce the strain on your spine and pelvis.
• Get enough rest: Getting enough rest can help your body recover from the strain of SPD.
• By following these tips, you can help reduce the symptoms of SPD and improve your quality of life.

Products and Services to Help with Spinal Pelvic Disorder
There are a number of products and services available to help people with spinal pelvic disorder manage their symptoms. Here are a few of the most popular:

• Orthotics and braces: Orthotics and braces can provide support to the spine and pelvis and help reduce the symptoms of SPD.
• Physical therapy: Physical therapy can help strengthen the muscles and improve range of motion.
• Pain-relieving medications: Pain-relieving medications can help reduce the pain and discomfort of SPD.
• Massage: Massage can help relax the muscles and reduce the strain on the spine and pelvis.
• Supportive footwear: Wearing supportive footwear can help reduce the strain on the spine and pelvis.
• By using these products and services, you can help manage the symptoms of SPD and improve your quality of life.

Conclusion
Spinal pelvic disorder is an increasingly common condition that affects the spine and pelvis and can cause a wide range of symptoms. There are a number of diagnostic and treatment strategies, including emerging surgical devices such as the Reverse HRS.

1. The Hip-Spine Challenge; Chavarria, Joseph MD; Douleh, Diana MD; York, Phillip MD; The Journal of Bone and Joint Surgery 103(19):p 1852-1860, October 6, 2021. 

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Stephen J. Zabinski, MD, Director of the Division of Orthopaedic Surgery at Shore Medical Center, Somers Point, NJ.

Dr. Zabinski obtained his medical degree from Columbia College of Physicians and Surgeons, Columbia University in 1991. He completed his orthopedic surgical residency and training at the Hospital for Special Surgery, Cornell University in 1996. Dr. Zabinski is board certified and specializes in joint replacement surgery, shoulder and elbow surgery, minimally invasive surgical procedures and sports medicine. He has served appointments as Assistant Clinical Professor of Orthopaedic Surgery at Jefferson University Hospital and The Hospital for Special Surgery at Cornell University.