Simultaneous L5-S1 anterior lumbar interbody fusion and total hip arthroplasty through minimally invasive anterior approaches in hip-spine syndrome

Abstract

The coexistence of degenerative spine disease and hip osteoarthritis (OA) is one of the most commonscenarios of Hip Spine Syndrome (HSS). Usually, when a patient with an HSS is referred to surgery, twoseparate treatments are considered for the hip and spine in two different hospitalization steps. We presenta novel strategy of HSS treated simultaneously with an anterior lumbar interbody fusion (ALIF) and atotal hip arthroplasty (THA) through an anterior minimally invasive surgery (AMIS). A simultaneousminimally invasive L5-S1 ALIF and an anterior minimally invasive total hip arthroplasty. (AMIS-THA)was performed on a 48-year-old man with left hip OA, and previous failed L5-S1 posterior instrumentedsurgery resulted in non-union and residual spinopelvic mismatch. A specific blended analgesic protocol(epidural injection plus deep sedation) was applied. Radiological evaluation showed improvement of L5-S1lordosis from 10° preop to 22° postop. Intraoperative total blood loss was 250 ml, and total surgical timewas 120 minutes. Four hours after surgery, the patient showed full ability to walk without crutches. Hewas discharged on post-operative day three. As far as we know, this is the first described case in which HSShas been treated with simultaneous single surgical step by two anterior minimal invasive approaches. Itwas planned to avoid a delay in one of the surgical procedures and to set the hip appropriately for the newlordosis, restoring the ideal spino-pelvic alignment and the hip’s full range of motion.