Ma С. Diagnostics of dynamic postural balance changes and basic principles of its correction in patients with degenerative spinal deformity after lumbar fusion

Object: dynamic postural balance in patients with degenerative spinal deformity after lumbar fusion. Objective: improving the diagnosis and treatment of disorders of the dynamic postural balance in patients with degenerative spinal deformities after lumbar fusion. Methods: clinical, radiological, radiometric, biomechanical using electromechanical computerized goniometer SpinalMouse (Idiag, Voletswil, Switzerland) and platform statograf, statistical. For the first time changes the dynamic postural balance of the spine in its sagittal movements in the preoperative period due lumbar segments miofixation when combined degenerative and antalgic deformations of the spine were revealed. First change in movement patterns of lumbar-pelvic rhythm in patients with degenerative spinal deformities was observed in the postoperative period. For the first time a violation of the dynamic postural equilibrium with increasing of walk energy intensity in patients with a combination of structural and functional spinal deformities in the stages of surgical treatment was found. For the first time the correlations between the parameters of the dynamic postural balance, spinal-pelvic balance, indicators of pain intensity, disability levels, kinesiophobia, anxiety which related to the expectation of pain on lumbar fusion stages were defined. For the first time a new pathogenetically substantiated method of selectively correcting kinesiotherapy for patients with degenerative spinal deformities was developed. Movement patterns of the lumbar-pelvic rhythm in the preoperative period were clarified. The balance parameters of vertical posture in the pre- and postoperative periods were clarified. The scientific knowledge about the dynamics of the intensity of low back pain, levels disability, kinesiophobia, as well as anxiety related to the expectation of pain at stages instrumental lumbar fusion in patients with degenerative spinal deformities was supplemented. A new method for the prevention and treatment of degenerative diseases of the lumbar spine was developed and introduced into practice. This method involves the use of selective therapeutic corrective exercise which intensity and modes depend on the value of K, the ratio indicators endurance of muscles - flexors and extensors of the lumbar spine, pelvis and hips and run up to the value of K in the range of 1.2-1.3 (patent 83739 Ukraine). The recommendations for the diagnosis of changes of lumbar-pelvic rhythm which complement assessment of functional disorders in patients with antalgic and degenerative spinal deformities have been developed and put into practice. The recommendations for the diagnosis of changes in the stabilography parameters which specify the functionality of the locomotor system in patients with lumbar osteochondrosis and degenerative lumbar spondylolisthesis were developed and put into practice. The results of the dissertation research introduced into clinical practice in SI "Sytenko Institute of Spine and Joint Pathology National Academy of Medical Science of Ukraine", KU "Dnipropetrovsk Regional Clinical Hospital named Mechnikov", KU "Donetsk Regional Trauma Hospital", KLPU "Central Clinical Hospital № 4 in Donetsk," KLPU "Central City Hospital number 14 in Donetsk", Kuoza "Kharkiv City Hospital number 18 " and in the educational process of the main department of Kharkiv National Medical University of the Ministry of Health of Ukraine, Uzhhorod National University of Ministry of Education and Science of Ukraine. Traumatology and Orthopaedics.