Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity

Abstract

Background context: Significant lumbar spinal stenosis and lower extremity arthritis may coexist in the elderly. This combination of lumbar stenosis with radiculopathy and lower extremity arthritis may lead to diagnostic uncertainty.

Purpose: To describe the findings of hip spine syndrome, a constellation of symptoms with extensive overlap of radiculopathy and lower extremity arthritis.

Conclusions: Evaluation of the patient with lower extremity pain in consideration for total joint arthroplasty should include functional inquiry of the spinal nerves. Diagnostic tests and injections may allow an informative weighting of the patient's symptoms, leading to a better understanding of the patient's pain syndrome. There is a group of patients who have a total hip arthroplasty and then develop or may continue to have pain of groin and buttock, secondary to sciatica of lumbar spinal stenosis. For the patient undergoing total hip arthroplasty with asymptomatic spinal stenosis, there may be increased neurological risk at surgery, related to the stenosis. The patient with both conditions may require surgical decompression of the lumbar stenosis as well as joint arthroplasty of the arthritic joint.