Hip Spine Syndrome

Original Editor - Fatma ElZahraa
Top Contributors - Fatma ElZahraa, Kapil Narale, Kim Jackson, Jess Bell, Ali Gomaa and Misha Ahir

Definition

Hip-spine syndrome was first described by Offerski and Macnab in 1983 . It refers to concurrent hip osteoarthritis and lumbar spine degenerative disease in older adult patients. It was explained that the patient had combined LBP and groin pain. Recently,
It has expanded and includes other hip pathologies such as femoral-acetabular impingement, labral tear, hip dysplasia, and other lumbar pathologies such as facet arthropathy, lumbar spinal stenosis, and sacroiliac joint pain. There is a high prevalence of lumbar and lumbosacral pathologies combined with hip abductor tendon disorders.

Low Back Pain

Groin pain

Classification

Hip-spine syndrome is classified into four categories:

• Simple:  The primary source of symptoms is attributed to either the hip or the spine. That means either a patient who has lumbar pathology refers pain to the inguinal region, but the source is the spine and no hip pathology, or a patient who has hip pathology refers pain to the lumbar spine without any problem at the lumbar spine.
• Secondary: Hip and spine pain are interdependent such that the symptoms of one are secondary to a deformity or pathology of the other. This means that hip pathology causes spinal pathology or vice versa.
• Complex: There are concurrent pathological changes in both the hip and spine, with no clear primary source of pain.
• Misdiagnosis: Same Pain pattern but not related to the hip or lumber spine. pain may be due to structures such as a visceral problem, which refers to pain in the spine and hip regions.
  

Clinical Presentation

The patient may be presented with combined symptoms that may be overlapped, such as:

• Low Back pain (LBP).
• Groin pain.
• Pain in the buttocks.
• Pain down the lower limb.
  

Diagnostic Procedures

  Although it is hard to differentiate the cause of the symptoms either the spine or hip pathology, it is necessary to examine both to classify the type of Hip-Spine Syndrome, including:

•  Hip-examination.
• Spine examination includes a straight leg raise test, femoral nerve tension test, reflexes in lower extremities, and gait assessment.
• If the clinical examination remains inconclusive, an ultrasound or fluoroscopic-guided intra-articular hip injection is used.
• Hip Arthroscopy.

Management / Interventions

The literature still needs to fill the gaps in research on this syndrome. It is important to identify whether the patient is a hip user or a spine user to go through the proper treatment procedure for this condition. The possible treatments are:

• Physical therapy includes decreasing the pain, improving hip and spine range of motion, strengthening core muscles, improving the surrounding muscles' flexibility, and improving neural mobility using 1/2-end nerve glide.
• Some cases may need to undergo hip arthroplasty or decompression surgery for the lumbar spine.