Tell me about hip-spine syndrome

Q: Have you ever heard of something called the hip-spine syndrome? It's what the doctor says I have. Just wondered what you could tell me about it.

A: Degenerative osteoarthritis of the hip along with degenerative lumbar spinal stenosis (DLSS) is referred to as the hip-spine syndrome. This is actually a fairly common problem in older adults. The term "degenerative" usually indicates it's something that happens over time as we age.

The processes related to both conditions could easily be inter-related and affect one another. In other words, what makes one condition worse can also make the second problem worst. For example, lumbar stenosis (narrowing of the spinal canal) causes pain when standing upright.

The affected person tends to stoop forward to get pressure off the nerves. That results in shortening of the hip flexor muscles along the front of the body and can contribute to problems with posture, balance, and alignment. The end result may be worsening of the already developing hip arthritis.

Other conditions that can cause symptoms like hip-spine syndrome include bone fractures, neuropathy from diabetes, poor circulation, labral tears of the hip, or even cancer metastasized to the bones. X-rays, MRIs, CT scans, myelography, and electromyography are all ways to evaluate the symptoms patients are presenting with. Sometimes the physician must rely on diagnostic treatment such as steroid injection to help sort out what is hurting and why.

Once the source of pain has been identified, then treatment to manage those symptoms is started. For example, conservative (nonoperative) care can be provided first to obtain pain relief before considering the more invasive surgery.

The difficulty is in knowing when two or more different sources of pain are present. Treatment is needed to address all the individual problems before patient comfort and quality of life are restored.

Physiotherapy is often recommended first. Restoring balance, alignment, and muscle flexibility is an important part of the treatment process. Studies show a poorer result if problems with posture, alignment, and flexibility are not taken care of before surgery (e.g., replacing the hip without addressing the problem of tight hip flexor muscles).

Treating one problem (hip) without treating the second area (spine) may lead to some relief of symptoms but not all. The patient is not happy nor satisfied with the results. A second surgery may be needed that could have been avoided otherwise.

Patients who have severe spinal stenosis should receive treatment for this problem first, then have a hip replacement (if needed) when fully recovered. Anyone who experiences pain beyond the expected time (after the first surgery) should be

Reference: Clinton J. Devin, MD, et al. Hip-Spine Syndrome. In Journal of the American Academy of Orthopaedic Surgeons. July 2012. Vol. 20. No. 7. Pp. 434-442.

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