Hip spine syndrome – A case series and literature review

Hip spine syndrome refers to the overlap in symptomatology between osteoarthritis of the hip and degenerative lumbar stenosis. In patient presenting with pathology in both areas, definitively establishing one as the source of a patient's pain, can be challenging. On history the attending spinal surgeon needs to note the significance of groin pain, which should alert him / her to a probable symptomatic hip. The specifics of the history related to neurogenic claudication, which characterizes patients with symptomatic degenerative lumbar stenosis, is often only elicited with specific questioning. On examination limited internal rotation of the hip, and a positive FADIR test, are regarded as indicative of hip pathology. Regarding degenerative lumbar stenosis, the majority of patients have a normal neurological examination, with subtle motor deficits and depressed ankle reflexes, only being seen in severe disease. In patients with an ambiguous history and clinical examination, diagnostic testing by experiencing a significant reduction in pain post undergoing a fluoroscopically guided intra-articular local anesthetic hip injection, is regarded as a reliable indicator that the source of pain is in fact hip related. Unfortunately, regarding patients with symptomatic degenerative lumbar stenosis, a lack of response to a fluoroscopically guided epidural injection, is an unreliable indicator that they will not benefit from surgical decompression. We present a series of 2 patients who presented to our unit complaining of progressive lumbar pain radiating to the groin and thigh, with normal neurological examinations. Our subsequent radiological investigations revealed one patient to have, and the other to have had, dual pathology in both areas. Through an inter-disciplinary approach, comprising communication between neuro-spine and orthopedic arthroplasty, we were able to successfully manage both patients. Our case series serves to highlight this specific patient sub-set, and affords an approach to the management of these challenging patients.