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Differentiating Hip Pathology From Lumbar Spine Pathology

Key Points of Evaluation and Management

Buckland, Aaron J. MBBS, FRACS; Miyamoto, Ryan MD; Patel, Rakesh D. MD; Slover, James MS, MD; Razi, Afshin E. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: February 2017 - Volume 25 - Issue 2 - p e23–e34
doi: 10.5435/JAAOS-D-15-00740
Instructional Course Lecture
CME

The diagnosis and treatment of patients who have both hip and lumbar spine pathologies may be a challenge because overlapping symptoms may delay a correct diagnosis and appropriate treatment. Common complaints of patients who have both hip and lumbar spine pathologies include low back pain with associated buttock, groin, thigh, and, possibly, knee pain. A thorough patient history should be obtained and a complete physical examination should be performed in these patients to identify the primary source of pain. Plain and advanced imaging studies and diagnostic injections can be used to further delineate the primary pathology and guide the appropriate sequence of treatment. Both the surgeon and the patient should understand that, although one pathology is managed, the management of the other pathology may be necessary because of persistent pain. The recognition of both entities may help reduce the likelihood of misdiagnosis, and the management of both entities in the appropriate sequence may help reduce the likelihood of persistent symptoms.

From the NYU Hospital for Joint Diseases, New York, NY (Dr. Buckland, Dr. Slover and Dr. Razi), Fair Oaks Orthopaedics, Fairfax, VA (Dr. Miyamoto), and the Department of Orthopaedic Surgery, University of Michigan Health System, Ann Arbor, MI (Dr. Patel).

Dr. Miyamoto or an immediate family member serves as a paid consultant to or is an employee of CONMED Linvatec and has stock or stock options held in Tornier. Dr. Patel or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of Stryker Spine, and serves as a paid consultant to or is an employee of Globus Medical and Stryker. Dr. Slover or an immediate family member has received research or institutional support from Zimmer Biomet and DJO Global. Dr. Razi or an immediate family member serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, the American Orthopaedic Association, and the Brooklyn Orthopaedic Society. Neither Dr. Buckland nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received December 21, 2015

Accepted September 16, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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