Hip and Spine Problems in the Elderly

It is not uncommon for adults 65 and older to develop hip and spine problems at the same time. Degenerative osteoarthritis of the hip along with degenerative lumbar spinal stenosis (DLSS) is referred to as the hip-spine syndrome. In this article surgeons from the Vanderbilt Orthopaedic Institute in Nashville, Tennessee review this condition.

Starting with the diagnostic process, the authors walk us through the history, physical exam, and diagnostic tests needed to make a differential diagnosis. Differential diagnosis means the physician considers all the possible causes of hip and spine pain presented at the same time and makes a decision about which one is the real, true cause of the problem.

For example, 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 surgeon 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. The processes related to both conditions could easily be inter-related and affected one another. In other words, what makes one condition worse can also make the second problem worst. Treatment is needed to address all the individual problems before patient comfort and quality of life are restored.

Even when surgery is indicated, physical therapy is 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 when fully recovered. Anyone who experiences pain beyond the expected time (after the first surgery) should be encouraged to see the surgeon for follow-up. A second problem may be diagnosed.