Hip-Spine Syndrome: It’s Complicated (and Often Overlooked)

A patient with arthritis may experience hip or groin pain, as well as trouble walking. A patient with lumbar spinal stenosis (the narrowing of the spinal canal) may have pain down their leg, or neurologic symptoms such as numbness, tingling, or weakness.

“Hip-spine syndrome is a distinct syndrome where both hip and spinal problems occur together,” says James D. Kang, MD, a Mass General Brigham orthopaedic surgeon.

Because hip and spine disorders have overlapping presentations and symptoms, it often can be challenging for doctors to determine if a patient’s symptoms come from the hip, spine, or both. This can delay diagnosis and treatment. Many patients with hip-spine syndrome have seen several physicians and therapists, or they may have undergone various procedures that did not relieve their pain.

How is hip-spine syndrome diagnosed?

“The first order of business is to make sure that the treating physician considers hip-spine syndrome in their evaluation. The problem is that many centers are so sub-specialized that hip surgeons only see hip problems, and spine surgeons only see spine problems,” says Dr. Kang.

As chairman of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, Dr. Kang has a strong academic interest in hip-spine syndrome, and has made it a point to raise the faculty’s awareness of this disorder.

“Our department is at the forefront of public and academic awareness of this complicated syndrome. We are spearheading several efforts in orthopaedic research, including clinical investigations and patient outcome studies, trying to determine the optimal treatment plans for patients with hip-spine syndrome,” says Dr. Kang.

How is hip-spine syndrome treated?

For patients with minor hip or back pain, Dr. Kang typically prescribes rehabilitation and physical therapy. Only patients with more advanced hip-spine syndrome who do not respond to physical therapy require invasive treatments, such as an injection therapy, or surgery.

Dr. Kang also recommends lifestyle changes to those with hip and spinal disorders, including weight loss through diet and exercise. Since many patients with hip-spine syndrome have trouble walking or running, he recommends less active forms of aerobic conditioning, such as swimming and stationary biking.

For those with lower back problems, quitting smoking is also important. Long-term exposure to cigarettes has been shown to impair the flow of oxygen to tissues, and may cause damage to the discs and joints. Using anti-inflammatory medications can also help improve symptoms.