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Difficulty of diagnosing the origin of lower leg pain in patients with both lumbar spinal stenosis and hip joint osteoarthritis.
- Source :
-
Spine [Spine (Phila Pa 1976)] 2012 Dec 01; Vol. 37 (25), pp. 2089-93. - Publication Year :
- 2012
-
Abstract
- Study Design: Case series.<br />Objective: To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis.<br />Summary of Background Data: Pain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain.<br />Methods: We reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Pain only at the ipsilateral lateral aspect of the lower leg but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. The symptoms resolved after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients.<br />Results: Leg pain did not resolve after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free.<br />Conclusion: It is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.
- Subjects :
- Aged
Arthroplasty, Replacement, Hip
Biomechanical Phenomena
Decompression, Surgical
Female
Humans
Magnetic Resonance Imaging
Middle Aged
Myelography
Nerve Block
Osteoarthritis, Hip complications
Osteoarthritis, Hip physiopathology
Osteoarthritis, Hip surgery
Pain etiology
Pain prevention & control
Pain Measurement
Predictive Value of Tests
Range of Motion, Articular
Spinal Fusion
Spinal Stenosis complications
Spinal Stenosis physiopathology
Spinal Stenosis surgery
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Hip Joint diagnostic imaging
Hip Joint physiopathology
Hip Joint surgery
Lumbar Vertebrae diagnostic imaging
Lumbar Vertebrae pathology
Lumbar Vertebrae physiopathology
Lumbar Vertebrae surgery
Osteoarthritis, Hip diagnosis
Pain diagnosis
Spinal Stenosis diagnosis
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1159
- Volume :
- 37
- Issue :
- 25
- Database :
- MEDLINE
- Journal :
- Spine
- Publication Type :
- Academic Journal
- Accession number :
- 22588380
- Full Text :
- https://doi.org/10.1097/BRS.0b013e31825d213d