Dynamic Changes in Lumbar Spine Kinematics During Gait May Explain Improvement in Back Pain and Disability in Patients With Hip-Spine Syndrome

Abstract

Study Design. Prospective cohort. Objective. Determine if total hip arthroplasty (THA) changes lumbar spine kinematics during gait in a manner that explains the improvements in back pain seen in patients with hip-spine syndrome. Summary of Background Data. For patients with hip-spine syndrome, improvements in both hip and back pain have been demonstrated after THA; however, the exact mechanism of improvement in back pain remains unknown, as no corresponding changes in lumbar spine static radiographic parameters have been identified. Methods. Thirteen patients with severe, unilateral hip osteoarthritis scheduled to undergo THA with concomitant back pain and disability were tested at baseline and 6 months after THA. Harris Hip Score (HHS) and Oswestry Disability Index questionnaires were completed; the static orientation of the spine and pelvis were measured on standing radiographs, and lumbar spine kinematics were measured during treadmill walking using a validated measurement system that matched subject-specific bone models created from CT scans to dynamic biplane radiographs. Results. After THA, both the Oswestry Disability Index (36.3–11.3, P<0.001) and Harris Hip Score (55.7–77.9, P<0.001) improved; however, there were no changes in static intervertebral or pelvis orientation. During gait after THA, the overall lumbar spine (L1 to L5) was less lordotic from heel strike to contralateral toe off (P<0.001), the L4 and L5 vertebra were less anteriorly tilted by 3.9° (P=0.038) from midstance to contralateral heel strike and by 3.9° (P=0.001) during stance, respectively. Conclusion: The decreased anterior tilt of the 2 lowest lumbar vertebrae and the corresponding loss of lumbar lordosis may reduce facet loading during the stance phase of gait after THA. This change in lumbar spine kinematics during gait is a potential mechanism to explain the observed improvements in back pain and disability after THA. Level of Evidence. 4.

Response to Letter to the Editor by Fukuda et al. Regarding Dynamic Changes in Lumbar Spine Kinematics During Gait May Explain Improvement in Back Pain and Disability in Patients With Hip-Spine Syndrome

“…Patients included in the present study 1 were meticulously screened for hip and spine pathology and underwent extensive physical exam by both spine and arthroplasty specialists. Ultimately, while patients were seen by a spine surgeon and had spinal pathology, the physical exam and imaging findings suggested that hip pathology was predominant.…”