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Nature of neurologic deficit drives order of surgery in patients with hip-spine syndrome
CHICAGO — When faced with patients with neurological deficits, such as myelopathy, in a fictional clinical scenario, spine surgeons and hip arthroplasty surgeons tended to have this factor drive their decision-making about the order in which they would treat the hip and lumbar spine in patients with hip-spine syndrome.
Kirkham B. Wood, MD, and his colleagues sought to determine if there was a particular treatment order surgeons preferred among patients with hip-spine syndrome. They also sought to determine the current thinking regarding how to manage patients with hip-spine syndrome, particularly when both parts of the anatomy were equally symptomatic.
“As we know, however, if patients are presenting with problems of the hip, as well as problems in the lumbar spine that are equally of significance clinically, the decision-making — in terms of which does one treat first — can be somewhat complicated and unclear,” Wood said. He noted previous research has shown the importance of choosing one pathology to treat first.
The researchers prospectively surveyed 37 experienced spine surgeons who were members of the Scoliosis Research Society and 51 experienced total hip arthroplasty surgeons who were members of The Hip Society about their decision-making in patients with hip-spine syndrome. They used the percentage of surgeons who gave “spine first” as their response as their main outcome for each of five clinical scenarios asked about in the survey.
The clinical scenarios proposed involved painful, but basic hip osteoarthritis that presented concurrently with either simple lumbar stenosis with neurologic claudication, degenerative lumbar spondylolisthesis with simple leg pain, somewhat advanced lumbar deformity or scoliosis with back pain, lumbar disc herniation with weakened muscle strength or upper disc herniation with myelopathy in the upper thoracolumbar region.
“In all the situations, surgery was felt to be indicated,” needed information about radiographs and clinical symptoms was provided and all the patients who “presented” had no treatment preferences, Wood said, noting that responses rates for the surveys were good.
“From the results, you can see that there is a wide range of variability,” Wood said.
For example, the division was 50/50 between hip and spine surgeons concerning how they would treat the patient in the first, lumbar stenosis scenario.
“When the patient had myelopathy, however, that vast number of respondents, both hip and spine, suggested treating the myelopathic problems first before proceeding with the hip osteoarthritis. That was the most common one choosing the nerve situation first as the primary driver in treatment choices,” Wood said.
“The nature of neurologic deficits seems to be the strongest driver in the surgical decision-making for surgeons in choosing treatment order,” he said. – by Susan M. Rapp
Reference:
Wood KB, et al. Abstract 81. Presented at: North American Spine Society Annual Meeting; Sept. 25-28, 2019; Chicago.
Disclosure: Wood reports he receives royalties from Globus and is a consultant for DePuy Synthes.