Publication
Title
What patient parameters influence lumbar stiffness in patients with hip pathology?
Author
Abstract
Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case-cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep-seated radiographic assessment to measure lumbar lordosis (ALL) (stiffness: ALL < 20 degrees), hip flexion (APFA: pelvic femoral angle), and degree of degenerative-disc-disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging, allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor-and extensor-muscle atrophy (Goutallier classification). Mean ALL was 45 degrees (range: 11 degrees-72 degrees) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (n = 22) had less ALL than those with no/single level (n = 43) DDD (34 degrees [range: 11 degrees-53 degrees] vs. 51 degrees [21 degrees-72 degrees]; p < 0.001). Number of DDD levels correlated strongly with ALL (p =-0.642; p < 0.001). Spinal stiffness was only seen in patients with >-4 DDD levels. There was no correlation between ALL and facet orientation (p > 0.05). ALL correlated strongly with extensor atrophy at L3-L4 (p = -0.4 73), L4-L5 (p = -0.52 0), and L5-S1 (p = -0.473) and poorly with flexors at L4-L5 (p = -0.134) and L5-S1 (p = -0.227). Lumbar stiffness is dependent on modifiable (muscle atrophy) and nonmodifiable (extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification >= 4 DDD levels should alert surgeons of increased THA instability risk. Level of evidence: level IV, cohort series.
Language
English
Source (journal)
Journal of orthopaedic research. - New York, N.Y.
Publication
New York, N.Y. : 2023
ISSN
0736-0266
DOI
10.1002/JOR.25749
Volume/pages
(2023) , p. 1-12
ISI
001113284400001
Pubmed ID
37997704
Full text (Publisher's DOI)
Full text (open access)
The author-created version that incorporates referee comments and is the accepted for publication version Available from 24.05.2024
Full text (publisher's version - intranet only)
UAntwerpen
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identifier
Creation 19.12.2023
Last edited 10.01.2024
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