An important part of any spine exam is figuring out what other body parts can mimic low back pain (LBP). Is the buttock pain a patient experiences coming from the lumbar disc, lumbar facet joints, sacro-iliac joint (SIJ) or hip joint? Sometimes, figuring out the answer is difficult and more importantly, maybe it’s all three!
Orthopedic Surgeons understand the neck is connected to the low back connected to the hips etc. With the specialization of Orthopedic Surgery, hip and knee specialists focus on their body parts as do spine surgeons. However, the human body is a very complex organism and making decisions in isolation may delay improvement or affect surgical outcomes. Many hip surgeons are now making a concerted effort to identify hip patients with spine issues as well.
Many times patients have BOTH hip and spine issues. The decision on which area to treat or operate on first can be difficult. Identifying the main pain source can be difficult and may require serial injections (Lumbar Epidural, Sacro-iliac joint & hip joint) and advanced imaging to identify the main pain generator. Figuring where the majority of pain is coming from is important in instituting a treatment plan to include potential surgery.
Next time, your surgeon looks puzzled or utters “I’m not sure”, realize that figuring out where the pain is being generated from is not as easy as it sounds.
Paul Saiz, MD