81. Nature of neurological deficits influences the treatment order preference for hip-spine syndrome

Abstract

BACKGROUND CONTEXT With the aging of society, patients with concurrent degenerative lumbar disorders and hip osteoarthritis, also referred to as the hip-spine syndrome, are frequently evaluated by both spine and arthroplasty surgeons. The decision-making can be straightforward in many but in others, the optimal treatment order—spine surgery or total hip arthroplasty (THA) first—remains unclear and complicated, especially when neurological deficits are involved. PURPOSE To compare, in spine and arthroplasty surgeons respectively, the treatment order preference among four typical scenarios of hip-spine syndrome with different neurological symptoms. STUDY DESIGN/SETTING Prospective survey at a professional society level. PATIENT SAMPLE Eighty-eight experienced spine (37) and total hip arthroplasty (51) surgeons from the Scoliosis Research Society (SRS) and The Hip Society, respectively. OUTCOME MEASURES Percentage of surgeons, in each specialty, choosing spine first in each scenario. METHODS Four fictional patients were devised to have concurrent degenerative lumbar disorders and painful hip osteoarthritis, with the primary neurological symptom in each scenario being (a) radicular leg pain, (b) neurogenic claudication, (c) leg weakness, and (d) myelopathy, respectively. A survey with history, physical examination, and radiographs was formulated and sent to clinical members of SRS and The Hip Society soliciting their treatment order preference—spine surgery or THA first—and their rationale. Surgeons choices, as measured by the percentage choosing spine surgery first, were compared among the four scenarios and between the two specialties. Text-mining was used to summarize the rationale for decision-making by identifying the most frequently used words in surgeons comments. RESULTS Responses were received from 37 (37/100, 37%) spine surgeons and 51 (51/101, 50%) arthroplasty surgeons across North America. In both specialties, the percentage choosing spine first varied in the same fashion among the four scenarios. Myelopathy, leg weakness, neurogenic claudication, and radicular pain, in that order, drove the decision-making toward spine first (97%, 73%, 46% and 8% of the spine surgeons and 86%, 45%, 33%, and 18% of the arthroplasty surgeons chose spine first ). Only in the scenario of leg weakness did a significant disparity noted between the two specialties: spine surgeons were more sensitive to weakness than arthroplasty surgeons (73% vs 45% choosing spine first, P=0.017). In both specialties, text-mining showed that the words that describe the symptoms or pathologies of the neurological deficits, such as stenosis, weakness, and myelopathy, were most frequently used in surgeons comments in most scenarios except for that of radicular pain. CONCLUSIONS The nature of neurological deficits influences the treatment order preference for hip-spine syndrome in both spine and arthroplasty surgeons, with myelopathy, weakness, neurogenic claudication, and radicular pain, in this order, driving the decision-making toward performing spine surgery first. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.