Is there a link between spinal fusion and degeneration of the hip joints?

Interesting article from Pritzker School of Medicine, Chicago, USA. Sean Pirkle has studied Hip-spine syndrome in more than two million patients.

What is Hip-spine syndrome?

Hip-spine syndrome (hip disease as a result of spinal fusion) has been well studied since it was first described by Offierski and MacNab in 1983. Today, there is considerable evidence linking hip symptoms to previous vertebrae. operations. Recent studies have reported an increased incidence of hip dislocation in patients who have undergone fusion spinal surgery. However, the effect of spinal surgery on the natural degeneration of the hip joint remains the subject of research. The aim of this study was to determine the relationship between lumbar fusion surgery and the acceleration of hip degeneration by analyzing the period to future total hip arthroplasty in patients with previous osteoarthritis of the hip.

Research Methods

This retrospective cohort study was not conducted using the PearlDiver research program. The initial group of patients is determined by the presence of diagnostic codes for osteoarthritis of the hip. Patients with were categorized according to whether they had undergone lumbar fusion after being diagnosed with hip disease. Survival curves with respect to total hip arthroplasty were generated by comparing a control group of patients without lumbar fusion with patients with lumbar fusion. To assess the influence of the length of the stabilization construct, the lumbar fusion group was then divided according to the number of stabilized levels (1–2, 3–7 or ≥ 8 levels). Then the risk factors for the number of operated levels, the patient's age and gender are calculated.

What are their results?

A total of 2,275,683 patients met the criteria for inclusion of the authors. The analysis of the logarithmic rank did not show a significant difference in the frequency of total arthroplasty of the hip joint in time between the group without lumbar fusion (2,239,946 patients) and the group with lumbar fusion (35,737 patients; p = 0.40). When patients were divided according to the number of surgery levels, again no differences were found in the incidence of total hip arthroplasty during the study period (p = 0.30). Patients aged 70–74 years (HR 0.871, p <0.001), 75–79 years (HR 0.733, p <0.001), 80–84 years (HR 0.557, p <0.001) and ≥ 85 years (HR = 0.275 p <0.001) were less likely to undergo total hip arthroplasty compared to the reference group (patients aged 65-69 years).

Basic conclusions?

Although lumbar fusion was initially thought to support hip degeneration and therefore shorten the period to require total hip arthroplasty, the data show that lumbar fusion is not associated with an increased need for future total hip arthroplasty in patients with pre-existing arthroplasty. the hip joint. In addition, there is no relationship between the length of the fusion construct and the period to total hip arthroplasty. Although previous studies have shown that lumbar fusion increases the risk of hip dislocation in patients with previous total hip arthroplasty, these data suggest that lumbar fusion is unlikely to accelerate the natural degeneration of the hip joint.

And here is a link to the original article in PubMed: 34359035