When patients are suffering from back pain and radiating pain in their lower extremities, it is usual to suspect that the symptoms are caused by a spinal disorder. The symptoms could, however, be due to one of many extraspinal disorders. Differentiating these from spinal pathology requires precise clinical and radiological examinations.
One of the most important extraspinal lesions that can mimic spinal problems is peripheral vascular stenos is in the lower extremities.1 Vascular Doppler ultrasound or angiography can be performed when vascular disorders are suspected. Attention must also be directed to etiologies such as facet joint arthrois, sacroiliac joint arthritis, pelvic insufficiency fractures, gynecologic disorders, malignancies, and neuropathies.2
Low back pain is one of the most common musculoskeletal complaints and is frequently accompanied by hip and thigh pain. Hip osteoarthritis is another common cause of pain and disability, particularly in the geriatric population.2 The true diagnostic dilemma in some patients is to determine whether chronic low back or leg pain is attributable to a spinal disorder, a hip/ leg disorder, or both.3,4
Although a careful history and physical examination may often distinguish radicular pain from pain originating in the joint, separating the two can be difficult.5 Clinical symptoms of lumbar spinal stenosis or radiculopathy may be similar to symptoms originating from the hip and pelvic region.5,6 One problem in diagnosing patients with lower extremity pain is identifying the cause as originating in the spine, hip, or both.7 Failure to recognize concurrent disease of both hip and spine may lead to misdiagnosis and possibly to erroneous treatment.8
Few studies describe hip and spine disorders coexisting in the same patient. Some patients in our own study (described below) reported persistent symptoms after spinal surgery. Their chief complaints originated from hip disorders. Several patients had hip pathology rather than a spinal lesion. Imaging examinations should be performed to exclude hip and pelvic disorders, even though this requires more time and incurs more expense.
Our imaging protocol when investigating spinal pathology usually comprises plain-film radiography, CT, and MRI. We tend to use only the routine sagittal and axial images when interpreting spine MRI examinations and to focus solely on spinal structures. Anteroposterior views in a plain radiograph sometimes show us the hip pathology,9 but this approach is relatively limited, and it is difficult to get more precise information.
