• Junya Saito, Seiji Ohtori, Shunji Kishida, Junichi Nakamura, Munenori Takeshita, Tomonori Shigemura, Makoto Takazawa, Yawara Eguchi, Gen Inoue, Sumihisa Orita, Masashi Takaso, Nobuyasu Ochiai, Kazuki Kuniyoshi, Yasuchika Aoki, Tetsuhiro Ishikawa, Gen Arai, Masayuki Miyagi, Hiroto Kamoda, Miyako Suzuki, Yoshihiro Sakuma, Yasuhiro Oikawa, Gou Kubota, Kazuhide Inage, Takeshi Sainoh, Kazuyo Yamauchi, Tomoaki Toyone, and Kazuhisa Takahashi.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
• Spine. 2012 Dec 1;37(25):2089-93.

Study DesignCase series.ObjectiveTo present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis.Summary Of Background DataPain arising from a degenerated hip joint is sometimes localized to the lower leg. Patients with lumbar spinal disease may also show radicular pain corresponding to the lower leg area. If patients present with both conditions and only pain at the lower leg, it is difficult to determine the origin of the pain.MethodsWe reviewed 420 patients who had leg pain with lumbar spinal stenosis diagnosed by myelography, computed tomography after myelography, or magnetic resonance imaging. Pain only at the ipsilateral lateral aspect of the lower leg but slight low back pain or pain around the hip joint was shown in 4 patients who had lumbar spinal stenosis and hip osteoarthritis. The symptoms resolved after L5 spinal nerve block, but remained after lidocaine infiltration into the hip joint. We performed decompression and posterolateral fusion surgery for these 4 patients.ResultsLeg pain did not resolve after lumbar surgery in all patients. Conservative treatment was not effective from 6 to 12 months, so ultimately we performed ipsilateral total hip replacement for all patients and they became symptom-free.ConclusionIt is difficult to determine the origin of lower leg pain by spinal nerve block and hip joint block in patients with lumbar spinal stenosis and hip osteoarthritis. We take this into consideration before surgery.

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