title: Difficulty of diagnosing the origin of lower leg pain in patients with both lumbar spinal stenosis and hip joint osteoarthritis.
abstract: METHODS
  Case series.
  
  
  OBJECTIVE
  To present the difficulty of diagnosing the origin of lower leg pain in patients with lumbar spinal stenosis and hip joint arthritis.
  
  
  BACKGROUND
  Pain 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Leg 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.
  
  
  CONCLUSIONS
  It 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.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Junya
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authors.lastname: Saito
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Shunji
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authors.lastname: Kishida
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakamura
authors.forename: Munenori
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authors.forename: Tomonori
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authors.lastname: Shigemura
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authors.lastname: Orita
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authors.forename: Nobuyasu
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authors.lastname: Ochiai
authors.forename: Kazuki
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authors.forename: Yasuchika
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authors.lastname: Aoki
authors.forename: Tetsuhiro
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authors.forename: Masayuki
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authors.lastname: Kamoda
authors.forename: Miyako
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Sakuma
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Oikawa
authors.forename: Gou
authors.initials: G
authors.lastname: Kubota
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Inage
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sainoh
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Toyone
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena; D019299:Decompression, Surgical; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009192:Myelography; D009407:Nerve Block; D015207:Osteoarthritis, Hip / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D010146:Pain / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D013123:Spinal Fusion; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome