What Causes Hip Pain After Spinal Fusion?
Experiencing hip pain after spinal fusion surgery is relatively common. But finding relief means identifying the root cause. Spinal fusion is a surgical procedure that fuses (attaches) two or more vertebrae together. It’s usually done to reduce pain and improve the stability of the spine.
While it can be a helpful procedure for many. It can sometimes lead to new issues such as hip or pelvic pain. This is often due to the relationship between the spine and hip, which can be compromised post-surgery.
If you’ve had spinal fusion and experienced hip pain, you may be wondering whether there is a connection between the two.
This article explains the relationship between the spine and the hip. The causes of hip pain after spinal fusion, and your treatment options.
The connection between the spine and hip
From your head to your toes, your bones and muscles are connected to help you move around. In particular, your upper body is connected to your lower body by way of the pelvis and spine. These two are connected through the sacroiliac (SI) joint, which connects each side of the sacrum (the bottom of your spine) to the inner surface of the ilium (the butterfly-shaped hip bone).
Your pelvis also connects to your femur (thigh bone) at the acetabulum. A hip socket that holds your femur bone in place. Because your pelvis and spine play a major role in movement and are closely connected, issues in one area can affect the other.
Potential causes of pain
After spinal fusion surgery, you’ll need time to recover, which likely means you’re going to be less active. To protect yourself while you heal, your muscles may tighten and function differently than usual. For example, your hip flexors may tighten, which can put additional stress on your hips, causing greater pain.
Because the spine — particularly the lumbar spine — and hips are closely connected, decreased mobility of the lumbar spine may create greater reliance and stress on the pelvis and hips to maintain posture and support movement. In fact, spinal fusion is known to cause changes in posture and gait (walking and balance) and may require the hips and pelvis to overcompensate, leading to pain or discomfort. Also, there may be greater stress on the sacroiliac joint, resulting in greater pain.
There are many potential causes of hip pain after spinal fusion. The main causes include:
greater load onto the SI joint after spinal fusion
misdiagnosis of back issues instead of hip issues
bone graft harvesting in the iliac joint (which is next to the SI joint)
concurrent spine and hip issues (known as a hip-spine syndrome)
Also, muscle weakness may occur post-surgery, which is why physical therapy is often recommended.
Prevalence of pain after spinal fusion
Hip pain — in particular, SI joint pain — after spinal fusion surgery is relatively common, affecting an estimated 32–42% of patients.
However, this statistic also includes patients who may have had preexisting SI pain before surgery. One study found that new SI pain after lumbar spinal fusion occurred in about 12.6% of patients.
Treating hip pain after spinal fusion
Due to the multifactorial nature of hip pain after spinal fusion, you’ll need to work closely with your healthcare professional to get a proper assessment, especially if the pain does not decrease or actually worsens after recovery from surgery.
Likely, your healthcare professional will first recommend conservative treatments such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen), wearing a pelvic belt to decrease movement of the hips and physical therapy.
During physical therapy, your therapist may implement strategies that help improve the stabilization of your pelvis, restore posture and balance, correct any walking and balance abnormalities, and strengthen your surrounding musculature.
In some cases, steroid injections or surgery may be needed if conservative treatments do not work.
Frequently asked questions about hip pain after spinal fusion
How long does hip pain after spinal fusion last?
Depending on the cause, your hip pain can be temporary as you recover from surgery or last much longer and may require treatment.
Is hip pain after spinal fusion typical?
Hip pain after spinal fusion is relatively standard. Studies suggest that stress to the sacroiliac joint is one of the main causes of hip pain post-surgery, affecting nearly 32-42% of patients.
What are the signs of a failed spinal fusion?
Known as failed back surgery syndrome, signs and symptoms of a failed spinal fusion include new or worsened pain, burning, tingling, or weakness in the lower extremities, reduced mobility, headaches or neck pain, or a return of previous symptoms.
The bottom line
The hips and spine are closely connected. Meaning if one is injured or has decreased mobility, the other may have to overcompensate.
Before deciding to undergo spinal fusion surgery, be sure you and your surgeon have a clear understanding regarding any other co-existing hip and pelvis problems in order to optimize your post-surgical outcome.
After spinal fusion surgery, it’s common for the hips to have to “pick up the slack” from the spine which may cause pain or discomfort.
To help relieve this pain, your healthcare professional may recommend first-line treatments such as pain medication or physical therapy to restore strength, and posture, and stabilize the hips. In some cases, additional surgery may be required.
If you suspect that your hip pain is due to your spinal fusion, speak with your healthcare professional to find the best course of treatment for you.
If you have any questions or want information on managing your orthopaedic issues don’t hesitate to contact us.
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