(Kiosk 2) A Variant of Hip-back Syndrome with Traumatic Lumbo-sacral Fractures: A Case Report

Case Diagnosis: Traumatic complex left hip spine syndrome

Case Description or Program Description: A 37 year old male presented to Trauma after falling 30 feet. Injuries included a comminuted fracture of the left iliac wing extending into the sacroiliac joint (SIJ), L1-L5 left transverse process fractures with iliopsoas hematoma, L1 compression fracture, and L5-S1 facet subluxation. The L5-S1 facets were surgically reduced. The remaining fractures were deemed non-operative. Rehab Medicine was consulted for mobilization recommendations. The patient could not progress from supine to sitting secondary to low back pain (LBP).

Setting: Level 1 Trauma center

Assessment/Results: A custom thoracolumbosacral orthosis (TLSO) with left hip spica was recommended primarily to address the patient’s LBP and support the pelvis/SIJ. He continued complaining of LBP, at which time a therapy strategy was conceived to provide supine left hip active-assisted ROM for flexion and internal rotation before donning the TLSO. This strategy alleviated the LBP and the patient began transferring to sitting and standing with less apprehension. He quickly progressed to ambulation with an assistive device.

Discussion (relevance): Prather and van Dillen’s narrative review of hip-back syndrome primarily involved degenerative joint disease (DJD) of the hip joint and lumbar spine. There are subgroups of lumbar DJD patients with reduced hip range of motion (ROM). Patients with truncal instability had significantly less hip ROM (specifically flexion and internal rotation), leading to early lumbopelvic motion and increased LBP. Improvement in LBP correlated with primary hip treatment.
Our patient had selective lumbar spine surgery without further lumbar or pelvic/SIJ intervention. In addition to the remaining fractures, hip mobility was potentially affected by injuries to the psoas-thoracolumbar spine complex.

Conclusions: This case reaffirms concepts of a hip-pelvic-lumbosacral kinetic chain that can be clinically useful in addressing presentations of the hip-back syndrome, even in a complex traumatic version that differs from the prevailing literature.