Spine and Pelvic Pathology Presenting with Posterior Hip Pain

  • Joshua S. Bowler
  • David Vier
  • Frank Feigenbaum
  • Manu Gupta
  • Andrew E. ParkEmail author


Many pathologic conditions of the spine and pelvis have posterior gluteal or “hip” pain as a presenting symptom. It is critical that a thorough history is taken as well as a detailed physical examination of the patient. From this information, pertinent imaging studies may be ordered to better direct the physician toward an accurate diagnosis for the patient’s symptoms. Because pain in this region can be from many different pathologic processes, it is very important that the evaluating physician considers and evaluates the patient in a systematic fashion to properly work up the patient.


Tarlov cyst Sacroiliac joint Lumbar disc herniation Spinal stenosis Buttock pain Synovial cyst Piriformis syndrome Meningeal cyst Vascular claudication 


  1. 1.
    Devin CJ, McCullough KA, Morris BJ, Yates AJ, Kang JD. Hip-spine syndrome. J Am Acad Orthop Surg. 2012;20:434–42.CrossRefPubMedGoogle Scholar
  2. 2.
    Savage JW, Patel AA. Fixed sagittal plane imbalance. Global Spine J. 2014;4:287–96.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Jauregui JJ, Banerjee S, Issa K, Cherian JJ, Mont MA. Does co-existing lumbar spinal canal stenosis impair functional outcomes and activity levels after primary total hip arthroplasty? J Arthorplasty. 2015;30:1569–73.CrossRefGoogle Scholar
  4. 4.
    Lazennec J, Brusson A, Rousseau M. Hip-spine relations and sagittal balance clinical consequences. Eur Spine J. 2011;20(suppl 5):S686–98.CrossRefGoogle Scholar
  5. 5.
    Fogel GR, Esses SI. Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity. Spine J. 2003;3:238–41.CrossRefPubMedGoogle Scholar
  6. 6.
    Ben-Galim P, Ben-Galim T, Rand N, et al. Hip-spine syndrome: the effect of total hip replacement surgery on low back pain in severe osteoarthritis of the hip. Spine (Phila Pa 1976). 2007;32:2099–102.CrossRefGoogle Scholar
  7. 7.
    Offierski CM, MacNab I. Hip-spine syndrome. Spine. 1983;8:316–21.CrossRefPubMedGoogle Scholar
  8. 8.
    Fardon DF, Milette PC. Nomenclature and classification of lumbar disc pathology. Recommmendations of the combined task forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976). 2001;26(5):E93–E113.CrossRefGoogle Scholar
  9. 9.
    Jordan J, Konstantinou K, O’Dowd J. Herniated lumbar disc. BMJ Clin Evid. 2011;2011:1118.PubMedPubMedCentralGoogle Scholar
  10. 10.
    Boden SD. The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. J Bone Joint Surg Am. 1996;78(1):114–24.CrossRefPubMedGoogle Scholar
  11. 11.
    Borenstein DG, O’Mara JW Jr, et al. The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study. J Bone Joint Surg Am. 2011;83-A(9):1306–11.CrossRefGoogle Scholar
  12. 12.
    Rhee JM, Schaufele M, Abdu WA. Radiculopathy and the herniated lumbar disc. Controversies regarding pathophysiology and management. J Bone Joint Surg Am. 2006;88(9):2070–80.CrossRefPubMedGoogle Scholar
  13. 13.
    Casey E. Natural history of radiculopathy. Phys Med Rehabil Clin N Am. 2011;22(1):105.CrossRefGoogle Scholar
  14. 14.
    Aydin S, Abuzayed B, et al. Discal cysts of the lumbar spine: report of five cases and review of the literature. Eur Spine J. 2010;19(10):1621–6.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Egund N, Jurik A. Anatomy and histology of the sacroiliac joints. Semin Musculoskelet Radiol. 2014;18(03):332–40.CrossRefPubMedGoogle Scholar
  16. 16.
    Forst S, Wheeler M. The sacroiliac joint: anatomy, physiology and clinical significance. Pain Physician. 2006;9:61–8.PubMedGoogle Scholar
  17. 17.
    Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976). 2008;33(18):E636–42. Scholar
  18. 18.
    Abdu WA, Lurie JD, Spratt KF, et al. Degenerative spondylolisthesis: does fusion method influence outcome? Four-year results of the spine patient outcomes research trial. Spine (Phila Pa 1976). 2009;34(21):2351–60. Scholar
  19. 19.
    Fischgrund JS, Mackay M, Herkowitz HN, Brower R, Montgomery DM, Kurz LT. Volvo award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine (Phila Pa 1976). 1997;22(24):2807–12. Accessed 27 Apr 2016.CrossRefGoogle Scholar
  20. 20.
    Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am. 2009;91(6):1295–304. Scholar
  21. 21.
    Tosteson ANA, Tosteson TD, Lurie JD, et al. Comparative effectiveness evidence from the spine patient outcomes research trial: surgical versus nonoperative care for spinal stenosis, degenerative spondylolisthesis, and intervertebral disc herniation. Spine (Phila Pa 1976). 2011;36(24):2061–8. Scholar
  22. 22.
    Martin CR, Gruszczynski AT, Braunsfurth HA, Fallatah SM, O’Neil J, Wai EK. The surgical management of degenerative lumbar spondylolisthesis: a systematic review. Spine (Phila Pa 1976). 2007;32(16):1791–8. Scholar
  23. 23.
    Radcliff K, Hilibrand A, Lurie JD, et al. The impact of epidural steroid injections on the outcomes of patients treated for lumbar disc herniation: a subgroup analysis of the SPORT trial. J Bone Joint Surg Am. 2012;94(15):1353–8. Scholar
  24. 24.
    Radcliff KE, Rihn J, Hilibrand A, et al. Does the duration of symptoms in patients with spinal stenosis and degenerative spondylolisthesis affect outcomes?: analysis of the Spine Outcomes Research Trial. Spine (Phila Pa 1976). 2011;36(25):2197–210. Scholar
  25. 25.
    Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med. 2008;358(8):794–810. Scholar
  26. 26.
    Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus nonsurgical treatment for lumbar degenerative spondylolisthesis. N Engl J Med. 2007;356(22):2257–70. Scholar
  27. 27.
    Hopayian K, Song F, Riera R, Sambandan S. The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. 2010;19(12):2095–109. Scholar
  28. 28.
    Jawish RM, Assoum HA, Khamis CF. Anatomical, clinical and electrical observations in piriformis syndrome. J Orthop Surg Res. 2010;5:3. Scholar
  29. 29.
    Pokorný D, Jahoda D, Veigl D, Pinskerová V, Sosna A. Topographic variations of the relationship of the sciatic nerve and the piriformis muscle and its relevance to palsy after total hip arthroplasty. Surg Radiol Anat. 2006;28(1):88–91. Scholar
  30. 30.
    Cass SP. Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep. 2015;14(1):41–4. Scholar
  31. 31.
    Smoll NR. Variations of the piriformis and sciatic nerve with clinical consequence: a review. Clin Anat. 2010;23(1):8–17. Scholar
  32. 32.
    Feigenbaum F, Henderson F. Surgical management of meningeal cysts, including perineurial (Tarlov) cysts and meningeal diverticula. Semin Spine Surg. 2006;18:154–60.CrossRefGoogle Scholar
  33. 33.
    Feigenbaum F, Henderson F. Tarlov cysts. In: Benzel E, editor. Spine surgery. 3rd ed. Philadelphia: Elsevier; 2012. p. 1135–40.Google Scholar
  34. 34.
    Hayashi K, Nagano J, Hattori S. Adhesive arachnoiditis after percutaneous fibrin glue treatment of a sacral meningeal cyst: case report. J Neurosurg Spine. 2014;20(6):763–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Patel M, Louie W, Rachlin J. Percutaneous fibrin glue therapy of meningeal cysts of the sacral spine. AJR Am J Roentgenol. 1997;163:367–70.CrossRefGoogle Scholar
  36. 36.
    Tarlov IM. Spinal perineurial and meningeal cysts. J Neurol Neurosurg Psychiatry. 1970;33:833–43.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Voyadzis J, Bhargava P, Henderson F. Tarlov cysts: a study of 10 cases with review of the literature. J Neurosurg Spine. 2001;95:25–32.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Joshua S. Bowler
    • 1
  • David Vier
    • 1
  • Frank Feigenbaum
    • 2
  • Manu Gupta
    • 3
  • Andrew E. Park
    • 4
    • 5
    • 6
    Email author
  1. 1.Baylor University Medical Center, Department of Orthopedic SurgeryDallasUSA
  2. 2.Feigenbaum NeurosurgeryDallasUSA
  3. 3.Division of NeuroradiologyBaylor University Medical Center—Dallas, Department of RadiologyDallasUSA
  4. 4.Orthopaedic SurgeryTexas A&M Health Science CenterDallasUSA
  5. 5.Baylor University Medical CenterDallasUSA
  6. 6.Department of Orthopaedic SurgeryMethodist Hospital for SurgeryAddisonUSA

Personalised recommendations