Differences in Gait Characteristics of Patients with Lumbar Spinal Canal Stenosis (L4 Radiculopathy) and Those with Osteoarthritis of the Hip.

Noriaki Yokogawa,Tetsuyou Watanabe,Hideki Murakami,Hiroyuki Tsuchiya,Hiroyuki Hayashi,Takeshi Yoneyama,Yasumitsu Toribatake,Stephen E Alway

doi:10.1371/journal.pone.0124745

Noriaki Yokogawa, Tetsuyou Watanabe + Show 6 more

Open Access

https://doi.org/10.1371/journal.pone.0124745

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Journal: PloS one	Publication Date: Apr 20, 2015
Citations: 14	License type: CC BY 4.0

Affiliation: Kanazawa University, Kouseiren Takaoka Hospital

Abstract

It is important to differentially diagnose thigh pain from lumbar spinal stenosis (particularly lumbar fourth nerve root radiculopathy) and osteoarthritis of the hip. In this study, using a treadmill and a motion analysis method, gait characteristics were compared between these conditions. Patients with lumbar fourth nerve root radiculopathy had increased physiological knee flexion immediately after foot-ground contact, possibly owing to a slight decrease in the muscle strength of the quadriceps femoris muscle. Patients with osteoarthritis of the hip had decreased range of motion of the hip joint probably due to anatomically limited mobility as well as gait strategy to avoid pain resulting from increased internal pressure on the hip joint during its extension. Our facile and noninvasive method can be useful for the differential diagnosis of lumbar spinal canal stenosis from osteoarthritis of the hip.

Highlights

Patients with pathogenic lesions of the hip joint frequently complain of pain at the anterior aspect of the thigh
Owing to the invasive nature of these methods, we have focused on walking motion analysis as a noninvasive alternative for differential diagnosis
None of the subjects had any changes in the manual muscle testing (MMT) grades before and after walking

Summary

Introduction

Patients with pathogenic lesions of the hip joint frequently complain of pain at the anterior aspect of the thigh. Anterior thigh pain may be confused with pain originating in the hip. Offierski and MacNab caution experienced spine and hip surgeons that failure to recognize concurrent hip and spine disease, often called hip-spine syndrome, may lead to confusion, a mistaken diagnosis, or even erroneous treatment [1]. They emphasize the necessity for ancillary investigation emphasizing the value of spinal nerve root infiltration or hip joint anesthetic injections in assessing the contribution of each area to the patient’s disability.

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