Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

Abstract

Introduction: Ischiofemoral impingement is a cause of posterior hip pain and limitation in hip extension. The compensatory motion at the lumbar spine associated with limitation in hip mobility has been associated with low-back pain, and an increase of 30% in the load at L3-L4 and L4-L5 lumbar facet joint is reported in a cadaveric study involving simulated ischiofemoral impingement. Case Presentation: A 66-year-old female developed low back pain associated with bilateral hip pain over a period of 12 years. The symptoms persisted despite 5 surgical interventions in the lumbar spine and sacroiliac joints. Impingement between the lesser trochanter and ischium, with limitation of hip extension, was identified on the physical examination and imaging studies. The patient underwent endoscopic partial resection of the lesser trochanter bilaterally. The Oswestry lumbar disability index improved from 56% before surgery to 14% at the 17-month follow-up. Impingement between the lesser trochanter and ischium should be considered in the differential diagnosis of low back pain. Conclusion: Ischiofemoral impingement should be considered as a differential diagnosis for patients with unsuccessful lumbar spine surgery. Keywords: Ischiofemoral impingement, Low back pain, Hip pain