{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:41:08Z","timestamp":1760028068989,"version":"3.37.3"},"reference-count":51,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,12,4]],"date-time":"2023-12-04T00:00:00Z","timestamp":1701648000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal Orthopaedic Research"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Lumbar stiffness leads to greater hip dependence to achieve sagittal motion and increases instability after total hip arthroplasty (THA). We aimed to determine parameters that influence lumbar stiffness among\u00a0patients with hip pathology. We hypothesized that modifiable (degenerative changes, spinal canal stenosis, facet orientation) and nonmodifiable factors (muscle condition) would be associated with lumbar spine stiffness. In this retrospective case\u2010cohort study from a tertiary referral center, consecutive patients presenting at a hip specialist clinic underwent standing and deep\u2010seated radiographic assessment to measure lumbar lordosis (\u2206LL) (stiffness: \u2206LL\u2009&lt;\u200920\u00b0), hip flexion (\u2206PFA:\u00a0pelvic femoral angle), and degree of degenerative\u2010disc\u2010disease (DDD) (facet osteoarthritis, disc height, endplate proliferative changes). Of these, 65 patients were selected with previous lumbar spine magnetic resonance imaging,\u00a0allowing to determine lumbar facet orientation, spinal canal stenosis (Schizas classification), and flexor\u2010 and extensor\u2010muscle atrophy (Goutallier classification). Mean \u2206LL was 45\u00b0 (range: 11\u00b0\u201372\u00b0) and four patients (6%) exhibited spine stiffness. Patients with multilevel DDD (<jats:italic>n<\/jats:italic>\u2009=\u200922) had less \u2206LL than those with no\/single level (<jats:italic>n<\/jats:italic>\u2009=\u200943) DDD\u00a0(34\u00b0 [range: 11\u00b0\u201353\u00b0]\u00a0vs. 51\u00b0 [21\u00b0\u201372\u00b0]; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Number of DDD levels correlated strongly with \u2206LL (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.642; <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Spinal stiffness was only seen in patients with \u22654 DDD\u00a0levels.\u00a0There was no correlation between \u2206LL and facet orientation (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). \u2206LL correlated strongly with extensor atrophy at L3\u2013L4 (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.473), L4\u2013L5 (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.520), and L5\u2013S1 (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.473)\u00a0and poorly with flexors at L4\u2013L5 (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.134) and L5\u2013S1 (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.227). Lumbar stiffness is dependent on modifiable\u00a0(muscle atrophy) and nonmodifiable\u00a0(extend of DDD) factors. This can guide nonoperative management of hip pathology, emphasizing the relevance of core muscle rehabilitation to improve posture and stiffness. Identification \u22654 DDD\u00a0levels should alert surgeons of increased THA instability risk. <jats:italic>Level of evidence<\/jats:italic>: level IV, cohort series.<\/jats:p>","DOI":"10.1002\/jor.25749","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T09:45:35Z","timestamp":1700819135000},"page":"1054-1065","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["What patient parameters influence lumbar stiffness in patients with hip pathology?"],"prefix":"10.1002","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2254-9451","authenticated-orcid":false,"given":"Jeroen C. F.","family":"Verhaegen","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery The Ottawa Hospital Ottawa Ontario Canada"},{"name":"Department of Orthopaedics &amp; Traumatology University Hospital\u00a0Antwerp Edegem Belgium"},{"name":"Orthopedic Center Antwerp, AZ Monica  Antwerp Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuno","family":"Alves Batista","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Ottawa Hospital Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Foster","sequence":"additional","affiliation":[{"name":"Department of Radiology The Ottawa Hospital Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Graham","sequence":"additional","affiliation":[{"name":"School of Human Kinetics, Faculty of Health Sciences University of Ottawa Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Ottawa Hospital Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7444-9498","authenticated-orcid":false,"given":"George","family":"Grammatopoulos","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery The Ottawa Hospital Ottawa Ontario 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