{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:22:07Z","timestamp":1777710127149,"version":"3.51.4"},"reference-count":13,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2022,10,1]],"date-time":"2022-10-01T00:00:00Z","timestamp":1664582400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"}],"funder":[{"DOI":"10.13039\/100008542","name":"Arthroscopy Association of North America","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008542","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009885","name":"American Academy of Orthopaedic Surgeons","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009885","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005382","name":"American Orthopaedic Association","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005382","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100011549","name":"American Orthopaedic Society for Sports Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011549","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100013894","name":"International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013894","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["arthroscopyjournal.org","clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The human pelvis represents a wonderful example of apparent idealistic simplicity overwhelmed by realistic complexity. Traditionally, the pelvis has been termed a \u201cring\u201d linking the lower extremity to the spine via the sacroiliac joint. In essence, the pelvis is the lowest vertebral level\u2014\u201cthe hip bone\u2019s connected to the spine bone.\u201d Thus, the law of parsimony seemingly applies in the diagnosis and management of both arthritic and nonarthritic hip and spine disorders in isolation or combination. However, an inverse Occam\u2019s razor is much more likely. The layered theory of hip disorders illustrates how a base osteochondral layer (femoroacetabular impingement syndrome, ischiofemoral impingement from either the lesser trochanter or greater trochanter, arthritis), a static inert soft\u2010tissue layer (labrum, capsule, ligament), a dynamic soft\u2010tissue layer (muscle, tendon), and a neurokinetic chain layer all interact and can lead to hundreds, if not thousands, of different combinations of primary and secondary symptom sources. Although correlation does not equal causation, intuitively and overly simplistically, a stiff painful hip can transfer stress across the pelvic ring to the spine, causing back pain. Alternatively, 2 separate symptom sources could be present at the same time. Biomechanical stress transfer can occur from flexion\u2010based (e.g., femoroacetabular impingement syndrome) or extension\u2010based (e.g., ischiofemoral impingement) problems. The diagnosis of hip\u2010spine syndrome in patients becomes really complicated usually really fast, encompassing the hip joint, peritrochanteric space, deep gluteal space, pelvis and pelvic floor, sacroiliac joint, and lumbosacral spine\u2014and don\u2019t forget mental health and the mind controls the musculotendinous system in these challenging, often frustrated, patients. Static imaging findings necessitate dynamic symptom correlation, especially via pertinent values including pelvic incidence; pelvic tilt; sacral slope; lumbar lordosis; femoral and acetabular version; cam, pincer, and dysplastic morphologies; and leg length. Judicious diagnostic injections can greatly assist in clinical symptom interpretation. Successful treatment requires consideration and management of the primary etiology and pertinent secondary downstream effects. When a patient\u2019s hip hurts, one should always look at the patient\u2019s back; when a patient\u2019s back hurts, one should always look at the patient\u2019s hip.<\/jats:p>","DOI":"10.1016\/j.arthro.2022.08.009","type":"journal-article","created":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T03:00:34Z","timestamp":1664506834000},"page":"2939-2941","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":5,"title":["<i>Editorial Commentary:<\/i>\n                    The Pelvis is the Lowest Vertebral Level: Diagnostic Approach to Hip\u2010Spine Syndrome"],"prefix":"10.1002","volume":"38","author":[{"given":"Joshua D.","family":"Harris","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,10,1]]},"reference":[{"key":"e_1_2_2_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.08.001"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2016.06.029"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-198304000-00014"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2022.04.015"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-012-1544-9"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/0363546510386002"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.12.049"},{"key":"e_1_2_2_9_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325967114523916"},{"key":"e_1_2_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.326.7401.1273"},{"key":"e_1_2_2_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-016-4036-y"},{"key":"e_1_2_2_12_2","first-page":"866","article-title":"Management of the adrenal \u201cincidentaloma","volume":"92","author":"Geelhoed G.W.","year":"1982","journal-title":"Surgery"},{"key":"e_1_2_2_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2014.11.042"},{"key":"e_1_2_2_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-015-4379-6"}],"container-title":["Arthroscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806322004807?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0749806322004807?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2022.08.009","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1016\/j.arthro.2022.08.009","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1016\/j.arthro.2022.08.009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T09:16:46Z","timestamp":1773566206000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1016\/j.arthro.2022.08.009"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10]]},"references-count":13,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["10.1016\/j.arthro.2022.08.009"],"URL":"https:\/\/doi.org\/10.1016\/j.arthro.2022.08.009","archive":["Portico"],"relation":{},"ISSN":["0749-8063","1526-3231"],"issn-type":[{"value":"0749-8063","type":"print"},{"value":"1526-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Editorial Commentary: The Pelvis is the Lowest Vertebral Level: Diagnostic Approach to Hip-Spine Syndrome","name":"articletitle","label":"Article Title"},{"value":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.arthro.2022.08.009","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"simple-article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2022 by the Arthroscopy Association of North America","name":"copyright","label":"Copyright"}]}}