Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy

Limited lumbopelvic mobility does not influence short-term outcomes after primary hip arthroscopy: a propensity-matched controlled study

“…In contrast to the findings of Heaps et al , the findings of the present study did not demonstrate inferior short-term outcomes after hip arthroscopy in patients with limited lumbopelvic motion when compared to a propensity-matched control group with normal lumbopelvic motion; however, the study by Heaps et al was better powered than the current study to detect differences which may account for the discrepancy. On the other hand, Luo et al evaluated the prevalence of LSTV in patients with FAI undergoing hip arthroscopy and associations between LSTV and PROs [ 17 ]. Similar to the present study, their study revealed an overall prevalence of 13.9% in a cohort of patients undergoing hip arthroscopy.…”

“…Conversely, Luo et al . [ 17 ] performed a large retrospective cohort study which was unable to establish inferior outcomes in patients with LSTV compared to controls. Given the evidence that spine pathology causing decreased lumbar mobility can potentially compromise outcomes after hip arthroscopy, normal anatomic variants that limit spinopelvic motion may have similar effects.…”

Editorial Commentary: Lumbosacral Anatomy and Mechanics Influence Femoroacetabular Impingement Syndrome and Surgical Outcomes: The Hip Bone Is Connected to the Back Bone

“…Luo, Barsoum, Ashraf, Cheng, Hurwitz, Goldsmith, and Moley help advance our understanding of the complex relationship between lumbosacral anatomy and mechanics and hip outcomes with their study in the current issue, "Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy." 17 In this outstanding study, the authors found both no correlation of unilateral lumbosacral transitional vertebrae (LSTV) sidedness and hip symptoms, as well as no association between LSTV anatomy and patient-reported outcomes measures following hip arthroscopy. Furthermore, the authors describe a similar incidence of LSTV to the low back pain literature, including a preponderance of this condition on the left side versus the right.…”

“…We would certainly benefit from further study to understand why patients with LSTV did worse than that of the current study by Luo et al, but it is important to note that a significantly greater proportion of patients with LSTV had Castellvi type 3 or 4 on this study (52% of patients included with LSTV) compared with the study by Luo et al (7.7% of patients included with LSTV). 17,18 This difference between cohorts may highlight the importance of lumbosacral motion loss on hip outcomes. This is in line with biomechanical and finite element studies that show that even with more stiffness, low-grade transitional vertebrae do retain some degree of mobility that may not be present in those with fused vertebrae.…”

“…Unfortunately, there remains a paucity of particularly high-quality studies on the pathomechanics of FAI, which limits our ability to translate our findings in clinical studies to anatomic and mechanical findings. 21 However, Luo et al 17 make a very salient point, as they begin to wrap up the discussion of their findings, when they "hope clinicians can consider the potential role of the lumbosacral junction in their examinations and treatments of symptomatic patients"da sentiment that I second, wholeheartedly. The posture and anatomy of the lumbosacral spine are intimately related to hip motion in general, and FAI in particular.…”