Background: The optimal sequence of hip and spine surgeries for managing hip-spine syndrome remains controversial. Objective: This study aimed to investigate the preferences and rationale for the sequence of surgical treatment of different hip-spine syndrome scenarios among potentially interviewed specialists. Design: A questionnaire survey was designed, featuring five fictional clinical presentations of hip-spine syndrome was established. These scenarios included symptomatic hip osteoarthritis and: 1) lumbar spinal stenosis with neurological claudication, 2) lumbar degenerative spondylolisthesis with leg pain, 3) lumbar disc herniation with leg weakness, 4) lumbar scoliosis with back pain, and 5) thoracolumbar disc herniation with myelopathy. Methods: The survey was conducted among German hip and spine surgeons to inquire their preferred surgical sequence and treatment rationale. Additionally, a cross-nation comparison of the German findings was made with the previous same questionnaire conducted in the United States. Results: German hip and spine surgeons demonstrated a surgical order preference paradigm characterized by prioritizing spine-first for spinal disease with neurological deficits (scenario 1, 3, 5), otherwise hip-first preferred without neurological deficits (scenario 2, 4). US surgeons had different patterns of surgical order preference, consistent with German surgeons in some scenarios and not in others. There was also a certain tendency of surgical order preference in different specialists. The surgeons' preference decision was primarily influenced by the severity and time urgency of symptoms, spine-pelvis-hip biomechanics, and ease and therapeutic effect of hip and spine surgery. Conclusion: The sequence of hip and spine surgery in different hip-spine syndrome scenarios has different preference patterns, with professional preferences and cross-nation differences, affected by many factors including disease and treatment regimen.

The authors have declared no competing interest.

No funding was received for conducting this study.

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Ethical approval was waived by the local Ethics Committee of Technical University of Dresden in view of the nature of the research study (No. EK45012019).

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