SPINAL INSTABILITY

What is Spinal Instability?

The medical term ‘Spinal Instability’ refers to a condition that occurs when a spine injury or degenerative changes leads to degeneration of the intervertebral discs in the spine. This condition causes the vertebrae to displace from their anatomical position and override the disc resulting in a reduction of the disc bulge and ultimately, height loss. This displacement eventually causes friction between the vertebrae resulting in pain, discomfort, and several other symptoms.

When an individual suffers from spinal instability, excessive movement between the vertebrae may occur, leading to a degeneration of the intervertebral joints. This degeneration can irritate the structures of the nervous system that pass through the joint spaces.

Spinal instability may increase the risk of spinal arthritis, development of bone spurs, and may also affect the ability of the spine to maintain the body’s structure and movement.

What are the Possible Causes and Risk Factors of Spinal Instability?

Several conditions may contribute to spinal instability. The most common causes and risk factors include:

1- External trauma or damage to the vertebrae

2- Damage to the ligaments or structures that bind the vertebrae to each other

3- Deterioration of the vertebral column caused by aaging4- Congenital spinal cord defect

5- Degenerative disc disease

6- Metastatic tumors which can expand within the vertebrae and structures connecting the vertebrae

7- Connective tissue disorders

8- Scoliosis; a sideways curvature of the spine

9- Spondylolisthesis; a spinal condition that causes lower back pain

What are the Symptoms of Spinal Instability?

Spinal Instability can result in low back pain, stiffness, and muscle spasms during movement. This pain may increase when performing activities that place more pressure on the spine, like lifting heavy objects, bending, or twisting. Other symptoms of spinal instability include:

1- Severe back pain that occurs while straightening the spine

2- Loss of sensation, tingling, and weakness in the arms and lower extremities

3- Pain that extends to the legs and buttocks, generally affecting one side of the body

4- Pain that may turn worse by standing or sitting for long periods triggered by coughing, sneezing, or laughing.

5- Sciatica

How do Spinal Specialists Diagnose Spinal Instability?

The spinal specialist may conduct physical exams to recreate conditions that may cause pain in the spine. This could help diagnose the pattern of pain and the specific movements that cause it. In addition to a complete medical and lifestyle history, the specialist may require x-ray imaging in both a sitting and standing position to study the changes in the bone structure. MRI and CT scans may also prove useful to detect the cause of pain in the back while lifting objects, bending, and straightening the spine.

How do Spinal Specialists Treat Spinal Instability?

Spinal specialists may recommend non-surgical or surgical treatment options to treat spinal instability depending on the condition causing it.

Non-surgical treatment options for spinal instability 

1- Physical therapy way prove effective in treating mild spinal instability as it focuses on strengthening the muscles in the spine

2- Use of painkillers and anti-inflammatory medicines to reduce swelling and inflammation of pinched nerves

3- Application of corticosteroid injections directly into the spine to provide temporary relief from inflammation and irritation around compressed nerve roots

4- Bracing

Surgical treatment options for spinal instability 

The spinal specialist may recommend surgical procedures to treat spinal instability in the case where non-surgical treatments fail to resolve pain and symptoms. These procedures may include:

1- Spinal fusion involves merging two or more spinal vertebrae to prevent any movement between them and improve the stability of the spine.

2- Microdiscectomy

References

Beazell J. R. (2010). Lumbar instability: an evolving and challenging concept. J Man Manip Ther., 18(1), p. 9–14 Level of evidence

Biely SA, Smith SS, Silfies SP. Clinical instability of the lumbar spine: diagnosis and intervention. Orthopedic Physical Therapy Practice. 2006;18:11-19

Kasai, Yuichi, et al. “A new evaluation method for lumbar spinal instability: passive lumbar extension test.” Physical therapy 86.12 (2006)

IC Lumbar Instability Available:https://www.institutoclavel.com/en/lumbar-instability (accessed 16.6.2021)

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