A stable joint moves through ‘normal’ range of motion. This continues even when it is subjected to a standard or ‘normal’ bodily load. The term ‘standard’ or ‘normal’ is defined as that which is pain-free and comfortable for an individual. Hence, an unstable joint can be defined as one that takes the similar ‘standard’ bodily load but experiences abnormal, excessive, range of motion.
In medical terms, instability may be defined as loss of functional capability of active and passive soft tissues responsible for offering restraint to movement of muscles, discs, capsules, and ligaments. A severe case of lumbar instability may occur from damage to bony elements such as a fracture-dislocation.
Causes of Spinal Instability
The term ‘Spinal Instability’ is devised to define abnormal movement between one vertebra and another. Disc tends to degenerate after losing tension or tumor resulting in bulging of the disc and enables increasing of movements between the vertebrae. Significant loss of height is a major cause of facet joints displacement. These tend to outweigh the correct congruent alignment. The situation is also responsible for inducing arthritic overgrowth of joints.
Signs and Symptoms
The patient may experience lumbar instability symptoms such as pain due to abnormal sliding that occurs between vertebrae occurring during lifting, flexion, or extension. This results in significant back pain. It is usually attended by a ‘catch’ sign which means the patient gets startled all of a sudden by a stabbing pain. The pain occurs when the sufferer in the middle of standing upright or getting out of a chair. Many patients associate it with a spasm and even locking up of the back.
Some of the other symptoms of lumbar instability include:
- Stabbing pain
- Locking up of the back
The process of degeneration of spinal segment starts as soon as a disc is unable to function normally. Diagnosis of this condition starts with a complete physical exam and history. During this assessment, the doctor will check the regular functioning of patient’s back through varied types of motion. For accurate diagnosis of the condition, the doctor may ask the patient to wear a back brace for a specific period of time. This is to see if the precaution provides any relief for pain. Some of the other diagnostic tests performed may include:
CT Scan – It helps doctor observe vertebrae, facet joints. It will also determine any bone spurs present.
X-Rays – Spine x-rays are taken in the standing straight position (neutral) and at varying degrees of flexion.
MRI – This checks for any lesions, such as a herniated disc.
Electromyogram (EMG) – It checks the patient for any signs of segmental instability.
Treatment Approaches for Lumbar Instability
Since it is conventionally believed that the issue lies within the disc itself, this kind of mechanical dysfunction is best treated through a fusion process. It involves removal of movement at that specific section. If possible, the doctor may also re-align the vertebrae to a usual position and disc height by opening the doorway (undercutting) of foraminal spaces. Unfortunately, these conventional methods often fail. So the symptoms may persist.
Endoscopic Lumbar Decompression & Foraminoplasty (ELDF)
The process allows the surgeon to treat the condition with least collateral damage to tissues. This also means that there is reduced risk to the patient. The conventional fusion surgery is a process where multi-level conditions are suspected. Hence, the surgeon treats all of the involved levels by making use of an ‘overkill’ multi-level surgery combined with its issues such as the following:
- Loss of blood
- Damage to potential nerve and tissue
- Extended post-operative care
- Needless operation on non-causal levels
This method has a very high success rate. Complications are rare and limited to the age group of patients that can be offered similar treatment.