What is it?
Spinal or lumbar instability occurs when the discs between the vertebra in the spine begin to degenerate, displacing them from their normal anatomical position. Eventually this causes friction between the vertebrae, resulting in pain and other symptoms. Spinal instability can increase the risk of developing spinal arthritis and can also affect the ability of the spine to maintain the body’s structure and movement.
Why does it occur?
Spinal instability can develop as a result of something as simple as repeated incorrect lifting patterns, but has a number of other possible causes. It can develop as a result of trauma or a fracture, a tumour, a degenerative disc, congenital defects in the spinal cord, scoliosis (curvature of the spine), spondylolisthesis (when a vertebrae has slipped out of place), or disorders within the connective tissues in the spine.
What are the symptoms?
The symptoms of spinal instability vary – you might feel severe pain in the back while lifting objects, or bending and straightening the spine. Some people get a locking-in feeling, for example, getting stuck when trying to get up from a chair. Muscle spasms, pain into the buttock and leg down one side of the body, and numbness in the lower extremities and arms, are other common symptoms that are aggravated when sitting or standing for too long.
How is it diagnosed?
Your consultant will take a full medical history and ask general questions about your lifestyle, as well as giving you a physical examination. Imaging, such as x-rays, MRI and CT scans, will often be requested so your consultant can obtain a clear look at the bone structure of your spine.
How is it treated?
The best course of treatment will depend on a number of factors, including your age, the level of pain you are experiencing, and what type of activity levels you wish to maintain, or return to.
Physiotherapy may be effective in the treatment of mild spinal instability symptoms, as it will focus on strengthening the muscles. Painkillers and anti-inflammatory medication may also be prescribed by your consultant. In certain cases steroid injections may be considered, which will reduce or eliminate for a certain period of time, and delay the need for more invasive treatment.
If none of the non-surgical options are viable, your surgeon may recommend, where appropriate, microdiscectomy. This is the removal of the intervertebral disc that is impinging on the spinal nerve.
In some cases it might be necessary to consider spinal fusion, which is when two or more spinal vertebrae are fused together. This stops any movement between them, and can improve the stability of the spine.
The One Orthopaedics team specialists
Consultant Orthopaedic Surgeon FRCS (Tr&Orth), Spine
Pain Management Consultant FRCA FFPMRCA