What is Spinal Instability?
The spine normally stacks solidly one on top of the other held in place by ligaments, discs and bony facets. The spinal segments are able to move but only enough to smoothly bend and twist the spine. Spinal (segmental) instability occurs when the spinal segments have the ability to move more than normal. The motion can be forwards, backwards or side to side. This hypermobility can happen when a vertebra degenerates enough so it can no longer support the weight of the spinal segment above it. The lumbar spine is the most common location for spinal instability to occur. Causes include degenerative disc disease and spondylolisthesis (one vertebral body sliding over another one). This can cause either a sharp pain or dull and chronic discomfort and usually and worsens with activity. You may have numbness or tingling or even weakness of muscles as well. Spinal instability can progress to include a herniated disc, pinched nerve, or cauda equina syndrome.
Spinal instability may be sudden or progressive over many years and may not have any symptoms for a long time. The symptoms depend on both the severity and area of your back affected. If the spinal instability is in the lower back (thoracic and sacral spine) then you may have pain, weakness and numbness extending from your back to your buttocks, thighs, and down to your calves. If the spinal instability is in your neck (cervical spine) then you may have the same symptoms in the neck and arms. You may have aching, tingling or burning sensations in the affected area. The pain is usually only on one side of the body but may be both. Movement, walking sitting and certain bending or twisting movements may worsen the pain. Spinal instability that causes pressure on the spine can cause loss of bladder or bowel control, numbness around the groin, sexual dysfunction and difficulty walking. This is cauda equina syndrome which is a spinal emergency. When you are unable to perform your normal daily activities then it is time to see your doctor.
Any condition that allows the spinal segments to move excessively can cause spinal instability. Spondylolisthesis is the forward slippage of one vertebra over the next vertebra and is the most common cause of spinal instability. Wear and tear over many years can cause degenerative disc disease that allows excess spine segment motion. Heavy lifting, repetitive motions or turning and twisting can also cause sudden injury in spinal instability. Other factors that can predispose you to spinal instability are having a few extra pounds, lack of exercise and weak core muscles including the muscles of the abdomen and back. Sporting injuries or car accidents are rare but possible causes of spinal instability.
Your doctor will take a complete history to evaluate you for spinal instability. A physical exam will evaluate you for your source of your pain and discomfort. Your nerve function will be evaluated along with and muscle strength and skin sensation. Imaging tests can help your doctor identify injured areas of spinal bones and muscles:
- X-rays taken in bending forward and then backward positions may show dynamic spinal instability.
- Computed tomography (CT) scan uses the electromagnetic energy of X-rays to provide a detailed look at the bony anatomy spine and tissue around it.
- Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to create a detailed picture of soft tissue of the spine, discs, ligaments, spinal cord and spinal nerves.
- Nerve conduction studies look for nerve damage by using electrodes to measure how quickly a nerve impulse is transmitted.
Electromyogram uses needle electrodes to look for muscle damage.
Spinal instability is a chronic condition that tends to worsen over time if not recognized and treated. Conservative treatment can be used to decrease spinal instability and decrease symptoms. Over-the-counter medications like ibuprofen (Advil, Motrin) or naproxen (Aleve) are NSAIDs (nonsteroidal anti-inflammatory drugs) that can decrease pain and swelling. If pain lasts more than 10 days you should talk to your doctor as the side-effects of long term NSAID use rarely include stomach ulcers, circulation problems and heart failure. Low impact exercises or massage may help improve your spinal instability. A physical therapist can show you targeted exercises to strengthen your core which will hold the spine in place and keep it from hypermobility.
Surgery may be needed if you fail conservative treatment, have severe spinal instability, have severe persistent pain, or have a progressive sensation or muscle weakness. Spinal fusion is the most effective way to stabilize the spine. It involves permanently attaching two of more of the spinal vertebrae together using bone grafts with plastic or metal screws and rods. This permanently fuses the spine vertebrae in the attached segments and prevents spinal instability in this portion of the spine. This also requires general anesthesia and a short hospital stay.
The pain and dysfunction from spinal instability can be mild or can be excruciating and debilitating. The neurosurgeons of Norelle Health are highly trained and skilled in the diagnosis, management, and treatment of spinal instability. Our neurosurgeons can provide the optimal treatment. Neurosurgery is considered essential by insurances and should be covered with your plan. As out-of-network providers, we will check your benefits for you and let you know what they are so there are no surprises. We use an individualized treatment plan for your concerns to provide a personalized holistic plan of care. If you would like assistance, please feel free to contact us (link to contact page) or call our office (link to phone number).