lumbar instability

[indytravl]

hi,

could anyone explain what lumbar instability actually means?

what's the difference between this & spondylolisthesis & subluxation?

any thoughts on rehab treatment for back pain between the three? does a back brace come into it at any time (well at least in grades 1 & 2 listhesis)?

thanks!

 

[PMR 4 MSK]

depends who's using the terms -

To a spine surgeon, instability means movemement that could cause serious harm and likely needs bracing and/or fusion. Instability could be from a fracture or dislocation, or disruption of the ALL and/or PLL causing spondylolisthesis - often seen with significant translocation on flexion and extension views.

To a chiro it means your spine moves, therefore it is unstable and needs manipulation. 😉

Spondylolisthesis simply means one vertebral body is malaligned anteriorly or posteriorly compared to the levels above or below it. The most common reason for this is probably facet arthropathy - in most cases it is benign. It could also come from pars defects and fractures, which when bilateral can create an unstable spine, needing bracing and possibly fusion. Xray often picks up pars defects, but you often want CT, SPECT or bone scan to confirm it.

Subluxation is most often a chiro term to say the spine is out of alignment and needs to be pushed back into shape. Since subluxation is a term that mainly refers to joints that are moving near dislocation, without completely dislocating, it should only be applied to the facet joints. I've never seen anyone truely demonstrate a facet joint subluxing. Dislocated after trauma - absolutely. Perhaps if one significantly ruptured a facet capsule it could sublux, but I've never seen it. I've even asked chiros to show me the subluxation they describe and I still don't see it. Maybe you have to believe it to see it?

 

[indytravl]

thanks for the input.

this is actually from radiology reports. the spondylisthesis I got but then instability & sublux on xrays or MRI?...I saw another MRI report today with "marrow edema due to mechanical instability with bulging discs covered by spondylitic bars, & posterior element degenerative changes". Is that diagnosable on static films?

 

[PMR 4 MSK]

thanks for the input.

this is actually from radiology reports. the spondylisthesis I got but then instability & sublux on xrays or MRI?...I saw another MRI report today with "marrow edema due to mechanical instability with bulging discs covered by spondylitic bars, & posterior element degenerative changes". Is that diagnosable on static films?

Marrow changes are not usually seen on plain films - lookup Modic changes for more info. By "spondylitic bars" I assume he means osteophytes? Those are easily seen on xray. "Posterior element degenerative changes" usually refers to facet degeneration (OA).

 

[ampaphb]

the spondylisthesis I got but the instability ... on x-ray or MRI ...

Instability can be seen on plain films with flexion/extension views

On MRI, a difference might be seen when contrasting standard images with those taken in a "stand-up" unit

 

[indytravl]

thanks, pmr 4!

appreciate your insight also, ampaphb.

so, what does instablity actually mean on plain films (upright or flex/ext)? As far as MIR reports noting it, did youmean comparing supine studies on the same pt with upright standing MIR views? The studies done here that I've seen were in the traditional units so what does it mean then?

😕