![]() The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain. These changes are not diagnostic of instability on a supine MRI but are suggestive and correlation with dynamic flexion/extension lumbar radiographs has to be considered 3,6. severe facet joint degeneration with effusion and >1 mm articular gap.bone marrow edema at the peduncle and isthmus.Modic type 1 endplate change, especially when involving 25-50+% of the vertebral body.change in segmental angulation >10º 5,6, or ≥20º on flexion or extension with ≥5º posterior opening 7įeatures suggesting instability include 3,6:.increased sagittal translation (thresholds between ≥3 to 5 mm 3-6.Lumbar instability is generally accepted to be present if one of the following can be found on dynamic flexion/extension lateral radiographs: In instability, disc height may be preferentially preserved with increasing loss of disc height associated with less instability, which may reflect the “restabilisation phase” 5. General features of instability include anterolisthesis or retrolisthesis with associated disc and facet joint degeneration although the relationship between imaging findings, instability and their clinical relevance is yet to be fully established 3. While features of instability can be seen on plain radiographs, CT and MRI, dynamic flexion/extension lumbar radiographs are still considered the gold standard 4. degenerative scoliosis can occur when lumbar degeneration is asymmetrical 1.lumbar canal stenosis can be developed not only from degenerative disc disease but also from compensatory ligamentous hypertrophy secondary to abnormal loads and spinal movements as well as hypertrophic facet joints 1.compensatory remodeling is evident including marginal osteophytes, hypertrophic change of the facet joints, endplate sclerosis.reduced mobility and stiffness, often with reduced low back pain.anterolisthesis, retrolisthesis and/or laterolisthesis.degenerative change evident on imaging including intervertebral disc spacing narrowing, disc degeneration, facet joint arthropathy.EtiologyĪ prominent theory on the pathogenesis of spinal instability was proposed by Kirkaldy Willis 1,2,4 with three phases considered: No strong relationship has been made between imaging-demonstrated instability and pain and might be more related to abnormal load distribution 3. Pathologyĭegenerative spinal instability, although associated with low back pain, is controversial as a causal factor with improving surgical fusion rates not leading to better clinical outcomes. Degenerative spinal instability may present with low back pain, radiculopathy and/or neurogenic claudication in some patients whereas in others it may be asymptomatic 1-3. ![]()
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