Spinal Instability: Specialists and Information

Working in conjunction with the muscles

• bones,
• tendons,
• joints, and
• intervertebral discs

work together throughout our lives to stabilize the spine and keep it in an upright position.

These structures wear down under constant strain, such as from repeatedly carrying heavy loads, as well as with advancing age.

If such wear and tear goes untreated, the vertebrae may eventually no longer be held properly in place. This spinal instability, in turn, is the starting point for a number of secondary conditions, such as

• spondylolisthesis,
• lateral curvature of the spine (scoliosis),
• herniated discs, or
• spinal degeneration (spondylosis).

Spinal slippage is a symptom of spinal instability © Henrie | AdobeStock

The main symptom of spinal instability is back pain. It occurs in cases of

• spondylolisthesis,
• spinal degeneration, and
• herniated discs

. The vertebrae in the cervical and lumbar regions are frequently affected.

Pain in the lumbar region can also

• radiate down into the legs,
• lead to abnormal sensations, or
• manifest as tingling in the legs.

Back pain resulting from spinal instability tends to worsen especially

• in the morning when getting out of bed,
• during rapid body twists, and
• under physical strain, such as when carrying heavy shopping bags.

The first step is a discussion of the patient’s medical history, known as the anamnesis. During this initial consultation—also referred to as a pain history—the doctor gains an initial impression of the patient and the back condition.

If spinal instability is suspected, an orthopedic examination and imaging tests are usually ordered. Imaging procedures include

• X-rays,
• magnetic resonance imaging (MRI), and
• computed tomography (CT).

Imaging provides insight into the condition of the spine and the structures supporting it. This also allows for the documentation of instabilities and signs of wear and tear.

The doctor typically classifies the extent of spinal instability as mild, moderate, or severe. The severity, in turn, helps determine the treatment, among other factors.

Mild signs of wear and tear can be treated conventionally using physical therapy and muscle-strengthening methods. Medications (pain relievers) or other treatments, such as acupuncture and massage, are also available to address back pain.

More severe cases of spinal instability require surgery as a last resort if conventional treatment is ineffective. This also applies to patients with chronic back pain.

Spondylodesis, also known as spinal fusion, is frequently used in these cases. In this procedure, the affected vertebral segment in patients with spinal instability is surgically fused, thereby rendering it immobile. This fusion is achieved by connecting several vertebral bodies with screws and plates. However, after the procedure, these vertebrae can no longer move articulately.

Spondylodesis is a difficult and invasive surgical procedure. It is therefore usually performed only on patients for whom

• physical therapy,
• muscle strengthening,
• rehabilitation, or
• pain medication

have failed to provide relief.

Depending on the duration and extent of the procedure, there are also risks associated with wound healing or the ability to remain pain-free after surgery. However, these risks are significantly lower when only a few vertebrae are involved and when minimally invasive surgery is performed.

Depending on the symptoms and severity, the various types of spinal instability have different prognoses.

The earlier the diagnosis is made, the sooner doctors can alleviate the symptoms for an extended period. Long-term use of pain medication, on the other hand, could mask symptoms and thus delay diagnosis and treatment. Experts therefore recommend seeing a doctor early on.

Surgery to treat spinal instability is difficult and complex. It is performed by experienced surgeons and specialists in neurosurgery.

When choosing a hospital or the surgeons who will perform the procedure, be sure to look for a high level of clinical experience in the field of spinal instability.