Damage to the bones of the spine or the joints that support it sometimes results in a condition called segmental spinal instability. The condition is characterized by a range of motion greater than what’s considered normal (hypermobility). Excessive movement between adjacent vertebrae may also be triggered when a spongy disc cushioning the spine becomes worn and causes the facet joint to fall out of place. Here’s what you need to know about segmental spinal instability.
Why It Develops
When healthy and functioning properly, the spinal joints (facet joints) and discs between vertebrae work together to provide support to the spine as the body moves. If a spinal joint is affected by an injury, age-related wear, or a stress fracture, the natural balance of movement is thrown off and the disc can move or slip forward onto an adjacent one (spondylolisthesis) and press on a nerve root. Bone spurs may develop over time, and abnormal sliding may also occur due to improper lifting or over-extension of the spine.
What It Feels Like
The type of pain often associated with segmental spinal instability is similar to what’s experienced with a herniated disc, although there are some differences. When the joint over-extends, a sharp stabbing pain can suddenly occur. Symptoms usually appear while in the middle of making some type of movement, such as getting up from a sitting position. Patients may also notice or experience:
- A “catch” or locking feeling
- Muscle spasms in the affected area of the back
- Radiating leg pain if a nerve is severely pinched
How It’s Diagnosed
Standing films or flexion-extension x-ray films are usually taken to identify the damage to facet joints and discs. What’s sometimes referred to as an apprehension test may be performed. During the test, the patient is asked to make certain movements, and there will often be hesitation if a certain motion triggers pain. MRIs and CT scans can identify damage to tissues and the presence of bone spurs or other irregularities.
Conservative Treatment Options
Attempts to reestablish stability of the affected area of the spine usually start with conservative non-surgical treatments. In addition to exercises to strengthen spine-supporting muscles, recommended remedies may also include:
- Soft tissue release
- Pain/anti-inflammatory medications
- Steroid injections
- Gentle stretching exercises like yoga or Pilates
When Surgery Is Considered
If conservative treatments aren’t providing relief after several months, surgery may be considered. Whether or not surgery is considered will also depend on how the vertebral segments shift or how severe and disruptive the symptoms become over time. At The Spine Institute in Santa Monica, spine surgery for this condition typically involves the realignment of the affected vertebrae to a normal position.
Specific procedures may include an endoscopic lumbar decompression and foraminoplasty (ELDF), which allows for removal of bone spurs and the release of pressure on nerve roots. If a disc needs to be removed, spinal fusion may be performed. Minimally invasive techniques are often used to reduce risks and speed up recovery.
The success rate with spinal fusion surgery to restore spinal stability ranges between 70 and 95 percent. However, due to the nature of the damage that can occur with segmental spinal instability, there may still be issues with the nerve root after surgery. Anchoring the affected vertebrae in place may restore normal range of motion enough to provide noticeable relief, and follow-up physical therapy can further minimize discomfort.
There are many different spinal conditions that may require minimally invasive surgery, and there are also many different types of procedures, including total disc replacement, lumbar interbody fusion, and foraminotomy. Santa Monica patients can rely on Dr. Hyun Bae at The Spine Institute to diagnose the source of their pain and help them start down the path to a pain-free life. Call 310-828-7757 today to schedule an appointment.