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NATIONAL CENTER FOR NEUROSURGERY

Functional instability of the spine

Functional instability of the spine is functional deviation, abnormal mobility of the spinal segment, when itshypermobility is provided exclusively by excessive slipping vertebrae without the express regional approaching.

Clinical findings of instability of segments manifests a functional deficiency of the spine when in the first place speaks pain, back muscle strain or their fatigue, and limiting of the mobility of a part and the entire spine. In this case, the pain always appearsat stator dynamic loads, i.e.at the transition from horizontal to vertical position, at any movement, heavy lifting. The pain disappears or is greatly facilitated in a horizontal position.

When atlantoaxial instabilityclinical syndromes are as follows:

Cervicocranialgia (paroxysmal sharp pain when bending head radiating to the parietal-occipital region), fixed torticollis, compression-ischemic myelopathy and transient states (vestibular syndrome, syncope, convulsions).

When cervical instability clinical syndromes are as follows:

  1.  cervicocranialgia
  2.  cervicalgia (discomfort in the neck, worse after exercise with turns and excessive straightening of the neck, while walking, after driving the car, etc. , stiffness in the morning, increased pain in the evening;
  3.  Lhermitte 's syndrome (sensation of current flow when tilting the head) ;
  4.  vertebral artery syndrome ;
  5.  cervicobrachialgia with vegetative-vascular disorder;
  6.  autonomic-visceral disorders, irritative and radicular syndromes, cervical myelopathy and radicular-spinal vascular syndromes.

Lumbar (lumbosacral) instability is characterized by the following clinical syndromes: chronic lumbodynia with a specific dynamic enhancement of pain: one-sided lumboischialgia; monoradicular syndrome, damage of the roots of the caudaequina (usually with a combination of instability with stenosis of the spinal canal).

Clinically they distinguish three degrees of functional insufficiency of the spine:

  1.  minimal or moderate signs of instability ( discomforts, increased fatigue, mild pain in the affected region of the spine ) at static-dynamic loads;
  2.  pronounced signs of instability (need to unload the spine) at brief static and dynamic loads;
  3.  complete loss of the bearing capacity of the spine (the inability to remain upright without external support).

Methods of treatment

  •  Decompressive-stabilizing operations with the use of pedicle designs, interbody cages and other implants
  •  Dynamicstabilizationofthespine