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Instability
Jeffrey S. Ross, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          TERMINOLOGY

          • Synonyms

            • Spine instability (SI), segmental instability, abnormal spinal motion, degenerative instability
          • Definitions

            • Loss of spine motion segment stiffness, when applied force produces greater displacement than normal, with pain/deformity
            • Neoplastic instability: Loss of spinal integrity from neoplastic process associated with movement-related pain, symptomatic or progressive deformity, &/or neural compromise under physiologic loads

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Fourney DR et al: Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 29(22):3072-7, 2011
                                            2. Fisher CG et al: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 35(22):E1221-9, 2010
                                            3. Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
                                            4. Winegar CD et al: A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 13(1):5-16, 2010
                                            5. Alamin T et al: Lumbar tumor resections and management. Orthop Clin North Am. 40(1):93-104, vii, 2009
                                            6. Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
                                            7. Haughton VM et al: Measuring the axial rotation of lumbar vertebrae in vivo with MR imaging. AJNR Am J Neuroradiol. 23(7):1110-6, 2002
                                            8. Kristof RA et al: Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. J Neurosurg. 97(3 Suppl):281-6, 2002
                                            9. Kuroki H et al: Clinical results of posterolateral fusion for degenerative lumbar spinal diseases: a follow-up study of more than 10 years. J Orthop Sci. 7(3):317-24, 2002
                                            10. Pitkanen MT et al: Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography. Clin Radiol. 57(7):632-9, 2002
                                            11. Tay BB et al: Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol. 22(2):221-30, 2002
                                            12. Bendo JA et al: Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Am J Orthop. 30(3):247-50, 2001
                                            13. Chen WJ et al: Surgical treatment of adjacent instability after lumbar spine fusion. Spine. 26(22):E519-24, 2001
                                            14. Nizard RS et al: Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am. 39(1):55-71, v-vi, 2001
                                            15. Gibson JN et al: Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. (3):CD001352, 2000
                                            16. Herkowitz HN et al: Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis. Spine. 24(12):1268-70, 1999
                                            17. Mochida J et al: How to stabilize a single level lesion of degenerative lumbar spondylolisthesis. Clin Orthop. (368):126-34, 1999
                                            18. Nakai S et al: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord. 12(4):293-9, 1999
                                            19. Murata M et al: Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain. Arch Orthop Trauma Surg. 113(6):297-301, 1994
                                            20. Whitecloud TS 3rd et al: Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine. 19(5):531-6, 1994
                                            21. Abumi K et al: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 15(11):1142-7, 1990
                                            22. Boden SD et al: Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 15(6):571-6, 1990
                                            23. Weiler PJ et al: Numerical [corrected] analysis of the load capacity of the human spine fitted with L-rod instrumentation. Spine. 15(12):1285-93, 1990
                                            24. Hayes MA et al: Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 14(3):327-31, 1989
                                            25. Johnsson KE et al: Postoperative instability after decompression for lumbar spinal stenosis. Spine. 11(2):107-10, 1986
                                            26. Frymoyer JW et al: Segmental instability. Rationale for treatment. Spine. 10(3):280-6, 1985
                                            27. Gertzbein SD et al: Centrode patterns and segmental instability in degenerative disc disease. Spine. 10(3):257-61, 1985
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    TERMINOLOGY

                                                    • Synonyms

                                                      • Spine instability (SI), segmental instability, abnormal spinal motion, degenerative instability
                                                    • Definitions

                                                      • Loss of spine motion segment stiffness, when applied force produces greater displacement than normal, with pain/deformity
                                                      • Neoplastic instability: Loss of spinal integrity from neoplastic process associated with movement-related pain, symptomatic or progressive deformity, &/or neural compromise under physiologic loads

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • Fluoroscopic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Fourney DR et al: Spinal instability neoplastic score: an analysis of reliability and validity from the spine oncology study group. J Clin Oncol. 29(22):3072-7, 2011
                                                                                      2. Fisher CG et al: A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine (Phila Pa 1976). 35(22):E1221-9, 2010
                                                                                      3. Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
                                                                                      4. Winegar CD et al: A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 13(1):5-16, 2010
                                                                                      5. Alamin T et al: Lumbar tumor resections and management. Orthop Clin North Am. 40(1):93-104, vii, 2009
                                                                                      6. Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
                                                                                      7. Haughton VM et al: Measuring the axial rotation of lumbar vertebrae in vivo with MR imaging. AJNR Am J Neuroradiol. 23(7):1110-6, 2002
                                                                                      8. Kristof RA et al: Degenerative lumbar spondylolisthesis-induced radicular compression: nonfusion-related decompression in selected patients without hypermobility on flexion-extension radiographs. J Neurosurg. 97(3 Suppl):281-6, 2002
                                                                                      9. Kuroki H et al: Clinical results of posterolateral fusion for degenerative lumbar spinal diseases: a follow-up study of more than 10 years. J Orthop Sci. 7(3):317-24, 2002
                                                                                      10. Pitkanen MT et al: Segmental lumbar spine instability at flexion-extension radiography can be predicted by conventional radiography. Clin Radiol. 57(7):632-9, 2002
                                                                                      11. Tay BB et al: Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol. 22(2):221-30, 2002
                                                                                      12. Bendo JA et al: Importance of correlating static and dynamic imaging studies in diagnosing degenerative lumbar spondylolisthesis. Am J Orthop. 30(3):247-50, 2001
                                                                                      13. Chen WJ et al: Surgical treatment of adjacent instability after lumbar spine fusion. Spine. 26(22):E519-24, 2001
                                                                                      14. Nizard RS et al: Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am. 39(1):55-71, v-vi, 2001
                                                                                      15. Gibson JN et al: Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. (3):CD001352, 2000
                                                                                      16. Herkowitz HN et al: Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis. Spine. 24(12):1268-70, 1999
                                                                                      17. Mochida J et al: How to stabilize a single level lesion of degenerative lumbar spondylolisthesis. Clin Orthop. (368):126-34, 1999
                                                                                      18. Nakai S et al: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord. 12(4):293-9, 1999
                                                                                      19. Murata M et al: Lumbar disc degeneration and segmental instability: a comparison of magnetic resonance images and plain radiographs of patients with low back pain. Arch Orthop Trauma Surg. 113(6):297-301, 1994
                                                                                      20. Whitecloud TS 3rd et al: Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine. 19(5):531-6, 1994
                                                                                      21. Abumi K et al: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 15(11):1142-7, 1990
                                                                                      22. Boden SD et al: Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 15(6):571-6, 1990
                                                                                      23. Weiler PJ et al: Numerical [corrected] analysis of the load capacity of the human spine fitted with L-rod instrumentation. Spine. 15(12):1285-93, 1990
                                                                                      24. Hayes MA et al: Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 14(3):327-31, 1989
                                                                                      25. Johnsson KE et al: Postoperative instability after decompression for lumbar spinal stenosis. Spine. 11(2):107-10, 1986
                                                                                      26. Frymoyer JW et al: Segmental instability. Rationale for treatment. Spine. 10(3):280-6, 1985
                                                                                      27. Gertzbein SD et al: Centrode patterns and segmental instability in degenerative disc disease. Spine. 10(3):257-61, 1985