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
Reeves NP et al: Are stability and instability relevant concepts for back pain? J Orthop Sports Phys Ther. 49(6):415-24, 2019
Vincent SA et al: The unstable spine: a surgeon's perspective. Semin Ultrasound CT MR. 39(6):618-29, 2018
Abbasi Fard S et al: Instability in thoracolumbar trauma: is a new definition warranted? Clin Spine Surg. 30(8):E1046-49, 2017
Muto M et al: Neuroimaging of spinal instability. Magn Reson Imaging Clin N Am. 24(3):485-94, 2016
Izzo R et al: Biomechanics of the spine. Part I: spinal stability. Eur J Radiol. 82(1):118-26, 2013
Izzo R et al: Biomechanics of the spine. Part II: spinal instability. Eur J Radiol. 82(1):127-38, 2013
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
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
Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
Winegar CD et al: A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 13(1):5-16, 2010
Alamin T et al: Lumbar tumor resections and management. Orthop Clin North Am. 40(1):93-104, vii, 2009
Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
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
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
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
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
Tay BB et al: Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol. 22(2):221-30, 2002
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
Chen WJ et al: Surgical treatment of adjacent instability after lumbar spine fusion. Spine. 26(22):E519-24, 2001
Nizard RS et al: Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am. 39(1):55-71, v-vi, 2001
Gibson JN et al: Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. (3):CD001352, 2000
Herkowitz HN et al: Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis. Spine. 24(12):1268-70, 1999
Mochida J et al: How to stabilize a single level lesion of degenerative lumbar spondylolisthesis. Clin Orthop. (368):126-34, 1999
Nakai S et al: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord. 12(4):293-9, 1999
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
Whitecloud TS 3rd et al: Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine. 19(5):531-6, 1994
Abumi K et al: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 15(11):1142-7, 1990
Boden SD et al: Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 15(6):571-6, 1990
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
Hayes MA et al: Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 14(3):327-31, 1989
Johnsson KE et al: Postoperative instability after decompression for lumbar spinal stenosis. Spine. 11(2):107-10, 1986
Frymoyer JW et al: Segmental instability. Rationale for treatment. Spine. 10(3):280-6, 1985
Gertzbein SD et al: Centrode patterns and segmental instability in degenerative disc disease. Spine. 10(3):257-61, 1985
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
Reeves NP et al: Are stability and instability relevant concepts for back pain? J Orthop Sports Phys Ther. 49(6):415-24, 2019
Vincent SA et al: The unstable spine: a surgeon's perspective. Semin Ultrasound CT MR. 39(6):618-29, 2018
Abbasi Fard S et al: Instability in thoracolumbar trauma: is a new definition warranted? Clin Spine Surg. 30(8):E1046-49, 2017
Muto M et al: Neuroimaging of spinal instability. Magn Reson Imaging Clin N Am. 24(3):485-94, 2016
Izzo R et al: Biomechanics of the spine. Part I: spinal stability. Eur J Radiol. 82(1):118-26, 2013
Izzo R et al: Biomechanics of the spine. Part II: spinal instability. Eur J Radiol. 82(1):127-38, 2013
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
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
Lall R et al: A review of complications associated with craniocervical fusion surgery. Neurosurgery. 67(5):1396-402; discussion 1402-3, 2010
Winegar CD et al: A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine. 13(1):5-16, 2010
Alamin T et al: Lumbar tumor resections and management. Orthop Clin North Am. 40(1):93-104, vii, 2009
Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
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
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
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
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
Tay BB et al: Indications, techniques, and complications of lumbar interbody fusion. Semin Neurol. 22(2):221-30, 2002
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
Chen WJ et al: Surgical treatment of adjacent instability after lumbar spine fusion. Spine. 26(22):E519-24, 2001
Nizard RS et al: Radiologic assessment of lumbar intervertebral instability and degenerative spondylolisthesis. Radiol Clin North Am. 39(1):55-71, v-vi, 2001
Gibson JN et al: Surgery for degenerative lumbar spondylosis. Cochrane Database Syst Rev. (3):CD001352, 2000
Herkowitz HN et al: Management of degenerative disc disease above an L5-S1 segment requiring arthrodesis. Spine. 24(12):1268-70, 1999
Mochida J et al: How to stabilize a single level lesion of degenerative lumbar spondylolisthesis. Clin Orthop. (368):126-34, 1999
Nakai S et al: Long-term follow-up study of posterior lumbar interbody fusion. J Spinal Disord. 12(4):293-9, 1999
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
Whitecloud TS 3rd et al: Operative treatment of the degenerated segment adjacent to a lumbar fusion. Spine. 19(5):531-6, 1994
Abumi K et al: Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine. 15(11):1142-7, 1990
Boden SD et al: Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine. 15(6):571-6, 1990
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
Hayes MA et al: Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine. 14(3):327-31, 1989
Johnsson KE et al: Postoperative instability after decompression for lumbar spinal stenosis. Spine. 11(2):107-10, 1986
Frymoyer JW et al: Segmental instability. Rationale for treatment. Spine. 10(3):280-6, 1985
Gertzbein SD et al: Centrode patterns and segmental instability in degenerative disc disease. Spine. 10(3):257-61, 1985
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