Skip to main content
SpringerLink
Log in

Spinal Instability and Imbalance: Definition, Clinical Manifestations, and Biomechanics

  • Chapter
Biomechanics and Biomaterials in Orthopedics

  • 922 Accesses

Abstract

Spinal biomechanics have been the focus of many studies aimed at elucidating the roles of anatomic structures, at analyzing the mechanisms underlying injuries, at interpreting clinical syndromes, and at defining and optimizing therapeutic indications. “Spinal instability” is a somewhat hazy concept used to explain protean clinical syndromes, on the basis of imaging findings that are difficult to interpret and provide only indirect and presumptive information on structural lesions. Most studies of spinal biomechanics investigated the cervical, thoracic, and lumbar segments separately. Recent insights into global spinal balance and its interrelations with the pelvis and lower limbs have prompted substantial changes in rehabilitation techniques and in surgical strategies and procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Pope M, Panjabi M. Biomechanical definitions of spinal instability. Spine 1985;10:255–6.

    Article  PubMed  CAS  Google Scholar 

  2. Knutsson R The instability associated with disk degeneration in the lumbar spine. Acta Radiol 1944;25: 593–609.

    Article  Google Scholar 

  3. Kirkaldy-Willis WH, Fargan HR Instability of the lumbar spine. Clin Orthop 1982;165:110–23.

    PubMed  Google Scholar 

  4. Mooney V. Where is the pain coming from? Spine 1987;12(8):754–9.

    Article  PubMed  CAS  Google Scholar 

  5. Putto E, Tallroth K. Extension-flexion radiographs for motion studies of the lumbar spine. A comparison of two methods. Spine 1990;15(2):107–10.

    Article  PubMed  CAS  Google Scholar 

  6. White AA, Panjabi MM. Clinical biomechanics of the spine, 2nd ed. Philadelphia: JB Lippincott, 1990.

    Google Scholar 

  7. Dvorak J, Panjabi M, Novotny. Clinical validation of functional flexion-extension roentgenograms of the lumbar. Spine 1991;16:943–50.

    Article  PubMed  CAS  Google Scholar 

  8. Mc Fadden KD, Taylor JR. Axial rotation in the lumbar spine and gaping of the zygapophyseal joints. Spine 1990;15:295–9.

    Article  CAS  Google Scholar 

  9. Nachemson A. Lumbar discography, where are we today. Spine 1989;14:555–7.

    Article  PubMed  CAS  Google Scholar 

  10. Denis R The column spine and signifiance in the classification of acute thoracolumbar injuries. Spine 1983;8:817–31.

    Article  PubMed  CAS  Google Scholar 

  11. Dickey JP, Bednar DA, Dumas GA. New insight into the mechanics of the lumbar interspinous ligament. Spine 1996;21:23.

    Article  Google Scholar 

  12. Duparc J, Shreiber A, Troisier O. Instabilités vertébrales lombaires. Paris: Exp. Scientifique Française-GIEDA, Paris, 1995.

    Google Scholar 

  13. Dupuis PR, Yong Hing K, Kirkaldt-Willis W. Radiologic diagnostis of the lumbar spine: flexion-extension and lateral bending. Spine 1991;16:943–50.

    Article  Google Scholar 

  14. Dvorak J, Panjabi M, Chang D. Functional radiographic diagnosis of degenerative lumbar spinal instability. Spine 1985;10:262–76.

    Article  Google Scholar 

  15. Roussouly P, Berthonnaud E, Dimnet J. Critères sagittaux de réglage d’une arthrodèse postérieure du rachis. Rachis 1998;10(6):224–6.

    Google Scholar 

  16. Palmgren T, Gronblad M, Virri J, Seitsalo S, Ruuskanen M, Karaharju E. Immunohistochemical demonstration of sensory and automatic nerve terminals in herniated lumbar disc tissue. Spine 1996;21:1301–6.

    Article  PubMed  CAS  Google Scholar 

  17. Friberg O. Lumbar instability: a dynamic approach by traction-compression radiography. Spine 1987;12(2): 119–29.

    Article  PubMed  CAS  Google Scholar 

  18. Nakamura SI et al. The afferent pathways of disco-genic low back pain. J Bone Joint Surg 1996;78:602–12.

    Google Scholar 

  19. Panjabi M, Goel V, Summers D. Effects of disc degeneration on the instability of a motion segment. Orthop Trans 1983;7:329.

    Google Scholar 

  20. Panjabi MM, Chang D, Dvorak J. An analysis of errors in kinematic parameters associated with in vivo functional radiographs. Spine 1992;7(2):200–5.

    Article  Google Scholar 

  21. Paris SV. Physical sign of instability. Spine 1985; 10: 277–9.

    Article  PubMed  CAS  Google Scholar 

  22. Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine 1989; 14:327–31.

    Article  PubMed  CAS  Google Scholar 

  23. Holmes DC, Browns MD, Eckstein EC, Larta L. Instability assessment of the lumbar functional spinal unit. Orthop Trans 1988;12:619–20.

    Google Scholar 

  24. Hoppe E, Tsou P. Postdecompression lumbar instability. Clin Orthop 1988;227:143–51.

    Google Scholar 

  25. Hukins DWL, Kirby MC, Sikoryn TA, Aspden RM, Cox AJ. Comparison of structure, mechanical properties and function of lumbar spinal ligaments. Spine 1990; 15:8.

    Google Scholar 

  26. Husson JL. Instabilité vertébrale à l’étage lombaire. Cahiers d’enseignement de la SOFCOT. Conférences d’enseignement 1995;63–78.

    Google Scholar 

  27. Dvorak J, Panjabi M, Chang D, Theiler R, Grob D. Functional radiographic diagnosis of the lumbar spine flexion-extension and lateral bending. Spine 1991; 16:562–71.

    Article  PubMed  CAS  Google Scholar 

  28. Mulholland RC. Lumbar segmental instability: clinical definition. In: Szpalski M, Gunzburg R, Pope MH, editors. Lumbar segmental instability. Philadelphia: Lippincott Williams & Wilkins, 1999;55–61.

    Google Scholar 

  29. Mimura M, Panjabi M, Oxland TR. Disc degeneration affects the multidirectional flexibility of the lumbar. Spine 1994;19(12):1371–80.

    Article  PubMed  CAS  Google Scholar 

  30. Ebara S, Harada T, Hosono N et al. Intraoperative measurement of lumbar spinal instability. Spine 1992; 17(3S):44–50.

    Article  Google Scholar 

  31. Saillant G, Lemoine J, Lazennec JY, Benazet JP. La déstabilisation du rachis. Rachis 1994;6(65):307–18.

    Google Scholar 

  32. McNab I. The traction spur. An indicator of segmental instability. J Bone Joint Surg 1971;53A:663.

    Google Scholar 

  33. Poulin P, Daumen-Legre V, Serratrice G. La camp-tocormie du sujet âgé: myopathie ou dystonie musculaire? Rev Rhum Mal Osteoartic 1993;60:159–61.

    Google Scholar 

  34. Junghans H. Spondylolisthesis onhe Spalt in Zwischengelenk-Stuck. Arch Orthop Unfall-Chir 1930;29: 118–27.

    Article  Google Scholar 

  35. Roy-Camille R. L’instabilité rachidienne. Rachis 1994; 6(2):107–12.

    Google Scholar 

  36. Louis R. Spinal stability as defined by the three-column spine concept. Anat Clin 1985;7:33–42.

    Article  PubMed  CAS  Google Scholar 

  37. Benazet JP, Rakover JP Saillant S, Roy-Camille R. Facteurs de déstabilisation chirurgicale du rachis lombaire. Edt Masson 1993:182–90.

    Google Scholar 

  38. Butler D, Trafimow JH, Anderson GNJ, McNeill TW, Huckman MS. Discs degenerate before facets. Spine 1990;15:2.

    Article  Google Scholar 

  39. Freemont AJ, Peacock TE, Goupille P, Hoyland JA, O’Brien J, Jayson MIV. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997;350:178–81.

    Article  PubMed  CAS  Google Scholar 

  40. Ida Y, Kataoka O, Sho T et al. Post-operative lumbar spinal instability occuring or progressing secondary to laminectomy. Spine 1990;15:1186–9.

    Article  Google Scholar 

  41. Lindahl O. Determination of the sagittal mobility of the lumbar spine. Acta Orthop Scand 1966;37:241–54.

    Article  PubMed  CAS  Google Scholar 

  42. Seenegas J. Stabilisation lombaire souple. Instabilité vertébrale lombaire, GIEDA InterRachis, Paris, Expansion Scientifique Française 1995;209–18.

    Google Scholar 

  43. Muggleton JM, Kondracki M, Allen R. Spinal fusion for lumbar instability: does it have a scientific basis? J Spinal Disord 2000;13–3:200–4.

    Article  Google Scholar 

  44. Bernhardt M, Bridwell KH. Segmental analysis of the sagittal plane alignment of the normal thoracic and lumbar spines and thoracolumbar junction. Spine 1989;14(7):717–21.

    Article  PubMed  CAS  Google Scholar 

  45. Boisaubert B, Montigny JP, Duval-Beaupere G, Hecquet J, Marty. Incidence, sacrum et spondylolisthesis. Rachis 1997;9(4):187–92.

    Google Scholar 

  46. Adams MA. The mechanical function of the lumbar apophyseal joints. Spine 1983;8:327–30.

    Article  PubMed  CAS  Google Scholar 

  47. Lazennec JY, Ramare S, Arafati N, Laudet CG, Gorin M, Roger B et al. Sagittal alignment in lumbosacral fusion: relations between radiological parameters and pain. Eur Spine J 2000;9:47–55.

    Article  PubMed  CAS  Google Scholar 

  48. Luk KD, Chow DH, Evans JH, Leong JCY. Lumbar spinal mobility after short anterior interbody fusion. Spine 1995;20(7):813–8.

    Article  PubMed  CAS  Google Scholar 

  49. Maigne R. Dérangements intervertébraux mineurs. Diagnostic et traitement des douleurs communes d’origine rachidienne. Paris: Expansion Scientifique Française, 1989.

    Google Scholar 

  50. Nachemson A. Lumbar interdiscal pressure. Acta Orthop Scand 1960;43:1–104.

    CAS  Google Scholar 

  51. Weinstein J, Claverie W, Gibson S. The pain of discog-raphy. Spine 1998;13:1344–8.

    Article  Google Scholar 

  52. Yang KH, King AL. Volvo award in biomechanics: mechanism of facet load transmission as a hypothesis of low back pain. Spine 1984;9:557–65.

    Article  PubMed  CAS  Google Scholar 

  53. Posner I, White AA, Edwards WT et al. A biomechani-cal analysis of the clinical stability of the lumbar and lumbosacral spine. Spine 1982;7:374–89.

    Article  PubMed  CAS  Google Scholar 

  54. Frymoyer JW, Selby DK. Segmental instability: rationale for treatment. Spine 1985;10:280–6.

    Article  PubMed  CAS  Google Scholar 

  55. Frobin W, Brinckmann P, Leivseth G, Biggerman M, Reikeras O. Precision measurement of segmental motion from flexion-extension radiographs of the lumbar spine. Clin Biomech 1996;11(8):457–65.

    Article  Google Scholar 

  56. Fujiwara A, Tamai K, An HS, Kurihashi A, Lim T-H, Yoshida H, Saotome K. The relationship between disc degeneration, facet joint osteoarthritis and stability of the degenerative lumbar spine. J Spinal Disord 2000; 13(5):444–50.

    Article  PubMed  CAS  Google Scholar 

  57. Cosentino R, Suarez A, Baccani S. Etude radiologique de la mobilité du rachis dorso-lombaire. Rev Chir Orthop 1982;68:91–5.

    PubMed  CAS  Google Scholar 

  58. Hanley EN, Matteri RE, Frymoyer JW. Accurate roentgenographic determination of lumbar flexion-extension. Clin Orthop 1976;115:145–8.

    PubMed  Google Scholar 

  59. Bram J, Zaneri M, Min K, Hodler J. Abnormalities of the intervertebral disks and adjacent bone marrow as predictors of segmental instabiliy of the lumbar spine. Acta Radiologica 1998;39:18–23.

    PubMed  CAS  Google Scholar 

  60. Sohei E, Takeo H, Noburu H, Masahiro I, Masao T, Yoshibaru M et al. Intraoperative measurement of lumbar spinal instability. Spine 1992;17(suppl):S40–50.

    Google Scholar 

  61. Murata M, Morio Y, Kuranobu K. 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 1994;113:297–301.

    Article  PubMed  CAS  Google Scholar 

  62. Schmidt TA, An HS, Lim TH, Nowicki BH, Haughton VM. The stiffness of lumbar motion segments with a high-intensity zone in the annulus fibrosus. Spine 1998;23:2167–73.

    Article  PubMed  CAS  Google Scholar 

  63. Nachemson A. Lumbar spine instability: a critical update and symposium summary. Spine 1985; 10: 290–1.

    Article  PubMed  CAS  Google Scholar 

  64. Rolander SD. Motion of the lumbar spine with special reference to stabilizing effect of posterior fusion. Acta Orthop Scand 1966;90:1–144.

    Google Scholar 

  65. Sato H, Kikuchi S. The natural history of radiographic instability of the lumbar spine. Spine 1993;18:2075–8.

    Article  PubMed  CAS  Google Scholar 

  66. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 1994;3(4):184–201.

    Article  PubMed  CAS  Google Scholar 

  67. Antonietti P, Saillant G, Gagna G, Lemoine J. Dystabil-ités dégénératives du rachis lombaire. “Instabilités vertébrales lombaires”. Paris: Exp. Scientifique Française, 1995;55–62.

    Google Scholar 

  68. Benoist M, Boulu P, Deburge A. Physiopathologie et aspects psycho-sociaux de la lombalgie. Cahiers de la SOFCOT 1997;14–18.

    Google Scholar 

  69. Bernick S, Walker JP, Pawle WJ. Age changes to the annulus fibrosus in human intervertebral discs. Spine 1991;16:520–4.

    Article  PubMed  CAS  Google Scholar 

  70. Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat 1981; 132:39–56.

    PubMed  CAS  Google Scholar 

  71. Lorentz M, Patwardhan A, Vanderby R. Load-bearing characteristics of lumbar facets in normal and surgically altered spinal segments. Spine 1983;8:122–30.

    Article  Google Scholar 

  72. Husson JL, Poncer R, De Korvin B, Meadeb J. Apport du scanner en twist-test dans la mesure de l’instabilité du rachis lombaire. Rev Chir Orthop 1993;79: 117.

    Google Scholar 

  73. Lavaste F, Robin S. Le rachis instable: aspects biomécaniques. Rachis 1995;7(3):173–5.

    Google Scholar 

  74. Penning L, Wilmink JT, Van Woerden HH. Inability to prove instability: a critical appraisal of clinical radiological flexion-extension studies in lumbar disc degeneration. Diagn Imag Clin Med 1984;53:186–92.

    CAS  Google Scholar 

  75. Stokes IA, Frymoyer JW. Segmental motion and instability. Spine 1987;12(7):688–91.

    Article  PubMed  CAS  Google Scholar 

  76. Coppes MH, Marani E, Thomeer RT, Groen GJ. Innervation of “painful” lumbar discs. Spine 1997;22:2342–50.

    Article  PubMed  CAS  Google Scholar 

  77. Boden SD, Wiesel SW. Lumbosacral segmental motion in normal individuals. Have we been measuring instability properly? Spine 1990;15:571–6.

    Article  PubMed  CAS  Google Scholar 

  78. Wood KB, Popp CA, Transfeldt EE, Geissele AE. Radiographic evaluation of instability in spondylolisthesis. Spine 1994;19:1697–03.

    Article  PubMed  CAS  Google Scholar 

  79. Pearcy M, Portek I, Shepherd J. Three-dimensional x-ray analysis of normal movements in the lumbar spine. Spine 1984;9(3):582–7.

    Article  PubMed  CAS  Google Scholar 

  80. Fernand R, Fox D. Evaluation of lumbar lordosis. A prospective and retrospective study. Spine 1985; 10(9):799–803.

    Article  PubMed  CAS  Google Scholar 

  81. Gerzbein SD, Seligman J, Holtby R. Centrode pattern and segmental instability in degenerative disc disease. Spine 1985;10:257–61.

    Article  Google Scholar 

  82. Marty C, Legaye J, Duval-Beaupere G. Equilibre rachi-dien sagittal normal. Ses relations avec les paramètres pelviens. Ses dysfonctionnements: cause de lombalgie. Résonnances Européennes du Rachis, Sept. 1997; 15:21–6.

    Google Scholar 

  83. Morgan FP, King T. Primary instability of lumbar vertebrae as a common cause of low back pain. J Bone Joint Surgl957;39B:6–22.

    Google Scholar 

  84. Aprill C, Bogduk N. High intensity zone: a diagnostic sign of painful lumbar disk on magnetic resonance imaging. Br J Radiol 1992;65:361–9.

    Article  PubMed  CAS  Google Scholar 

  85. Park WM. The place of radiology in the investigation of low back pain. Clin Rheum Disord 1980;6:93–132.

    Google Scholar 

  86. Modic MT, Steinberg PM, Rodd JS, Masaryk T, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193–9.

    PubMed  CAS  Google Scholar 

  87. Seligman JV, Gertzbein SD, Tile M, Kapasouri A. Computer analysis of spinal segment motion in degenerative disc disease with and without axial loading. Spine 1984;9:566–73.

    Article  PubMed  CAS  Google Scholar 

  88. Weiler PJ, King GJ, Gerbein SD. Analysis of sagittal plane instability of the lumbar spine in vivo. Spine 1990;12:1300–6.

    Article  Google Scholar 

  89. Burton AK, Barrie MC, Gibbons L, Videman T, Tillotson KM. Lumbar disc degeneration and sagittal flexibility. J Spinal Disord 1996;9:418–24.

    Article  PubMed  CAS  Google Scholar 

  90. Casey L. Lumbar spinal instability after extensive posterior spinal decompression. Spine 1983;8:429–537.

    Article  Google Scholar 

  91. During J, Goudfrooij H, Keessen W, Beeker TW, Crowe A. Toward standards for posture. Postural characteristics of the lower back system in normal and pathologic conditions. Spine 1985;83–7.

    Google Scholar 

  92. Legaye J, Hecquet J, Marty C, Duval-Beaupere G. Equilibre sagittal du rachis. Relations entre bassin et courbures rachidiennes sagittales en position debout. Rachis 1993;5(%):215–6.

    Google Scholar 

  93. Lazennec JY, Desjardins A, Laudet CG, Lazennec A, Roger B, Saillant G et al. Déstabilisation du rachis lombaire en L4 L5 et L5 SI. Etude expérimentale des conséquences biomécaniques de la discectomie chirurgicale, de Parthrectomie et de la laminectomie. Edt Masson 1993; 192–9.

    Google Scholar 

  94. Van Royen BJ, De Kleuver M, Slot GH. Polysegmental lumbar posterior wedge osteotomies for correction of kyphosis in ankylosing spondylitis. Eur Spine J 1998;7: 104–10.

    Article  PubMed  Google Scholar 

  95. Duval-Beaupere G, Schmidt C, Cosson P. A barycentre-metric study of the sagittal shape of spine and pelvis. Ann Biomed Eng 1992;20:451–62.

    Article  PubMed  CAS  Google Scholar 

  96. Mangione P, Senegas J. Sagittal balance of the spine. Rev Chir Orthop Réparatrice Appar Mot 83:22–32.

    Google Scholar 

  97. Kuniyoshi A, Panjabi M et al. Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 1990;15(11):1142–7.

    Article  Google Scholar 

Download references

Authors
  1. J.-Y. Lazennec
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Saillant
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Service de Chirurgie Orthopédique et de Traumatologie, Centre Hospitalo-Universitaire Nord, Marseille Cedex 20, France

    Dominique G. Poitout MD (Professeur à l’Université de la Mediterranée, Chef de Service) (Professeur à l’Université de la Mediterranée, Chef de Service)

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag London

About this chapter

Cite this chapter

Lazennec, JY., Saillant, G. (2004). Spinal Instability and Imbalance: Definition, Clinical Manifestations, and Biomechanics. In: Poitout, D.G. (eds) Biomechanics and Biomaterials in Orthopedics. Springer, London. https://doi.org/10.1007/978-1-4471-3774-0_40

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-3774-0_40

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-3776-4

  • Online ISBN: 978-1-4471-3774-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation