SPINAL INSTABILITY

Spinal instability refers to a condition in which the spine is unable to maintain its normal alignment or motion. This leads to pain and disability. This can occur due to a variety of causes, including trauma, degenerative conditions, and congenital disorders. Treatment options may include physical therapy, medication, and surgery, depending on the underlying cause and the severity of the instability.

Schedule an Appointment

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Spinal Instability

Spinal instability refers to a condition in which there is a more-than-normal range of motion between two vertebrae. It causes severe disc degeneration, and thus, the spine becomes unable to support the body.

It tends to increase the risk of spinal arthritis along with the development of bone spurs. Also, since a healthy spine provides protection, structure, and support for the body and its internal organs, an unstable spinal cord can no longer hold the spinal ligaments, muscles, discs, and bones together.

So, spinal instability occurs when a degenerative change or spine injury leads to structural changes. This impacts movement along with load transfers to the spine. In this condition, the spinal segments move more than normal and the motion can be backward, forward, or side to side. As a result, it causes pain, symptoms, and an inability of the spine to maintain normal structure and movement.

Affected Subsystems

Spinal instability is likely to develop if any one of the 3 subsystems that build up the spine is damaged.

The passive subsystem – This part features the vertebrae, intervertebral discs, ligaments, and facet joints that provide stabilization and support.
The active subsystem – It comprises the muscles and tendons that control movement within the spine.
The neural subsystem – This part is made up of the nerves and central nervous system that controls the motion within the spine.

When one or multiple subsystems are damaged, it causes excessive motion in the spine. Also, other structures in the spine have to overcompensate and deal with an abnormal load.

QUESTIONS AND ANSWERS

What causes spinal instability in my child, and is it a common condition?

Spinal instability in children can have various causes. It may result from congenital issues, traumatic injuries, inflammatory conditions, or neurological disorders affecting the spine. The specific cause will be determined through a thorough examination and diagnostic tests. While spinal instability is not as common as other spinal conditions, it can occur, and the treatment approach will depend on the underlying cause and severity of the instability.

What are the treatment options for my child's spinal instability, and will surgery be necessary?

The treatment for spinal instability in a child depends on the underlying cause and the degree of instability. Non-surgical options may include bracing, physical therapy, and activity modification to support and stabilize the spine. In some cases, especially if the instability is severe or progressive, surgery may be recommended to fuse the affected vertebrae or use instrumentation to stabilize the spine. The decision on whether surgery is necessary will be based on a thorough evaluation by the healthcare team.

What is the long-term outlook for my child with spinal instability, and will it affect their daily activities?

The long-term outlook for a child with spinal instability varies based on the underlying cause, the effectiveness of treatment, and how well the child responds to interventions. With appropriate management, many children with spinal instability can lead active and fulfilling lives. Regular follow-up appointments will be essential to monitor the stability of the spine, adjust treatment plans as needed, and address any emerging issues. The impact on daily activities will depend on the severity of the instability and the success of the chosen treatment approach.

It’s crucial for parents to maintain open communication with healthcare professionals to address their specific concerns about their child’s spinal instability. The medical team will provide detailed information about the condition, discuss treatment options, and offer guidance on managing the child’s health and well-being.

Schedule an appointment and see a pediatric orthopedist quickly at Medical City Children’s Orthopedics and Spine Specialists.

Causes of Spinal Instability

Any condition that causes excessive movements in the spinal segments can lead to spinal instability.
Spondylolisthesis, which is the forward slippage of one vertebra over the next vertebra, is the most common reason for spinal instability.
Wear and tear over time can lead to degenerative spine disease that causes excess motion in the spine segment.
Heavy lifting, repetitive motions, and excessive turning and twisting can also cause sudden injury and spinal instability.
Having a few extra pounds, weak core muscles along with the muscles of the abdomen and back, and lack of exercise, are the other reasons.
Some rare but possible causes of spinal instability are sporting injuries or car accidents.
Other causes are external trauma, Scoliosis, Spondylolisthesis, disorders of the connective tissues, poor lifting techniques, fracture of the spine, Metastatic tumors in the spine, Degenerative Disc Disease, Congenital defects in the spinal cord, etc.

Symptoms

Spinal instability is often sudden or sometimes, progressive over time. The signs depend on both the affected area of the back and the severity.

The signs of spinal instability located in the lower back (thoracic and sacral spine) are pain, weakness, and numbness spreading from your child’s back to the lower body parts such as the hips, thighs, and down to the calves.
The signs of spinal instability in your child’s neck (cervical spine) are the same symptoms in the neck and arms. Your child might experience aching, tingling, or burning sensations in the affected area.
The pain usually stays on one side of the body but sometimes it may be on both sides of the body.
Walking, sitting, movement, and certain twisting or bending movements may even worsen the pain.
Spinal instability causes pressure on the spine and can lead to loss of bowel or bladder control, numbness in the groin, difficulty walking, sexual dysfunction, etc. This is called cauda equina syndrome which is a spinal emergency. When your child is not able to perform normal daily activities, parents should immediately make an appointment with a pediatric spine doctor like those at Medical City Children’s Orthopedics and Spine Specialists.
Spinal instability can cause low back pain, stiffness, muscle spasms, etc.
The pain might worsen with movements or activities that place more pressure on the spine, like lifting heavy objects or bending or twisting.
Spinal discs and vertebrae displacement can cause irritation and compression of the nearby nerves or the spinal cord. Sciatica is a common range of symptoms that develop with the compressed lumbar spine nerves.
Sciatic pain worsens by standing or sitting for long periods. It can also be triggered by laughing, coughing, or sneezing.

Diagnosis

Your doctor will take your child’s complete history to assess for spinal instability. A physical exam will evaluate for the source of pain and all discomfort. Doctors will also assess your child’s nerve function, muscle strength, and skin sensation. Additionally, the imaging tests can help your doctor identify the injured bones and muscles of the spine:

X-rays – Doctors take X-rays in bending forward and backward positions. This may demonstrate dynamic spinal instability.
Computed tomography (CT) scan – It uses the electromagnetic energy of X-rays to present an elaborate image of the bony anatomy spine and surrounding tissues.
Magnetic resonance imaging (MRI) – It utilizes high-power magnets along with radio waves to create an elaborate picture of soft tissue, discs, ligaments, cords, and nerves of the spine.
Nerve conduction studies – These help point out nerve damage by using electrodes to measure how quickly a nerve impulse transmits.
Electromyogram – It uses needle electrodes to find out muscle damage.

Spinal Instability Treatment

Spine doctors use conservative measures to treat mild cases of spinal instability. The treatment aims to relieve pain and strengthen the spine muscles. A doctor may recommend the following:

Activity modifications – It means avoiding activities that cause pain or trigger painful muscle spasms.
Medications – Over-the-counter painkillers and anti-inflammatories can help relieve mild to moderate pain. To deal with significant pain and painful muscle spasms, doctors may prescribe high-power pain medications or muscle relaxants.
Physical therapy – Physical therapy has a crucial role to play in treating spinal instability. This therapy focuses on strengthening the back, leg, and core muscles that stabilize and support the spine.
Injections – A corticosteroid injection taken directly into the spine helps relieve inflammation and irritation around compressed nerve roots. However, this effect is temporary and may provide a maximum of several months or a year of pain relief.

If conservative treatments fail to improve the symptoms, spine doctors may recommend surgery.

Surgical Options

Mild to moderate spinal instability requires surgery, especially if it entails nerve damage and compression.

In one surgical option, experts replace the degenerated disc with an artificial disc.
In another surgical option, doctors remove the degenerated disc and attach the adjacent vertebrae to restrict movement and limit instability at the vertebral level.

Also, there are minimally invasive spine surgeries that reduce pain and improve mobility for patients diagnosed with this problem. The benefits of these surgeries include smaller incisions, fewer complications, and blood loss during surgery, reduced damage to the surrounding muscled and soft tissues, etc. Also, there will be a reduced risk of infection and less pain after surgery. Your child will enjoy a faster recovery and rehabilitation and as a result, your child will get better cosmetic results with minimal scarring.

Spinal Instability Conclusion

Spinal instability-related pain and dysfunction can be mild or sometimes, excruciating. Our spine doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists are highly trained and skilled in the diagnosis, treatment, and management of spinal instability. We will provide the optimal treatment. With the use of an individualized treatment plan, we provide a comprehensive plan of care. For your convenience, we have offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.

____________________

Footnote:

National Institute of Health: Spinal Instability

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.