SPINAL INSTABILITY

QUESTIONS AND ANSWERS

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 a 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 can occur 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. 
• 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.
• Too much irregular movement of the facet joints encourages the growth of bone spurs in the joints as well as arthritis, which may further exacerbate the problem.
• Spinal disc 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 when standing or sitting for long periods. It can also trigger 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 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 detect 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. This procedure is commonly known as spinal fusion surgery. During spinal fusion, the surgeon connects two or more vertebrae using a bone graft, either sourced from another part of the patient’s body or a bone bank. The graft is placed between the vertebrae and stabilized with plates, screws, and rods, allowing the bone tissue to gradually merge. As the vertebrae fuse over time, the spine gains stability, and the patient typically experiences reduced pain.

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 muscles and soft tissues, etc. Also, infection will be reduced and patients will incur 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.

Use of Back Braces and Cervical Collars After Surgery

Following spinal surgery, your child may need to stay in the hospital for a few days. During this time—and often for a period after returning home—the doctor may recommend a back brace or cervical collar, depending on where the surgery was performed.

These supportive devices serve a vital purpose. While they temporarily restrict movement, they help stabilize the spine and protect the area where surgery or spinal fusion took place. Limiting movement allows the bones, discs, and tissues involved in the procedure to heal properly, significantly increasing the chances of a successful recovery. Additionally, wearing a brace or collar can minimize discomfort, decrease the risk of complications, and promote the long-term health of your child’s spine.

Recovery After Spinal Fusion Surgery

Following spinal fusion surgery, your child will typically stay in the hospital for several days so that our team can carefully monitor the initial stages of healing. During this period, it’s common for doctors to recommend wearing a supportive device such as a back brace or cervical collar. While this brace may temporarily limit movement, it is essential for stabilizing the spine and encouraging proper fusion between the vertebrae.

Once home, a structured rehabilitation program is crucial. Physical therapy is tailored to each patient and focuses on gradually restoring strength, flexibility, and function to the affected muscles. Therapy begins gently and progresses as healing continues to ensure a safe return to daily activities.

Most children can expect a full recovery period ranging from 3 to 6 months. The specific timeline depends on factors such as age, the surgery’s complexity, and individual healing rates. Throughout the process, regular follow-ups with the spinal team help ensure the best possible outcome and support a smooth path back to normal movement and play.

Spinal Instability Conclusion 

Spinal instability-related pain and dysfunction can be mild or, sometimes, excruciating. 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. 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 Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX.

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Footnote:

National Institute of Health: Spinal Instability