Local Complicators: Instability Lx Spine

Question 1

Segmental Hypermobility Lx spine

Answer 1

Multiple joints
Programming dynamic instability
Structural instability
Structural surgical instability

Question 2

Segmental compensatory hypermobility

Answer 2

Genetic mobility
Compensatory segmental hypermobility
Structural instability - ligament damage
Surgical instability - significant damage

Question 3

Hypermobility and instability significants

Answer 3

Reversible segmental hypermobility
Structural instability - difficult to reverse
Surgical instability - surgery

Question 4

2 categories of spinal instability

Answer 4

Structural

Functional

Question 5

3 Structural instability characteristics

Answer 5

Excessive end range
Loss of passive structure (ligaments, IVD)
> 4mm end range listhesis

Question 6

4 Functional instability characteristics

Answer 6

Broadinging neutral zone / lack spinal stiffness
Motor control / neurologic control breakdown
Buckling / poor segmental control
Low load ADLs injury

Question 7

Management of hypomobile segments

Answer 7

Manipulation

Question 8

Hypermobility segment management

Answer 8

Exercise stabilization program

Question 9

5 part management treatment program

Answer 9

Attach to Dx as a complicating factor
Possibility of recurrence
Manipulation / mobilization to adjacent levels of dysfunction
6-12 week stabilization exercise program
Surgical intervention

Question 10

3 things to address in the stabilization exercise program

Answer 10

Proprioception
Core stabilization
Muscle endurance

Question 11

4 indication for spinal fusion

Answer 11

Spondylolisthesis w/ stenosis
Non-specific intractable LBP
Stenosis w/out spondylolistesis
Lx disc herniation w/ radiculopathy

Question 12

2 type of grade B, “fair” spinal fusion indications

Answer 12

Spondylolisthesis w/ stenosis

Non-specific interactable LBP

Question 13

2 type of grade C, “poor” spinal fusion indications

Answer 13

Stenosis w/out spondylolisthesis

Lx disc herniation w/ radiculopathy