Symptom, Causes and Diagnosis of Spinal Instability

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What is Spinal Instability?

A healthy spine provides structural protection and support for our body’s internal organs. Spinal instability, also known as lumbar instability, is an example of an unhealthy spine. This leads to abnormal movement between two or more vertebrae in the spine.

Spinal instability can be categorised as either micro-instability or macro-instability. The former does not cause any structural changes as the movements between vertebrae are minor. However, it can still lead to inflammation in the discs or the joints between the vertebrae, resulting in back pain.

 In contrast, the latter causes the spine to lose its normal alignment. This type is usually linked to conditions such as spondylolisthesis and scoliosis. Macro-instability can result in more severe symptoms including damage to the spinal cord and nerve roots, and painful spinal deformity.

Spine Instability | Avant Orthopaedics

What are the Common Causes of Spinal Instability?

These are defects which are present at birth and affect the development of the spine and its structures, leading to instability.


  • Scoliosis

Scoliosis is a side-to-side curvature of the spine which may cause it to form either an “S” or “C” shape. In this condition, the spine curves sideways, and the individual vertebrae may also rotate. This can affect the alignment and stability of the spine, making it more prone to instability.

  • Thoracic Hyperkyphosis

Thoracic hyperkyphosis is an excessive thoracic spine forward rounding curve, resulting in a slouched or hunched appearance. It can lead to spinal instability, especially when the condition is severe by changing the spine's normal alignment. This, in turn, affects how weight is distributed along the vertebral column and causes increased stress on certain areas of the spine, which affects its stability.

  • Spina Bifida

Spina bifida is a condition that is present at birth and occurs when the spine and spinal cord do not form properly in the womb. It causes the vertebrae to be malformed, resulting in gaps in the spinal column, potentially leading to spinal instability.

Depending on the injury, your spine may sustain structural damage, displacement of intervertebral discs, or weakened soft tissues and ligaments. If left untreated, it can lead to instability along with long-term complications.

Whether it is lifting weights at the gym or a laundry basket at home, proper techniques are a must if you want to keep your spine healthy. Improper lifting techniques like bending from the waist, and twisting your body while carrying objects can cause back muscles to become strained. This can lead to spinal instability as well as an increased risk of injuries.

What are the Symptoms of Spinal Instability?

Depending on the area of the spine that is affected, you may experience neck or back pain. The sensation can vary from person to person, ranging from a dull ache to sharp and stabbing. When it comes to spinal instability, the pain is often worsened by certain movements such as bending forward or twisting the spine.

This feeling is caused by the structures which are supposed to support the spine, being unable to maintain its stability during movement. It may also be accompanied by a sense of unsteadiness in the spine, especially during activities that involve bending, lifting, or twisting.

Paralysis is a symptom that requires immediate medical attention and may be present if there is severe damage to the spinal cord. This can greatly affect an individual's quality of life with it possibly affecting all four limbs, or the legs and lower body.

Spinal instability can put pressure on the spinal cord and nerves, leading to symptoms such as numbness and tingling. The affected areas may depend on the location of the instability along the spine. For example, instability in the cervical (neck) spine can lead to numbness and tingling in the arms, hands, and fingers, while instability in the lumbar (lower back) spine can cause these sensations in the legs, feet, and toes.

How is Spinal Instability Diagnosed?

Your doctor will examine your spine for signs of instability. This may include assessing your posture, range of motion, muscle strength, and reflexes. They may also perform specific tests to evaluate the stability of your spine, such as:


  • Sit-to-stand Test

This test is positive (indicating an association with instability) if the person feels immediate pain when sitting down in a chair, which is partially relieved by standing up.

  • Passive Lumbar Extension Test

This is conducted with the patient lying on their stomach. The examiner then gently elevates both lower extremities (passively) to a height of about 30 cm while maintaining knee extension. This manoeuvre stabilises the T12 vertebrae in a ventrocaudal direction. The test can also be performed with the patient in a lateral position, with the legs bent. A positive result is noted if the test provokes similar complaints as the patient's primary symptoms.

  • Painful Catch Sign

This is assessed with the patient in a supine position. The examiner asks the patient to lift both lower extremities while keeping the knees extended. The patient is then instructed to return slowly to the starting position. A positive result is indicated if the lower extremities fall instantly due to low back pain.

  • Instability Catch Sign

The patient bends their body forward as far as they can and tries to touch their toes. They are then asked to return to the upright, neutral position. If the patient experiences difficulties in doing so, it is seen as a positive sign of spinal instability.

Medical history can play an important role when it comes to diagnosing and assessing the risk of spinal instability. Your doctor may ask about previous spinal injuries or surgeries which you have experienced, along with if you have a family history of spinal disorders.

A spine X-ray is an imaging test that provides detailed images of the bones in the spine. This allows your doctor to examine the alignment, structure, and integrity of the vertebrae. It can help in identifying fractures, misalignments, or signs of degeneration that may contribute to spinal instability.

Are You or Your Loved Ones Suffering from Spinal Instability | Avant Orthopaedics

Are You or Your Loved Ones Suffering from Spinal Instability?

Without medical intervention, spinal instability can cause your quality of life to take a hit. It can cause basic tasks such as standing or lifting objects to be challenging. If you suspect that you or your loved one is suffering from spinal instability, contact us at Avant Orthopaedics for a consultation and personalised treatment recommendations.

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