Lumbar Instability

(Clinical/Radiographic)
History

944
1

Knuttson: Method of diagnosing segmental

instability by measuring sagittal plane translation
and rotation with lateral flexion/extension
radiographs, then compared to normal ranges
History

44 990
1 9 1

White and Panjabi: Defined criteria for diagnosing instability

-Sagittal translation > 4.5mm, or > 15% vertebral body width

-Sagittal rotation > 15o at L1-2, L2-3, or L3-4,
> 20o at L4-5 or 25o at L5-S1
History

44 990
1 9 1

White and Panjabi: Defined criteria for diagnosing instability

-Sagittal translation > 4.5mm, or > 15% vertebral body width

-Sagittal rotation > 15o at L1-2, L2-3, or L3-4,
> 20o at L4-5 or 25o at L5-S1
History

90 92
944 1 9 19
1

Panjabi: presents a conceptual model of the spinal

stabilization system, the neutral zone and clinical instability
History

90 92
944 1 9 19
1

Panjabi: presents a conceptual model of the spinal

stabilization system, the neutral zone and clinical instability
History

92 ay
44 990 19 To
d
1 9 1

Multiple studies on lumbar clinical instability and its role in LBP

How far have we come in nearly 70 years?

Definitions
Clinical Instability (Panjabi, 1992)
“A significant decrease in the capacity of the stabilizing
system of the spine to maintain the intervertebral neutral
zones within the physiological limits so that there is no
neurological dysfunction, no major deformity, and no
incapacitating pain”
 Stabilization System
Vertebrae
(3 Subsystems)
Facets Muscles
Discs Tendons
Ligaments

Passive
Active
Neural Control

CNS
Nerves
Feedback System
Subsystem Dysfunction?

Compensatory
Passive
Active response from
Ne
ur
al other
Co
ntr
ol subsystems
Passive
Active
Response to Subsystem Dysfunction
Ne
ur
al Conceptual Response Conceptual Outcome
Co
nt 1. Immediate successful
ro
l
compensation from Normal Function
other subsystems

2. Long-term Normal function with

compensation from altered stabilization
one or more system
subsystems

3. Injury to one or more Overall system dysfunction,

subsystems LBP
Definitions
Clinical Instability (Panjabi, 1992)
“Cause pain despite the absence of any radiological
anomaly, can be defined as the loss of neuromotor
capability to control segmental movement during mid-
range”
Structural Instanbility
“Disruption of passive stabilisers, which limit the excessive
segmental end range of motion (ROM)”
Neutral Zone
“That part of the range of the intervertebral motion,
measured from the neutral position, within which the
spinal motion is produced with a minimal internal
resistance.” (Panjabi)
Zone of high flexibility or laxity
Elastic Zone
“That part of the physiological intervertebral motion,
measured from the end of the neutral zone up to the
physiological limit.”
Zone of high stiffness/resistance
Diagram of IV movement(Biely et al.)
Zone ROM Zone ROM
High Laxity
Weakness or Strengthening,
Injury Osteophytes, Fusion

High Resistance

Neutral Zone + Elastic Zone = Physiological ROM

 Theoretical Construct
Passive

Neural Active
 Bệnh nguyên
Thoái hóa
Bẩm sinh
Chấn thương
Mắc phải
Đặc điểm lâm sàng
HC cột sống:
 Đau CSTL -> Test corset (+)
 Điểm đau CS và cạnh sống TL
 Biến dạng CS: Dấu hiệu bậc thang
 Tư thế chống đau
 Hạn chế tầm vận động
HC chèn ép rễ TK
+ Đau lan theo dọc đường đi của rễ thần kinh chi phối
+ Rối loạn cảm giác lan theo dọc các dải cảm giác.
+ Teo cơ do rễ thần kinh chi phối bị chèn ép.
+ Giảm hoặc mất phản xạ gân xương.
HC chèn ép rễ TK
Dấu hiệu kích thích rễ
HC chèn ép rễ TK
Dấu hiệu tổn thương rễ
 Rối loạn cảm giác
- Rối loạn vận động
 Giảm phản xạ gân xương
 Teo cơ
Dấu hiệu đau cách hồi tủy
XQ
Tư thế thẳng
XQ
Tư thế nghiêng
XQ
Tư thế nghiêng động
XQ
Tư thế nghiêng động
XQ
Tư thế chếch 2 bên
CLVT
CLVT
CLVT
MRI
MRI
MRI
Thank You