Spinal instability: no home treatment

Vertebral instability is one of the common reasons for seeking medical help. This pathology causes a feeling of discomfort in the affected part of the spine and is caused by increased non-physiological mobility between the vertebrae due to degeneration of the intervertebral discs, sprain of the spinal ligaments, weakening of the muscle corset or as a result of gross mechanical impact on the spinal structures, i.e. trauma. At the same time, the spine, and more often one or more of its segments, are not able to remain in their normal physiological position and maintain it when a person is at rest and especially in motion.

Instability of the cervical and thoracic vertebrae is caused by their displacement in different directions. This pathological condition can appear at any age, and the lack of timely medical care can lead to serious complications in the event of compression of the spinal cord and to profound disability of the patient. You can undergo a course of treatment for instability of the cervical vertebrae at the CELT multidisciplinary clinic. Our highly qualified spine doctors and neurosurgeons have a whole arsenal of modern tools that allow us to return our patients to normal life.

At CELT you can get advice from a neurosurgeon.

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• Repeated consultation – 2,000

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Types of instability, their causes

Instability of the thoracic or cervical vertebrae can be caused by various reasons. In accordance with them, it is customary to distinguish the following types:

• post-traumatic - appears due to dislocations or fractures of the vertebrae;
• degenerative - appears due to the development of degenerative processes in the spine against the background of other diseases;
• postoperative - appears due to excessive load on the spine during rehabilitation after surgery;
• dysplastic - appears as a result of pathological processes in the connective tissue of the vertebrae, their joints and ligaments.

Science and clinical practice

Spine development

Normally, the development of the spine continues until 20–22 years of age. Osteogenesis of different parts of the spine occurs in the following order: upper cervical, midthoracic, cervical, lower thoracic, lumbar and sacral. The apophyses of the vertebrae become ossified from 8 to 15–16 years of age. Ossification of the C2 vertebra occurs at the age of 4–6 years. Physiological curves of the spine are visible between the ages of 2 and 4 years and become distinct at 6 years of age. The magnitude of cervical lordosis decreases up to 9 years. With age, there is a change in the orientation of the facets of the intervertebral joints. In early childhood they have a relatively horizontal arrangement. The increase in the angle of inclination until the facets assume a horizontal position continues up to 10 years, after which they are able to limit the movement of the vertebrae.

Anatomical and functional features of the upper cervical spine

The cervical spine has characteristic structural and functional features.

The first cervical vertebra, the atlas (C1), and the second, the axis, or epistropheus (C2), connect the spine to the skull and form the atlantoaxial-occipital complex. Vertebra C 1 does not have a body, but there are anterior and posterior arches that limit the lumen of the spinal canal. The superior surface of the C1 vertebra has slightly concave articular processes that are connected to the condyles of the occipital bone. Vertebra C 2 has a body that passes into the odontoid process. It protrudes upward, articulates with the inner surface of the anterior arch of the atlas and reaches the level of the foramen magnum. Vertebra C 1 connects to the condyles of the occipital bone. There are three joints between vertebrae C1 and C2: two paired joints between C1 and C2 and one between the odontoid process of C2 and the arch of the C1 vertebra.

Functionally, these joints are combined into a combined joint, in which rotational movements of the head together with the C1 vertebra are possible. Approximately half of all neck movements occur at the atlantooccipital and atlantoaxial joints.

In the spine, axial and rotational loads are placed on the vertebral bodies and intervertebral discs. Combined into a single structure, they ensure a vertical position of the body, withstand axial pressure, absorb and distribute shock loads. Intervertebral discs connect the vertebrae to each other and provide the stabilizing function of the spine. Fixation of the intervertebral disc to the vertebral body is carried out by the fibers of the fibrous ring. The nucleus pulposus distributes the load applied to the spine. Intervertebral joints, reinforced by articular capsules, do not bear axial load. They determine the direction of movement of the vertebrae. Spinal ligaments fix the vertebrae and intervertebral discs together and influence the range of motion of the spine. The anterior longitudinal ligament prevents the extension of the spine, the posterior longitudinal, supraspinous, interspinous ligaments, as well as the nucleus pulposus limit the flexion of the spine, the intertransverse ligaments limit lateral bending. Of all the ligaments of the spine, the anterior longitudinal one is the strongest. With age, their strength decreases.

The extensibility of the ligaments is most pronounced in places of maximum physiological kyphosis and lordosis, where vertical loads on the spine are absorbed. The greatest extensibility is found in the posterior longitudinal ligament in the cervical spine, which results in greater mobility. The ability of the vertebrae to move is related to their location and the direction of the shear force. The displacement at the level of the apex of lordosis and kyphosis occurs in the direction of the convexity of the curvature. The mobility of the entire spine is the sum of movements of individual segments, which on average fluctuates within 4°

The spine moves around three axes:

1) flexion and extension around the transverse;

2) lateral tilts around the sagittal;

3) rotational movements around the longitudinal.

Circular movements are possible along all three axes, as well as movements along the vertical one.

Mobility and stability of the spine

• The spine combines the properties of mobility and stability. Mobility depends on the structural features of the vertebrae, the size of the intervertebral disc, and the mechanical strength of the structures that provide stability in this section. The most mobile part of the spine is its cervical region. In it, one half of all movements are carried out in the atlantoaxial and atlantooccipital joints, and the other half in the lower cervical region.
• Spinal stability is the ability to maintain such relationships between the vertebrae that protect it from deformation and pain under physiological load. The main stabilizing elements of the spine are the fibrous ring and the nucleus pulposus of the intervertebral disc, the spinal ligaments and the capsule of the intervertebral joints. The stability of the entire spine is ensured by the stability of its individual segments. A vertebral segment consists of two adjacent vertebrae connected by an intervertebral disc. The segment contains several supporting complexes that perform a stabilizing function. According to Holdsworth, the spine has two supporting complexes

Spinal instability

Instability is pathological mobility in the spinal segment. This can be either an increase in the amplitude of normal movements, or the emergence of new degrees of freedom of movement that are uncharacteristic for the norm. An indicator of spinal instability is the displacement of the vertebrae. Vertebral displacement is a radiographic finding, while spinal instability is a clinical concept. Displacement of the vertebrae can occur without pain, but instability is characterized by pain.

Instability has characteristic signs:

1. Violation of the load-bearing capacity of the spine occurs when exposed to external loads, both physiological and excessive. The spine loses its ability to maintain certain relationships between the vertebrae.

2. Instability indicates the failure of the supporting complexes, which protect the spine from deformation, and the spinal cord and its structures protect from irritation.

3. The disorder manifests itself in the form of deformation, pathological movement of the vertebrae or destruction of the elements of the spine. Instability causes pain, neurological damage, muscle tension and limited movement.

There are factors that predispose to excessive mobility of spinal segments. Normally, for the cervical spine, excess mobility is determined by two factors: age and vertebral location. The range of mobility of the spine in children is greater than in adults. Increased mobility of the C2–C3 segment is observed until the age of 8 years. In children, excessive mobility is observed in the upper cervical spine in 65% of cases, which is associated with the absence of an intervertebral disc at the C1–C2 level. In children, the most mobile segment is C2–C3. Disorders at this level are diagnosed in 52% of cases of spinal instability.

The main symptom of instability is pain or discomfort in the neck. In the cervical spine in patients with instability in the atlanto-occipital joint, irritating pain can be periodic and intensify after physical activity. Pain is the cause of chronic reflex tension of the neck muscles. In children, instability is the cause of the development of acute torticollis. At the onset of the disease, there is increased tone of the paravertebral muscles, which leads to their overwork. Microcirculation disorders occur in the muscles, the development of malnutrition and decreased tone. There is a feeling of uncertainty when moving in the neck. The ability to withstand normal load is impaired. There is a need for means of additional immobilization of the neck, including supporting the head with the hands. In the clinic, cervical spine instability in adults is measured using a clinical scoring system.

Post-traumatic instability

Develops as a result of trauma, which includes fracture, fracture-dislocation and dislocation of the vertebrae. When the spine is damaged, flexion, flexion-rotation, extension and compression mechanisms of injury operate. The first two mechanisms operate in road and sports injuries and account for 70% of the total number of spinal injuries. The extensor mechanism occurs when the head is thrown back sharply and is found in whiplash-like motor vehicle injuries. The compression mechanism is associated with a sharp load along the axis of the spine and acts when falling from a height. Post-traumatic instability complicates about 10% of cases of vertebral fractures and fracture-dislocations. After an injury, the segment of the spine in which damage to either the anterior or posterior supporting complexes occurs is unstable. Post-traumatic instability produces spinal or radicular symptoms. In case of traumatic injury, displacement of the vertebrae by more than 3.5 mm and an increase in the angle between the endplates of adjacent vertebral bodies by more than 11° are interpreted as the result of gross damage to the ligamentous apparatus. Damage to the posterior supporting complex with displacement of the vertebral body up to 2 mm and articular processes up to 1/3 can be considered a favorable variant of the course of instability. At the same time, complete destruction of the anterior supporting complex with displacement of the vertebral bodies of 2 mm or more is considered unfavorable in terms of prognosis. In such patients there is reason for the progression of instability.

Post-traumatic instability occurs in all age groups. In children, instability develops both as a consequence of intranatal trauma to the cervical spine during obstetric care, during which damage to the ligaments of the cervical spine occurs, and as a result of postnatal compression fractures of the vertebral bodies with unstable damage to the intervertebral discs and ligaments. In adults, after a spinal injury, a decrease in the height of the intervertebral discs, pathological mobility and displacement of the vertebrae caused by disc damage and ligament rupture are found in the damaged area. In isolated vertebral fractures, which are not accompanied by ligament rupture and vertebral displacement, there is residual stability due to the preservation of the supporting complexes of the spine.

Degenerative instability

Degeneration of intervertebral discs occurs with spinal osteochondrosis. Degenerative-dystrophic changes consist in the disintegration of the fibrous ring and fragmentation of the disc tissue, which leads to a decrease in its fixation ability. Degeneration of the intervertebral disc can be either primary (based on a violation of cartilage metabolism) or secondary, caused by a violation of the statics of the spine. When a load is placed on a segment of the spine with a degenerated defective disc, pathological mobility and displacement of the vertebrae occurs, which is called degenerative spondylolisthesis or pseudospondylolisthesis. Displacement of the vertebra causes overload in the posterior supporting complex with the development of degenerative spondyloarthrosis. When the vertebrae are displaced, extensive changes develop in both supporting complexes, from where pain impulses come. In 85% of cases, instability with severe disc degeneration is observed at the C3–C4, C4–C5 and C5–C6 levels.

Postoperative instability

Postoperative spinal instability is associated with disruption of the integrity of supporting complexes during surgery. In practice, postoperative instability is most often observed after laminectomy, the extent of which has a significant impact on spinal stability. Unilateral laminectomy is a relatively gentle operation, while bilateral laminectomy with resection of the articular facets significantly worsens the support ability of the spine. A decrease in the load-bearing capacity of the posterior supporting complex leads to a redistribution of the load in the spine, resulting in an increased load on the vertebral bodies and intervertebral discs, which contributes to the further progression of their degeneration after a significant period of time after the intervention. The development and progression of postoperative spinal instability is associated with the influence of several factors:

1) inadequate load on the spine in the postoperative period;

2) ongoing disc degeneration and recurrent hernia;

3) errors and shortcomings in surgical technique in the form of an unreasonably large volume of resection of bone and ligamentous structures and lack of fixation of the spine;

4) development of instability at a level adjacent to the level of surgery. Spinal fusion after laminectomy can lead to overload of segments ranging from 60 to 180%, which are located above and below the level of spinal fixation.

To eliminate postoperative instability, repeated operations are required, which are not inferior in complexity to the primary intervention.

Dysplastic instability

Dysplastic instability of the spine develops due to dysplastic syndrome. Signs of dysplasia are found in the vertebral body, intervertebral disc, intervertebral joints and spinal ligaments.

Instability at the lower cervical level is associated with congenital inferiority of the intervertebral disc. A manifestation of dysplasia is the eccentric position of the nucleus pulposus, narrowing of the intervertebral disc, disruption of the integrity and parallelism of the endplates, as well as wedge-shaped vertebral bodies. In dysplasia, a change in the structure of collagen fibers leads to disruption of the hydration process of the tissue of the nucleus pulposus, which causes a violation of the mechanical properties of the intervertebral disc, a decrease in the rigidity of fixation of the vertebrae, and a violation of the relationship between the nucleus pulposus and the fibrous ring. These changes lead to the development of spinal instability at the C1 to C7 level.

Dysplastic changes can affect any element of the spine. Congenital underdevelopment of the bursa-ligamentous apparatus forms the syndrome of the posterior support complex, described by A.V. Demchenko in adolescents. Dysplastic changes lead to the early development of a degenerative process at a young age with impaired spinal stability. Congenital asymmetry of intervertebral joints, or tropism, manifests itself in changes in the size and position of the articular facets. Changes in the plane of the intervertebral joints cause changes in the rigidity of the posterior supporting complex, redistribution of the load on both supporting complexes, and early degeneration of the spinal segment, which is complicated by its instability. Underdevelopment of the articular processes leads to overstretching of the joint capsule, displacement of the articular surfaces, narrowing of the intervertebral foramina, looseness of the intervertebral joints, a decrease in the rigidity of the posterior supporting complex and an increase in the load on the anterior supporting complex. Disproportionately large articular processes lead to increased rigidity of the posterior supporting complex, which contributes to an increase in the load on this part of the spine.

In adulthood, dysplasia of the intervertebral joints is the cause of the development of dysplastic osteochondrosis, which can lead to both spinal instability and spondyloarthrosis.

Conservative treatment

• Conservative treatment is based on the controlled process of fibrosis of the intervertebral disc in an unstable segment of the spine. Wearing a head support promotes the development of disc fibrosis and stops the progressive displacement of the vertebrae. In an adult patient, the development of fibrosis can lead to gradual relief from pain. As a rule, treatment of spinal instability begins with the use of conservative methods. Conservative treatment methods are indicated in patients with instability of minor severity, which is not accompanied by severe pain and spinal symptoms. Conservative treatment methods include the following:

1) adherence to a gentle regimen;

2) wearing a soft or hard head holder;

3) taking non-steroidal anti-inflammatory drugs (NSAIDs);

4) novocaine blockades for exacerbation of pain syndrome;

5) massage and physical therapy of the back muscles;

6) physiotherapy (electrophoresis, ultrasound).

Surgical treatment

The main principles of surgical treatment of cervical spine instability are spinal stabilization and decompression of neural structures. The operation eliminates compression of the nerves and creates conditions for ankylosis of the spine. Surgical treatment has the following indications:

1) unsuccessful treatment of pain syndrome for 1–1.5 months;

2) persistent radicular and spinal symptoms caused by compression of nerve structures by exostoses, disc herniation, hypertrophied ligamentum flavum;

3) subluxation due to instability;

4) intolerance to certain types of conservative treatment (NSAIDs, physiotherapy, etc.);

5) frequent exacerbations of pain syndrome with short remission.

The choice of surgical treatment method depends on the type of instability. In severe post-traumatic instability with vertebral subluxation, the most reliable stabilization of the spine is achieved with a combination of intervention by anterior and posterior approaches. A combined intervention provides the opportunity to take advantage of the benefits of each approach. A wide laminectomy is performed using a posterior approach to decompress all nerve structures. An anterior approach is used to perform spinal fusion, which achieves spinal stabilization.

To summarize what has been written, I would like to urge my colleagues not to make a diagnosis

Instability of the cervical spine in children - and adults - without any specific clinical reasons for this (based only on radiological signs, which may be a feature of the child’s body). The diagnosis frightens parents and relatives terribly and leads to the prescription of incorrect treatment, which not only does not help, but often worsens the clinical situation.

Health to you and your FAMILY!

Clinical manifestations

Instability of the cervical or thoracic vertebrae has a number of clinical manifestations:

• pain symptoms localized in the affected part of the spine or spreading to the entire spinal column, accompanied by a feeling of heaviness and discomfort;
• increased pain when the body remains in an uncomfortable, forced position for a long time, after physical exertion or lifting heavy weights;
• limitation of mobility, which is expressed in difficulties when turning and bending the body;
• pain in the lower extremities when walking;
• headaches and dizziness;
• the appearance of crunching and clicking sounds when turning and bending the body;
• a feeling of numbness in the back muscles in the affected area.

Characteristic symptoms

It is not enough to know the causative factors that can cause pathology; you need to learn to recognize the signs of spinal instability. The earlier a pathology is identified, the greater the chances of its rapid and successful elimination. The most common signs indicating instability of the spine in the cervical region include:

• painful sensations in the neck area, which, as a rule, are periodic. The pain may worsen when turning the head or after intense physical activity;

  
  Neck and back of head hurt

• general body fatigue, tension in the neck. Even with minor physical activity, fatigue occurs;
• decreased sensitivity in some areas of the body;
• change in the shape of the spine (deformity). If the head is fixed in one position, the pain subsides, but with prolonged stay, deformation of the spine can occur. In rare cases, pathological changes are so strong that they can be noticed without any devices or tools;
• signs of neuralgia (the patient’s nervous system begins to react to the manifestation of pathology). Twitching or numbness in the limbs, a feeling of weakness in the arms, or frequent shooting sensations occur;

  
  Neuralgia

• severe dizziness, decreased visual acuity, and tinnitus. All these signs indicate pinching of the vertebral artery.

Second period (cervical region). Instability

When the first suspicious symptoms appear, you should seek help from a doctor as soon as possible. Only with a timely diagnostic examination and diagnosis can the signs of pathology be eliminated in the shortest possible period.

Complications

Often, the stability of the vertebrae can be a signal of the development of a disease such as osteochondrosis. At the initial stage, it may practically not manifest itself - however, as the pathology progresses, even one unsuccessful movement or a slightly more intense load than usual can cause severe pain. Due to the mobility of the vertebrae, the development of osteochondrosis occurs much faster and will ultimately lead to complications in the form of arthrosis of the intervertebral joints. Due to instability of the vertebrae, the load on the muscles and ligaments is significantly increased, which leads to impaired muscle tone and the appearance of pain symptoms when sitting for long periods and trying to perform simple movements. In the absence of proper treatment, pathology can lead to the following consequences:

MRI of the spine

• Cost: 16,000 rub.

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• neurological disorders;
• restriction of movements;
• spasms;
• headaches accompanied by nausea and weakness (with damage to the cervical vertebrae);
• development of spondylosis.

Risk factors, causes in adults and children

The causes of spinal instability include:

• various spinal injuries (car accident, heavy lifting, fall, etc.);
• osteochondrosis;
• age-related changes;
• increased sports loads;
• underdevelopment or congenital weakness of the articular-ligamentous apparatus;
• surgeries on the spinal cord and spine, etc.

In children, spinal instability is usually caused by injuries (including those received during childbirth), sports activities and birth defects.

Instability does not appear by itself. Its occurrence is due to a number of predisposing factors.

These include:

• metabolic disorders;
• sedentary lifestyle;
• deficiency of essential vitamins in the body;
• curvature of the spine at any stage;
• atherosclerosis, which is accompanied by deterioration of blood supply;
• dysfunction of the endocrine system;
• failure to follow the recommendations of the attending physician regarding recovery after surgery.

Thus, spinal instability occurs more often in old age and childhood . In the first case, it can be caused by age-related changes occurring in the body, such as muscle sagging and ligament weakness. In the second case, instability appears against the background of rapid development and growth of all tissues of the body. Most often, children experience abnormal mobility of the cervical vertebrae, which can lead to the development of infantile torticollis.

Diagnostics

Before starting treatment for instability of the thoracic vertebrae, our specialists conduct diagnostic examinations to correctly determine the cause and make a diagnosis. This is very important because it ensures that the treatment will bring the desired results. In addition to the examination and history taking, the following is prescribed:

• traditional and functional radiography of the spine, which allows you to determine the location of displaced vertebrae, the degree of displacement, the severity of the curvature of the spine and a decrease in the height of the intervertebral discs; the presence of congenital anomalies of insufficiency of the posterior supporting complex - spondylolysis.
• Magnetic resonance imaging, which allows you to detect the presence/absence of damage to the discs, nerves and spinal cord.

Pathogenesis

The pathogenesis of instability of the cervical spine is based on several anatomical anomalies:

• destruction of the disc/disturbance of its structure, which contributes to the appearance of excessive translational movement in the posterior (dorsolateral) direction;
• the inability of the disc to perform the function of stabilization and transfer of the center of gravity to neighboring structures (discs, ligaments);
• increase in the neutral zone;
• formation of a center of pathological movement (rotation around the longitudinal axis).

Reviews of doctors providing the service - Vertebral instability

In 2000, Andrei Arkadyevich performed spinal surgery on me.
Four days in the clinic and I have been living a full life for 20 years without restrictions on movement and I remember with gratitude Dr. A.A. Khodnevich. God bless him. And in 2000 he could walk no more than 10 meters. Read full review Viktor Alexandrovich

20.05.2020

Low bow to Alexander Semenovich Bronstein and Andrei Arkadyevich Khodnevich. I arrived at CELT on July 2, 2021 with extreme pain that I endured for 10 days. Hernia C6-C-7. I was given two blockades in Ivanovo, about 9 complex IVs, I lost 6 kg in a week and was in a panic, I didn’t see a way out and nothing happened to me... Read full review

Elena Nikolaevna L.

20.10.2019

Patient reviews

Vladimir Pokladov Minsk

I injured my back while training at the gym. I couldn’t calmly tie my shoelaces. I came to the clinic through work acquaintances when it was just opening. I was amazed that they immediately told me how to heal economically. They recommended some procedures to choose from. What immediately caught my eye was what they thought about people. There are significant improvements at the moment.

Oksana Aleksandrovna Minsk

I discovered the wonderful SpineMed center, where all the staff treats clients with great attention! I would like to thank massage therapists Vitaly Trotsyuk and Maxim Troyan for their work, professionalism, and their golden hands! Massage therapists work responsibly and efficiently! Thanks to the administration and management of the center for the good selection of personnel. I wish all the employees of the center good health and all the best! Good luck and prosperity to the center!

Treatment

The treatment plan for vertebral instability is drawn up taking into account the patient’s individual indications and the results of diagnostic studies. The following treatment methods are distinguished:

Operations for diseases of the spine

• Cost: 100,000 - 250,000 rubles.
• Duration: 40-60 minutes
• Hospitalization: 2-3 days in hospital

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It is worth noting that surgical intervention is practiced only in the most extreme cases, when the following indications exist:

• conservative methods did not produce any effect;
• there is vertebral subluxation;
• neurological symptoms are present;
• frequent relapses of the disease.

Surgical intervention involves fixing unstable vertebrae using special metal structures or implants.

Prevention

In order to minimize the risk of developing vertebral instability, the following rules must be followed:

• perform exercises aimed at strengthening the muscular frame of the back;
• Healthy food;
• eliminate intense stress on the spine;
• Lead an active lifestyle and exercise regularly.

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• Monday—Friday: 8.00—20.00
• Saturday: 8.00–18.00
• Sunday is a day off

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