Perspective of Lumbar Segmental Instability for Surgical Evalua tion of Lumbar Disc Herniation

Abstract

Surgery of lumbar disc herniation is most common procedure in neurosurgical practice. However poor outcomes, recurrent disc herniation and recurrence of low back and leg pain which affect quality of life, are still challenging. Lumbar spine instability develops as a result of a gradual degenerative process and lumbar segmental instability is one of main reason of failed back surgery. Presence of lumbar segmental instability or potential secondary instability after surgery should not be overlooked. Accurate preoperative evaluation of patients with lumbar disc herniation needs to understand biomechanics of spinal stability and predict possible result of postoperative instability. Thus failure of treatment modalities can be avoided.

The Effects of Core Stabilization Exercise with the Abdominal Drawing-in Maneuver Technique versus General Strengthening Exercise on Lumbar Segmental Motion in Patients with Clinical Lumbar Instability: A Randomized Controlled Trial with 12-Month Follow-Up

“…The prevalence of CLI is approximately 13-35% among patients suffering from CLBP [5][6][7][8]. Progressive pathology in CLI may induce spondylolisthesis, which can present a high risk of neurological problems such as cauda equina syndrome [9,10]. In the last two decades, surgical spinal fusion, often aimed at reducing instability, has increased about 2.4 times [11].…”

A Screening Tool for Patients With Lumbar Instability

“… 3 , 4 Delayed diagnosis may result in invasive therapy such as surgery with or without spinal fusion. 5 Early detection of lumbar instability enables timely noninvasive treatment and helps prevent further structural degeneration. 6 , 7 …”