The myth of lumbar instability: the importance of abnormal loading as a cause of low back pain

Abstract

Spinal fusion became what has been termed the ''gold standard'' for the treatment of mechanical low back pain, yet there was no scientific basis for this. Operations of fusion for low back pain were initially done at the beginning of the last century for back pain thought to be related to congenital abnormalities or for past spinal infection.

In vivo preclinical evaluation of the influence of osteoporosis on the anchorage of different pedicle screw designs

“…To overcome complications related to disc degeneration at the adjacent hypermobile segments occurring in spinal fusion surgery, non-fusion systems have been developed, such as dynamic stabilization devices, which are able to control the segment motion and share the load with the disc [1][2][3][4][5][6][7]. Dynamic stabilization devices are divided in two groups according to the way they are appended to the spinal segment: interspinous and pedicle-screw-based devices.…”

Radiographic Parameters of Segmental Instability in Lumbar Spine Using Kinetic MRI

“…Lumbar segmental instability is thought to be a possible causative mechanism of underlying low back pain and sciatica 6,[15][16][17][18][20][21][22]25,28) . It is often an important factor in determining surgical indications for spinal fusion in lumbar degenerative disc disease (DDD) 8,11,16,17,21,25) .…”

“…It is often an important factor in determining surgical indications for spinal fusion in lumbar degenerative disc disease (DDD) 8,11,16,17,21,25) . Spinal fusion surgeries allow symptomatic patients with mechanically unstable lumbar segments to significantly improve their quality of life by ameliorating low back pain.…”

“…Radiographic studies may include plain radiographs, magnetic resonance imaging (MRI), computed tomography, and provocative discography 1,3,4,10,16,17,20,22,25,27) . Unfortunately, there is poor correlation between the presence of low back pain and imaging study findings in the general population 16,17,21) . Numerous studies have documented that a high percentage of asymptomatic patients have abnormal findings on imaging studies of the presence of DDD 3,4,10,16,17,21,27) .…”

“…Unfortunately, there is poor correlation between the presence of low back pain and imaging study findings in the general population 16,17,21) . Numerous studies have documented that a high percentage of asymptomatic patients have abnormal findings on imaging studies of the presence of DDD 3,4,10,16,17,21,27) . Consequently, the decision to undertake surgical management of DDD requires extensive radiographic analysis.…”