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Chiropractic Research Review

Diagnosing Segmental Instability

Instability of the lumbosacral and cervical spine from degeneration or trauma is thought to be a significant contributor to lower back and neck pain. Instability is defined as, "abnormal response to applied loads, characterized by motion in motion segments beyond normal constraint." Although this definition can include all present definitions of instability, it is not a reliable guide for diagnosing segmental instability.

A recent study was conducted to depict the change patterns of intervertebral motion of the cervical spine during flexion, upright, and extension positions using dynamic radiographs, with special interest focused in the flexion position.

The objective was to find reliable criteria for judging the normal intervertebral flexibility based on a survey of the normal population.

It was found that from extension to flexion, the angles of intervertebral angular displacement changed from lordosis with different degrees to nearly 0 degrees, meaning that the adjacent endplates are parallel, except at C1-C2; the intervertebral translation changes from slightly retrolisthetic to zero displacement. Using C2-C3 as a baseline to calculate the intervertebral differences of angular displacement and translation in flexion radiographs, nearly all the intervertebral differences of angular displacement were less than 7 degrees, and those of translation were less than 0.06 mm.

From extension to flexion, the intervertebral angular displacement changed from lordotic to slightly kyphotic (almost neutral), and translation changed from retrolisthetic to slightly antelisthetic, or almost zero displacement. When the intervertebral differences in flexion position and the levels and frequency distribution are considered, the normal behavior of cervical motion can be depicted more clearly.

Lin R, Tsai K, Chu L, et al. Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine 2001:26(3), pp. 256-261.

Chiropractic Research Review

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