Clinical manifestations of lumbar instability
Common symptom: lower back pain or with sciatica.
Features
Acute onset
Pain is severe and can be relieved for a short time by rest, braking, massage and so on, but it is easy to recur
Pain is often bilateral, but the degree may vary
Pain often radiates in the lumbosacral region and to the buttocks, sometimes to the back of the thigh, or even radicular symptoms
Symptoms
Sometimes patients have sudden obstruction of lumbar spine movement (called instability catch), which disappears dramatically.
Most patients complain of easy lumbar sprain
{Patients with lumbar spondylolisthesis who have recurrent or worsening low back pain with severe sciatica often suggest a combination of lumbar instability.
It is also believed that frequent episodes of lumbar sprain, with patients complaining of a feeling of lumbar “catch” or standing up after bending and squatting with lumbar stiffness and back pain, and not being able to stand up straight immediately, are considered to be lumbar instability.
Physical signs
1, spasm of paraspinal muscles, abnormal alignment of spinous process, etc.
2.When the lumbar spine is slipped in a thin person, the interspinous process is step-like, and the lumbar convexity is increased.
3.Sudden interlocking in lumbar spine mobility examination
4. Usually there is no abnormality in neurological examination, and the straight leg raising sign is often negative
Imaging performance
Dynamic radiographs (power radiographs) are currently the simplest and most commonly used method to diagnose lumbar instability, including: lumbar maximum flexion and extension lateral radiographs, left and right lateral bending ortholateral radiographs and traction and compression radiographs
The degree of slippage is directly proportional to the degree of clinical pain in the lower lumbar spine.
However, the displacement values of the normal human lumbar spine during activity are reported differently.
According to Nachemson, the relative horizontal displacement between lumbar vertebrae greater than 3 mm is considered unstable, and lumbosacral joint displacement >4 mm is considered unstable
Other scholars have diagnosed the following criteria as persistent, frequent episodes of low back pain and predominantly low back pain.
1, intervertebral slippage >3mm
2. Spinal space narrowing >10%
3, change in intervertebral space angle >10º
One of the above three can be diagnosed