Detection of Spinal Microinstability: A Real Clinical and Forensic Problem
|Alessandro Landi*, Fabrizio Gregori, Cristina Mancarella, Roberto Delfini|
|Department of Neurology and Psychiatry, division of Neurosurgery A, University of Rome Sapienza, Rome, Italy|
|Corresponding Author :||Alessandro Landi
Department of Neurology and Psychiatry
division of Neurosurgery A
University of Rome Sapienza
Viale del Policlinico 155, 00161 Rome, Italy
Tel: +39 0649979105
E-mail: [email protected]
|Received September 13, 2015; Accepted September 16, 2015; Published September 19, 2015|
|Citation: Landi A, Gregori F, Mancarella C, Delfini R (2015) Detection of Spinal Microinstability: A Real Clinical and Forensic Problem. J Spine 4:e119. doi:10.4172/21657939.1000e119|
|Copyright: © 2015 Landi A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.|
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The concept of vertebral instability has evolved in the last years, given the last scientific evidences on the degenerative cascade. Another concept has been developed in a parallel way to the one of the vertebral instability: it is the concept of microinstability, intended as biomechanical dysfunction of the motor spinal unit, responsible of symptoms but not showed by dynamic X-Rays. The introduction of the concept of microinstability has increased the diagnostic capacities towards low back pain and, subsequently, the therapeutic choices, but has increased the number of medico-legal issues related to the diagnostic and therapeutic pathway of this condition.
Many issues related to microinstability have to be explained, to guarantee to the patients the best treatment available and, at the same time, to uphold the surgeon to perform the treatment in a safe condition.
Our group has proposed a test, developed with the aim to furnish quantitative data on the basis of radiological examinations that can diagnose microinstability, giving indications on diagnosis and therapy of the dysfunctional phase of the degenerative cascade.
The retrospective analysis seems to validate the test, with a good predictive value, mainly towards Adjacent Segment Syndrome (ASD). The few cases analysed in a perspective manner, even if in preliminary phase and with a short follow-up, seem to confirm the data.