How to treat lumbar instability

Some occupational diseases are related to the lumbar spine. Long-term bending over work can lead to lumbar instability, which can cause some complications. For example, some people may suffer from dizziness due to poor lumbar spine. But how to treat lumbar instability? There are two methods to choose from. If the condition is not serious, you can choose non-surgical physical therapy, and the other is surgical treatment. If you choose, it depends on how serious your condition is.

How to treat lumbar instability

Nonsurgical treatment

It is generally believed that non-surgical treatment is the first choice for lumbar instability. Since the instability of the lumbar segment will eventually compensate by itself and establish a stable state, the symptoms of some patients disappear after non-surgical treatment due to the restabilization of the lumbar segment. Non-surgical treatment can achieve good results in 33% of patients (10-year follow-up), especially in elderly patients. Non-surgical treatments include: bed rest, reducing the load on the intervertebral joints and lumbar and back muscles, functional exercises of the lumbar and back muscles and abdominal muscles, drug therapy, physical therapy, aerobic rehabilitation training, hormone blockade, waist circumference protection, brace fixation, etc. There are many methods used for soft tissue therapy, such as heat therapy, hydrotherapy, wax therapy, ultrasound, massage, and electrical stimulation. Frequent use of hormone blockade is not recommended as it has significant side effects and the risk of epidural adhesions, hematomas, infections, etc. Acupuncture treatment is not recommended because some patients may develop severe complications such as nerve damage and hematoma and require surgical treatment.

Surgery

The absolute indication for surgical treatment is progressive lower limb muscle weakness or cauda equina syndrome. For patients whose quality of life is still very poor after non-surgical treatment, surgical treatment can be carefully chosen. There are currently a variety of methods to choose from, but the principles and purposes are the same: reduction and decompression, internal fixation, bone grafting and fusion, relieving nerve compression, correcting spinal deformity and enhancing spinal stability.

In order to prevent the recurrence of deformity and nerve compression and maintain the segmental stability after the unstable vertebra is reduced, methods such as pedicle screw system internal fixation, intervertebral fusion cage (Cage, TFC and BAK, etc.) plus autologous cancellous bone intervertebral fusion, and artificial ligament fixation can be used. Methods of bone graft fusion include posterolateral PLIF, anterior interbody ALIF, and transforaminal TLIF. Vertebral fusion devices include materials such as titanium alloy, polyetheretherketone, and allogeneic cortical bone. The surgical approaches include posterior approach, anterior approach, and transforaminal approach. Currently, posterior pedicle fixation plus intervertebral bone grafting and fusion are widely used, with less trauma and fewer complications.