The Myth of Spinal "Instability"


The Myth

Concepts abound in Spinal Surgery derived from operating upon anaesthetised patients or cadavers. Back pain is thought to arise from disc itself. The stabbing back pain or “catch” on standing up from a chair is thought to arise from “Instability “of one vertebra sliding upon another. The presence of Modic changes on the MRI can are stated to confirm the diagnosis of instability.
Aware state surgery reveals that only 11% od disc walls cause back pain when palpated and only when deeply inflamed.
Endoscopic exploration of discs with Modic changes in the adjacent vertebrae reveals that the endplates are cracked and the breakdown products from the degenerating disc are leaking into the vertebrae with consequent reaction seen as Modic changes rather than the results of instability.
Aware state examination of the contents of the foramen reveal that light palpation or irritation of the surface of the nerve reproduces back pain.  Deeper pressure adds peripheral radiation to the symptoms presentation.
Therefore the symptoms of catching back pain or a sense of weakness in the back due to deep muscle (Multifidus) inhibition and wasting can be relieved by removing the impaction or the causes of the irritation of the nerve endoscopically rather than fusing the level and unnaturally taking away movement of the segment.

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