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DOI: 10.1148/radiol.2451051359
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(Radiology 2007;245:62-77.)
© RSNA, 2007

Reviews

Lumbar Intervertebral Instability: A Review1

Antonio Leone, MD, Giuseppe Guglielmi, MD, Victor N. Cassar-Pullicino, MD, and Lorenzo Bonomo, MD

1 From the Department of Radiology, Catholic University, School of Medicine, Largo A. Gemelli 8, 00168 Rome, Italy (A.L., L.B.); Department of Radiology, Scientific Institute Hospital Casa Sollievo della Sofferenza, San Giovanni Rotondo and University of Foggia, Italy (G.G.); and Department of Diagnostic Imaging, the Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, Shropshire, England (V.N.C.). Received August 15, 2005; revision requested November 3; revision received February 5, 2006; accepted March 7; final version accepted June 1; final review and update by A.L. March 22, 2007. Address correspondence to A.L. (e-mail: a.leonemd{at}tiscali.it).

Intervertebral instability of the lumbar spine is thought to be a possible pathomechanical mechanism underlying low back pain and sciatica and is often an important factor in determining surgical indication for spinal fusion and decompression. Instability of the lumbar spine, however, remains a controversial and poorly understood topic. At present, much controversy exists regarding the proper definition of the condition, the best diagnostic methods, and the most efficacious treatment approaches. Clinical presentation is not specific, and the relationship between radiologic evidence of instability and its symptoms is controversial. Because of its simplicity, low expense, and pervasive availability, functional flexion-extension radiography is the most thoroughly studied and the most widely used method in the imaging diagnosis of lumbar intervertebral instability. In this article, we provide an overview of the current concepts of vertebral instability, focusing on degenerative lumbar intervertebral instability, and review the different imaging modalities most indicated in diagnosing vertebral instability.

© RSNA, 2007