Vo P, MacMillan M
Department of Orthopaedics, University of Florida, Gainesville 32610-0246.
South Med J. 1994 May;87(5):S26-35.
Clinical instability of the spine is an intensely controversial subject, and its diagnosis, especially in the aging, is difficult. Yet success in its management rests on accurate diagnosis. Because both clinical presentation and radiographic manifestations are nonspecific, the diagnosis of clinical instability lies in understanding the biomechanics involved, in recognizing the relevant radiographic manifestations, and, most importantly, in correlating those observations with the patient's clinical history and physical examination. Stabilization is the treatment of choice for clinical instability. Strengthening of the dynamic stabilizers, especially early in the course of the disease, may prevent or alleviate the incapacitating symptoms of instability, and further research into this area should be undertaken. Static stabilization by bracing has not proved effective, and spinal fusion carries a high risk of complication. Fusion should be reserved for patients whose diagnosis is clear and whose symptoms are recalcitrant to conservative management. Further understanding of clinical spinal instability in the aging will require more precise definition of terms and better standardization of criteria for its diagnosis, management, and research.
脊柱的临床不稳定性是一个极具争议的话题，其诊断，尤其是对于老年人来说，很困难。然而，成功的治疗取决于准确的诊断。由于临床表现和影像学表现都不具有特异性，临床不稳定性的诊断在于理解其中涉及的生物力学，识别相关的影像学表现，最重要的是，将这些观察结果与患者的临床病史和体格检查相关联。稳定化是临床不稳定性的首选治疗方法。加强动态稳定器，尤其是在疾病早期，可能预防或减轻不稳定性的致残症状，并且应该对该领域进行进一步研究。通过支具进行静态稳定化尚未被证明有效，并且脊柱融合术具有较高的并发症风险。融合术应仅用于诊断明确且症状对保守治疗无效的患者。要进一步了解老年人的临床脊柱不稳定性，需要对术语进行更精确的定义，并更好地规范其诊断、治疗和研究标准。
