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              "nombre" => "J."
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La inestabilidad espinal es una de las causas m&#225;s frecuentes de dolor lumbar&#44; y sin embargo no ha sido plenamente definida y no muy bien comprendida&#46; En general se considera que un segmento lumbar es inestable cuando genera movimientos anormales que a la larga conducen a una restricci&#243;n en los movimientos fisiol&#243;gicos vertebrales para compensar la aparici&#243;n del dolor&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Para que la columna se defienda de la aparici&#243;n de la inestabilidad pone en marcha tres subsistemas&#44; musculoesquel&#233;tico pasivo&#44; activo y neural&#44; pero la disfunci&#243;n aguda o cr&#243;nica degenerativa de alguno de ellos provoca una disfunci&#243;n vertebral&#46; La inestabilidad debe de ser detectada cl&#237;nicamente durante el examen m&#233;dico y refrendada por un concienzudo y din&#225;mico examen radiol&#243;gico&#46; Sobre estas bases se proceder&#225; al tratamiento espec&#237;fico de cada caso&#44; de forma individualizada&#44; bien conservadoramente o con cirug&#237;a&#46; Pero el n&#250;mero de fallos es mayor de lo deseable&#44; lo que significa que la plena comprensi&#243;n est&#225; por llegar&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En esta revisi&#243;n se analizan los criterios de diversos autores para establecer una m&#225;s uniforme aproximaci&#243;n al diagn&#243;stico cl&#237;nico&#44; radiol&#243;gico&#44; as&#237; como la indicaci&#243;n del tratamiento&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Spinal instability is considered to be one of the most important causes of low back pain but it is poorly defined and not well understood&#46; A lumbar motion segment is considered to be unstable when it exhibits abnormal movement&#46; The spinal stabilizing system is conceptualized as consisting of three subsystems&#59; passive musculoskeletal&#44; active musculoskeletal and neural subsystems&#46; Chronic dysfunction of the components of any of the subsystems or increased functional demands on them may lead to adaptive changes&#46; The instability can be detected during the physical examination by a trained observer and by radiographic studies with dynamic views obtained in the frontal and lateral projections identifying unstable states&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The majority of patients with spinal instability unresponsive to conservative management require only decompressive surgery or fusion&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">In this review we analyze the opinions related with the management of segmental instability of the lumbar spine and comment on the diagnosis criteria used by different authors&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara">Fandi&#241;o&#44; J&#46;&#59; Garc&#237;a-Abeledo&#44; M&#46;&#58; Inestabilidad segmentaria lumbar degenerativa&#46; Neurocirug&#237;a 1998&#59; 9&#58; 135&#8211;140&#46;</p>"
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                          "etal" => false
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                            0 => "G&#46;H&#46; Bell"
                            1 => "O&#46; Dunbar"
                            2 => "J&#46;S&#46; Beck"
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                      "titulo" => "Some meehanical tests on the lumbosacral spine with particular reference to the intervertebral dises&#58; a preliminary report"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46; Brown"
                            1 => "R&#46;J&#46; Hansen"
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                          ]
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                  ]
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                        "fecha" => "1957"
                        "volumen" => "39A"
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                    0 => array:2 [
                      "titulo" => "Variations in balance and body sway in middle-aged adults&#58; subjects with healthy backs compared with subjects with low back dysfunction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N&#46;N&#46; Byl"
                            1 => "P&#46;L&#46; Sinnott"
                          ]
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                      ]
                    ]
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "fecha" => "1991"
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1827539"
                            "web" => "Medline"
                          ]
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                      "titulo" => "Biomechanical properties of spinal Iigamentes and a histological study of the supraspinal ligament in traction"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46; Chazal"
                            1 => "A&#46; Tanguy"
                            2 => "M&#46; Bourges"
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                        ]
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                  ]
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                        "fecha" => "1985"
                        "volumen" => "18"
                        "paginaInicial" => "167"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3997901"
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                      "titulo" => "Radiologic diagnosis of degenerative lumbar spinal instability"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "P&#46;R&#46; DuPuis"
                            1 => "K&#46; Yong-Hing"
                            2 => "J&#46;D&#46; Cassidy"
                            3 => "W&#46;H&#46; Kirkaldy-Willis"
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                        ]
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                    ]
                  ]
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                      "Revista" => array:6 [
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                        "fecha" => "1985"
                        "volumen" => "10"
                        "paginaInicial" => "262"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3992347"
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                          ]
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                ]
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                    0 => array:2 [
                      "titulo" => "Clinical validation of functional flexion-extension roentgenograms of the lumbar spine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Dvorak"
                            1 => "M&#46;M&#46; Panjabi"
                            2 => "J&#46;E&#46; Novotny"
                            3 => "D&#46;G&#46; Chang"
                            4 => "D&#46; Grob"
                          ]
                        ]
                      ]
                    ]
                  ]
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                      "Revista" => array:6 [
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                        "fecha" => "1991"
                        "volumen" => "16"
                        "paginaInicial" => "943"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1835156"
                            "web" => "Medline"
                          ]
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              ]
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                    0 => array:2 [
                      "titulo" => "Mechanical disorders of the low back"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;F&#46; Farfan"
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                      "Libro" => array:3 [
                        "fecha" => "1973"
                        "editorial" => "Lea and Febiger"
                        "editorialLocalizacion" => "Philadelphia"
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              ]
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                    0 => array:2 [
                      "titulo" => "Risk factors in low-back pain&#58; an epidemiological study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Frymoyer"
                            1 => "M&#46;H&#46; Pope"
                            2 => "J&#46;H&#46; Clements"
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                        ]
                      ]
                    ]
                  ]
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                        "tituloSerie" => "J&#46; Bone Joint Surg"
                        "fecha" => "1983"
                        "volumen" => "65A"
                        "paginaInicial" => "213"
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                      "titulo" => "Segmental instability&#59; Rationale for treatment"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;W&#46; Frymoyer"
                            1 => "D&#46;K&#46; Selby"
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                    ]
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                      "Revista" => array:6 [
                        "tituloSerie" => "Spine"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3992349"
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                      "titulo" => "Roentgenographic evaluation of lumbar spine flexion-extension in asymptomatic individuals"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Hayes"
                            1 => "T&#46;C&#46; Howard"
                            2 => "R&#46;G&#46; Curtis"
                            3 => "J&#46;A&#46; Kopta"
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                    ]
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Vol. 9. Núm. 2.
Páginas 135-140 (enero 1998)
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Vol. 9. Núm. 2.
Páginas 135-140 (enero 1998)
Inestabilidad segmentaria lumbar degenerativa
Degenerative lumbar segmental instability
Visitas
8154
J. Fandiño, M. García-Abeledo
Unidad de Neurocirugía. Policlínico de Lugo
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Resumen

La inestabilidad espinal es una de las causas más frecuentes de dolor lumbar, y sin embargo no ha sido plenamente definida y no muy bien comprendida. En general se considera que un segmento lumbar es inestable cuando genera movimientos anormales que a la larga conducen a una restricción en los movimientos fisiológicos vertebrales para compensar la aparición del dolor.

Para que la columna se defienda de la aparición de la inestabilidad pone en marcha tres subsistemas, musculoesquelético pasivo, activo y neural, pero la disfunción aguda o crónica degenerativa de alguno de ellos provoca una disfunción vertebral. La inestabilidad debe de ser detectada clínicamente durante el examen médico y refrendada por un concienzudo y dinámico examen radiológico. Sobre estas bases se procederá al tratamiento específico de cada caso, de forma individualizada, bien conservadoramente o con cirugía. Pero el número de fallos es mayor de lo deseable, lo que significa que la plena comprensión está por llegar.

En esta revisión se analizan los criterios de diversos autores para establecer una más uniforme aproximación al diagnóstico clínico, radiológico, así como la indicación del tratamiento.

Palabras clave:
Inestabilidad
Segmentaria
Lumbar
Biomecánica
Abstract

Spinal instability is considered to be one of the most important causes of low back pain but it is poorly defined and not well understood. A lumbar motion segment is considered to be unstable when it exhibits abnormal movement. The spinal stabilizing system is conceptualized as consisting of three subsystems; passive musculoskeletal, active musculoskeletal and neural subsystems. Chronic dysfunction of the components of any of the subsystems or increased functional demands on them may lead to adaptive changes. The instability can be detected during the physical examination by a trained observer and by radiographic studies with dynamic views obtained in the frontal and lateral projections identifying unstable states.

The majority of patients with spinal instability unresponsive to conservative management require only decompressive surgery or fusion.

In this review we analyze the opinions related with the management of segmental instability of the lumbar spine and comment on the diagnosis criteria used by different authors.

Key words:
Instability
Segmental
Lumbar
Biomechanical

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