THE AGING SPINE - CLINICAL INSTABILITY

Clinical instability of the spine is an intensely controversial subjec t, and its diagnosis, especially in the aging, is difficult. Yet succe ss in its management rests on accurate diagnosis. Because both clinica l presentation and radiographic manifestations are nonspecific, the di agnosis of clinical instability lies in understanding the biomechanics involved, in recognizing the relevant radiographic manifestations, an d, most importantly, in correlating those observations with the patien t's clinical history and physical examination. Stabilization is the tr eatment of choice for clinical instability. Strengthening of the dynam ic stabilizers, especially early in the course of the disease, may pre vent or alleviate the incapacitating symptoms of instability, and furt her 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 di agnosis is clear and whose symptoms are recalcitrant to conservative m anagement. Further understanding of clinical spinal instability in the aging will require more precise definition of terms and better standa rdization of criteria for its diagnosis, management, and research.