Vertical spinal instability – Advanced neuromuscular therapy protocol

Abstract

The term vertical spinal instability (VSI) was popularised by Atul Goel following his extensive research work in the field of spine disorders. Many spinal degenerative disc disease, have been treated by his innovative surgical techniques, based on this concept (VSI). Due to our upright posture against gravity, as well as loss of center of gravity while we walk, stand and sit, human spine tends to accumulate stress signals, and there is a constant mechanical strain over the spine. During the process of mechanotransduction, all stress signals are converted to degenerative changes of the spine. As a consequence neuromuscular incoordination of paraspinal muscles occurs and it becomes weak to hold the spine in position, thereby instability occurs. At first facetal translation occurs, followed by ligamentum flavum buckling, in a measure to maintain spinal stability. But the instability still persists, further changes occurs as osteophytes formation in either directions, protrusion of disc and canal compromise with neurological deficits. On the other hand, the degenerative osteophytes may over grow and form stable fusion between vertebral bodies in an attempt to maintain stability and at times successful. All these degenerative changes of spine and neurological deficits are attributed secondary to VSI which should be the prime concern of treatment. With respect to treatment options to overcome instability, at first conservative measures inform of advanced neuromuscular therapy protocol, to stretch and strengthen involved muscles and then improvement in neuromuscular coordination. The second standard option is the surgical approach aimed at stabilization of the involved spinal segments and correction of sagittal balance.