Beyond radiological imaging: Direct observation and manual physical evaluation of spinal instability

The science of spine surgery revolves around the identification of spinal instability and its subsequent treatment. However, both clinical and radiological guides for the identification of spinal instability are rather presumptive and arbitrary. It seems that the issue of spinal instability is underdiagnosed and undertreated as radiological imaging is not conclusively contributory and definite clinical diagnostic criteria are not laid down and uniformly agreed. Our clinical experience in the field suggests that spinal instability forms the nodal point of pathogenesis of number of spinal pathologies that include spinal degeneration and ossified posterior longitudinal ligament.[1‐4] Understanding of the fact that instability is the causal or primary issue in a number of spine‐related problems can lead to rational treatment.