Iatrogenic Spinal Instability

Iatrogenic spinal instability can occur following both spinal decompression and fusion procedures. Although it is useful to be able to consider instability clinically, imaging studies, including radiographs and magnetic resonance imaging, are the mainstay of diagnosis. Treatment for instability usually involves stabilization in the form of spinal fusion. Various prevention strategies aimed at avoiding iatrogenic instability have been described. These include avoiding damage to the stabilizing structures such as the facet capsules and posterior ligamentous complex. Other techniques such as unilateral approach for bilateral decompression have been suggested to avoid iatrogenic destabilization. Instability after an index decompression and/or fusion is a common problem faced by all spine surgeons. Attention to details in the preoperative and intraoperative settings can help reduce the risk for postoperative instability.