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Diagnostic Methods for Clinical Lumbar Instability: A Systematic Review of Current Status, Challenges, and Future
Mebin S Thomas1, Sandeep Shinde1, Neha S Chaudhary2
1Musculoskeletal Sciences, Krishna College of Physiotherapy, Krishna Vishwa Vidyapeeth, Deemed to be University, Karad, IND.
Cureus
|June 15, 2026
Summary
Diagnosing lumbar instability requires multiple tests, as no single method is sufficient. Dynamic imaging and clustered clinical tests offer better precision than static views or isolated assessments for this condition.
Area of Science:
- Orthopedics
- Radiology
- Evidence-Based Medicine
Background:
- Lumbar segmental instability causes pain and functional loss.
- Current diagnostic methods lack standardization, leading to variable clinical practices.
Purpose of the Study:
- Critically analyze existing diagnostic protocols for lumbar instability.
- Identify methodological limitations in current diagnostic strategies.
- Synthesize evidence for multimodal diagnostic approaches.
Main Methods:
- Systematic review following PRISMA 2020 guidelines (PubMed, Scopus, Web of Science, Cochrane, Embase).
- Included diagnostic/observational human studies; excluded AI algorithms.
- Quality assessment using QUADAS-2, NOS, PROBAST; narrative synthesis via SWiM.
Main Results:
- No single diagnostic test is adequate for lumbar instability.
- Passive Lumbar Extension and Lumbar Rocking tests show screening potential.
- Dynamic imaging (e.g., flexion radiographs) and clustered clinical tests improve diagnostic precision.
- Advanced predictive models show high theoretical accuracy but lack external validation and carry bias risk.
Conclusions:
- A comprehensive, multimodal strategy is essential for diagnosing lumbar instability.
- Evidence quality is limited by small cohorts and lack of confidence intervals.
- Future research should focus on externally validated predictive models and standardized imaging criteria.
