Segmental instability, such as Grade III/IV spondylolisthesis or traumatic/post-surgical instability, is a primary contraindication to HVLA manipulation because it may ...

Segmental instability, such as Grade III/IV spondylolisthesis or traumatic/post-surgical instability, is a primary contraindication to HVLA manipulation because it may ...

• A. increase risk of instability or neurological compromise
• B. indicate a standard HVLA approach
• C. not affect HVLA safety
• D. only require minor adjustments

Answer: (B)

Segmental instability means the spinal segment can move abnormally, so a rapid, high-velocity thrust relies on that segment being stable. When instability is present, applying HVLA can cause the vertebra to slip further or translate, and it may compress or irritate neural structures. This raises the risk of worsening instability or causing neurological compromise, which is why instability is a primary contraindication to HVLA manipulation. Saying it would indicate a standard HVLA approach would be inappropriate, because instability undermines safety and the rationale for using HVLA; HVLA is not considered safe or indicated in this context. The idea that it wouldn’t affect safety or that only minor adjustments are needed also misses the real risk, since instability changes how the segment responds to forces and often requires stabilization or non-thrust care instead.

Segmental instability means the spinal segment can move abnormally, so a rapid, high-velocity thrust relies on that segment being stable. When instability is present, applying HVLA can cause the vertebra to slip further or translate, and it may compress or irritate neural structures. This raises the risk of worsening instability or causing neurological compromise, which is why instability is a primary contraindication to HVLA manipulation.

Saying it would indicate a standard HVLA approach would be inappropriate, because instability undermines safety and the rationale for using HVLA; HVLA is not considered safe or indicated in this context. The idea that it wouldn’t affect safety or that only minor adjustments are needed also misses the real risk, since instability changes how the segment responds to forces and often requires stabilization or non-thrust care instead.