Instability is caused by changes in structural positioning of the spinal column. As spinal discs degenerate they lose their hold on adjacent spinal vertebra allowing abnormal sliding between the vertebrae (see Spondylolithesis for details). This sliding directly irritates the neighboring nerves as they are unable to move freely with the vertebrae. Pain from spinal instability will most often present with movement of the back. In some cases, our specialists will recommend physiotherapy and/or medications. If the instability is acute, a Spinal Fusion surgery might be needed to restore normal functionality and relieve the pain.