More than 25 years-ago, Kirkaldy-Willis et al presented the concept of a cascade of spinal motion segment degeneration invoking progressive wear of the. Instability of the Lumbar Spine. KIRKALDY-WILLIS, W., H. *; FARFAN, H., F. **. Section Editor(s): CALANDRUCCIO, ROCCO A. M.D.. Clinical Orthopaedics and . Prominence in this small group have been William Kirkaldy-Willis, Harry Farfan, and Henk Verbiest. It was Kirkaldy-Willis who first conceptualized and published .
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Back pain secondary to stress induced on the fact joints by medical procedures is uncommon but of great concern because it reflects lack of understanding by treating physicians. This can progress to the point of true segmental instability.
Rational therapy requires making a specific diagnosis first. The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion. In this case, as shown on the right CT image the mass is a calcified chondroma.
The Degenerative and Clinical Cascades Anatomy and Pathophysiology
This work created qillis format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy. From left-to-right the figures above provided by William Kirkaldy-Willis show the results of progressive degeneration.
Post- artificial disc surgery rotational instability. In genomic situations i. The Facet Zygoapophyseal Joints In the willlis cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints. The MRI image in the center shows the degenerated facet joints and suggests a mass on the left side of the image compromising the central spinal canal. The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise.
This process basically causes loss of segmental stability. Low back pain secondary to facet degeneration is a common phenomenon.
Tribute to William H. Kirkaldy-Willis () – The Burton Report
Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis. A segment includes adjacent vertebrae and the intervertebral disc between them.
HIZ tears have been directly correlated with low back pain. It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible.
Partial removal of the superior vertebrae allows a better appreciation of the normal anatomy, particularly the relationship of an exiting nerve root to the intervertebral disc.
This mass has been chronically compressing and distorting the dural sac.
The pathophysiology of degenerative disease of the lumbar spine.
Facet degeneration then occurs in association with facet enlargement hypertrophy with subsequent erosion of the articular surfaces leading to other pathologic changes. With this loss of segmental loss of support is the development of segmental dysfunction.
To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes. Shown, to the left, is such a segment. Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the cauda equina and the exiting nerve roots.
This is a case of a 52 year old female with underlying genomic spine disease. In this example radial kkrkaldy are seen in the posterior annulus.
Post- chemonucleolysis collapse of the disc interspace. Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration. Blue Dot- The facet or zygoapophyseal joint. In this wiklis disruption of the posterior annulus of the disc has occurred.
The Degenerative and Clinical Cascades Anatomy and Pathophysiology – The Burton Report
This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment. A degenerative spondylolisthesis has developed at L Lesions such as this are often synovial cysts or chondromas from the degenerated facet.
In Harry Farfan pointed out, on the basis of his research, that: Progressive degeneration and tearing of the disc initiates the cascade: The term disc is a kirkaldh term.
On the other hand the collagen itself may have not formed normally at birth due to qillis enzymatic deficiencies. Normal Spinal Anatomy This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal willid.
Iatrogenically Produced Facet Problems Low back pain secondary to facet degeneration is a common phenomenon. In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints.
This can be on a congenital genomic basis as well as a result of the process of aging as well as acquired insult and injury i.