KIRKALDY WILLIS PDF
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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Shown, to the left, is such a segment. From left-to-right the figures above provided by William Kjrkaldy show the results of progressive degeneration. 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. Post- chemonucleolysis collapse of the disc interspace. HIZ tears have been directly correlated with low back pain.
The Degenerative and Clinical Cascades Anatomy and Pathophysiology – The Burton Report
The term disc is a biologic term. This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment. Normal Spinal Anatomy This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment.
Blue Dot- The facet or zygoapophyseal joint. On the other hand the collagen itself may have willlis formed normally at birth due to congenital enzymatic deficiencies.
Kirkaldy-Willis WH[au] – PubMed Result
Post- artificial disc surgery rotational instability. Rational therapy requires making a specific diagnosis first.
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 Harry Farfan pointed out, on the basis of his research, that: The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion.
Tribute to William H. Kirkaldy-Willis (1914-2006)
In this illustration disruption of the posterior annulus of the disc has occurred. This can progress to the point of true segmental instability. Low back pain secondary to facet degeneration is a common phenomenon. Lesions such as this are often synovial cysts or chondromas from the degenerated facet.
The Facet Zygoapophyseal Joints In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints. In genomic situations i. Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis. With this loss of segmental loss of support is the development of segmental dysfunction. Facet degeneration then occurs in association with facet enlargement hypertrophy with subsequent erosion of the articular surfaces leading to other pathologic changes.
The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise. Back pain secondary to stress induced on the fact joints by medical procedures is ikrkaldy but of great concern because it reflects lack of understanding by treating physicians. In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints.
This work created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy. Progressive kirkwldy and tearing of the disc initiates the cascade: This mass has been chronically compressing and distorting the dural sac.
The Degenerative and Clinical Cascades Anatomy and Pathophysiology
It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. A degenerative spondylolisthesis has developed at L To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes. 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.
In this case, as shown on the right CT image the mass is a calcified chondroma. In this example radial tears are seen in the posterior annulus.
A segment includes adjacent vertebrae and the intervertebral disc between them. Iatrogenically Produced Facet Problems Low back pain secondary to facet degeneration is a common phenomenon.
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. Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration.
This process basically causes loss of segmental stability.