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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It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Rational therapy requires making a specific diagnosis first. This work created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy. This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment.
A segment includes adjacent vertebrae and the intervertebral disc between them. Shown, to the left, is such a segment. Blue Dot- The facet or zygoapophyseal joint. Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the cauda equina and the exiting nerve roots.
Partial removal of the superior vertebrae allows a better appreciation of the normal anatomy, particularly the relationship iwllis an exiting kifkaldy root to the intervertebral disc. Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis.
The term disc is a biologic term. In Harry Farfan pointed out, on the basis of his research, that: 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. In genomic situations i. Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration.
On the other hand the collagen itself may have not formed normally at birth due to congenital enzymatic deficiencies. The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise.
Tribute to William H. Kirkaldy-Willis (1914-2006)
With this loss of segmental loss of support is the development of segmental dysfunction. This can progress to the point of true segmental instability. In this illustration disruption of the posterior annulus of the disc has occurred. In this example radial tears are seen in the posterior annulus. HIZ tears have been directly correlated with low back kjrkaldy.
Progressive degeneration and tearing of the disc initiates the cascade: This process basically causes loss of segmental stability. In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints.
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. To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes. From left-to-right the figures above provided by William Kirkaldy-Willis show the results of progressive degeneration.
The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion. This is a case of a 52 year old female with underlying genomic spine disease.
A degenerative spondylolisthesis kirkalvy developed at L 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.
Tribute to William H. Kirkaldy-Willis () – The Burton Report
Lesions such as this are often synovial cysts or chondromas from the degenerated facet. In this case, as shown on the right CT image the mass is a calcified chondroma. This mass has been chronically compressing and distorting the dural sac. Low back pain secondary to facet degeneration is a common phenomenon.
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. Post- chemonucleolysis collapse of the disc interspace. Post- artificial disc surgery rotational instability. Normal Spinal Anatomy This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment.
The Facet Zygoapophyseal Joints In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints. Iatrogenically Produced Facet Problems Low back pain secondary to facet degeneration is a common phenomenon.