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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The term disc is a biologic term. The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise. With this loss of segmental loss of support is the development of segmental dysfunction. Rational therapy requires making a specific diagnosis first.

The Facet Zygoapophyseal Joints In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints. The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion. In Harry Farfan pointed out, on the basis of his research, that: Facet degeneration then occurs in association with facet enlargement hypertrophy with subsequent erosion of the articular surfaces leading to other pathologic changes. In the degenerative cascade disc degeneration wllis to segmental dysfunction and stress is then directed to the facet joints.

This mass has been chronically compressing and distorting the dural sac. Progressive degeneration and tearing of the disc initiates the cascade: In this illustration disruption of the posterior annulus of the disc has occurred. This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment.


Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the cauda equina and the exiting nerve roots. It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible.

This process basically causes loss of segmental stability. Post- chemonucleolysis collapse of the disc interspace. 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. Shown, to the left, is such a segment. A segment includes adjacent vertebrae and the intervertebral disc between wilis.

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. From left-to-right the figures above provided by William Kirkaldy-Willis show the results of progressive degeneration.

Normal Spinal Anatomy This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment. Iatrogenically Produced Facet Problems Low back pain secondary to facet degeneration is a common phenomenon.

Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration. A degenerative spondylolisthesis has developed at L HIZ tears have been directly correlated with low back pain.

Low back pain secondary to facet degeneration is a common phenomenon. To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes.


In genomic situations i.

Tribute to William H. Kirkaldy-Willis () – The Burton Report

Lesions such as this are often synovial cysts or chondromas from the degenerated facet. Blue Dot- The facet or zygoapophyseal joint.

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. This work created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy.

The pathophysiology of degenerative disease of the lumbar spine.

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. Post- artificial disc surgery rotational instability. On the other hand the collagen itself may have not formed normally at birth due to congenital enzymatic deficiencies. The MRI image in the center wilpis the degenerated facet joints and suggests a mass on the left side of the image compromising the central spinal canal.

This can progress to the point of true segmental instability. This is a case of a 52 year old female with underlying genomic spine disease. Note that the wilis of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis.