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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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Lesions such as this are often synovial cysts or chondromas from the degenerated facet. The facets are markedly willid, mechanically incompetent, eroded and contain fluid effusion. Post- chemonucleolysis collapse of the disc interspace.

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.

This process basically causes loss of segmental stability. Normal Spinal Anatomy This section, on the Clinical Cascade, begins kir,aldy a depiction of the basic elements of a spinal segment.

With this loss of segmental loss of support is the development of segmental dysfunction. Progressive degeneration and tearing of the disc initiates the cascade: This can be on a congenital genomic basis as well as a result of the process of aging as well as acquired insult oirkaldy injury i.

Kirkaldy-Willis WH[au] – PubMed Result

In this illustration disruption of the posterior annulus of the klrkaldy has occurred. The term disc is a biologic term. A segment includes adjacent vertebrae and the intervertebral disc between them. 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 Degenerative and Clinical Cascades Anatomy and Pathophysiology

In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to the facet joints. HIZ tears have been directly correlated with low back pain. Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis. Low back pain secondary to facet degeneration is a common phenomenon. Rational therapy requires making a specific diagnosis first. From left-to-right the figures above provided by William Kirkaldy-Willis show the results of progressive degeneration.

Facet degeneration then occurs in association with facet enlargement hypertrophy with subsequent erosion of the articular surfaces leading to other pathologic changes. This kirkaldj created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy. In Harry Farfan pointed out, on the basis of his research, that: It is only through the understanding willis lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible.

In this example radial tears are seen in the posterior annulus. Shown, to the left, is such a segment. Blue Dot- The facet or zygoapophyseal joint. This mass has been chronically compressing and distorting the dural sac. This is a case of a 52 year old female with underlying genomic spine disease.

Back pain wilis 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. 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.

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A degenerative spondylolisthesis has developed at L This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment. To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes.

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

This can progress to the point of true segmental instability. The entire process can and is adversely affected by factors such as cigarette smoking kjrkaldy, environmental pollutants and lack of exercise. Post- artificial disc surgery rotational instability. Iatrogenically Produced Facet Problems Low back pain secondary to facet degeneration is a common phenomenon.

On the other hand the collagen itself may have not formed normally at birth due to congenital enzymatic deficiencies. Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration.

Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the willls equina and the exiting nerve roots.

In this case, as shown on the right CT image the mass is a calcified chondroma.