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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On the other hand the collagen itself may have not formed normally at birth due to congenital enzymatic deficiencies. A segment includes adjacent vertebrae and the intervertebral disc between them. The Facet Zygoapophyseal Joints In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to williz 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.

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

The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion. A degenerative spondylolisthesis has developed at L Rational therapy requires making a specific diagnosis first.

In the degenerative cascade disc degeneration leads to segmental dysfunction and stress is then directed to krikaldy facet joints. With this loss of segmental loss of support is the development of segmental dysfunction. The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise.


The Degenerative and Clinical Cascades Anatomy and Pathophysiology – The Burton Report

Post- chemonucleolysis collapse of the disc interspace. Facet degeneration then occurs in association with facet enlargement hypertrophy with subsequent erosion of the articular surfaces leading to other pathologic changes. The term disc is a biologic term. Kirkaldu this illustration disruption of the posterior annulus of the disc has occurred.

Blue Dot- The facet or zygoapophyseal joint. This is a willsi of a 52 year old female with underlying genomic spine disease. 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.

In this case, as shown on the right CT image the mass is a calcified chondroma. This process basically causes loss of segmental kirkalvy.

Juvenile Discogenic Disease disc nutrition may be poor because of the existing endplate abnormalities and premature disc collagen deterioration. Post- artificial disc surgery rotational instability.

The Degenerative and Clinical Cascades Anatomy and Pathophysiology

Progressive degeneration and tearing of the disc initiates the cascade: In Harry Farfan pointed out, on the basis of his research, that: Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the cauda equina and the exiting nerve roots. Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis. From left-to-right the figures above provided by William Kirkaldy-Willis show the results of progressive degeneration.


This section, on the Clinical Cascade, begins kirkldy a depiction of the basic elements of a spinal segment.

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 eillis. In this example radial tears are seen in the posterior annulus. This work created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy.

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. 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.

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.