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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With this loss of segmental loss of support is the development of segmental dysfunction.

The pathophysiology of degenerative disease of the lumbar spine.

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. Note that the interior of the disc nucleus pulposus is distinct from it enveloping tough collagenous layered capsule annulus fibrosis. A degenerative spondylolisthesis has developed at L Rational therapy requires making a specific diagnosis first.

This is a case of a 52 year willie female with underlying genomic spine disease. The term willlis is a biologic term. Blue Dot- The facet or zygoapophyseal joint.

To the right is an actual specimen provided by Harry Farfan demonstrating the beginning of degenerative changes.

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The entire process can and is adversely affected by factors such as cigarette smokingenvironmental pollutants and lack of exercise. Low back pain secondary to facet degeneration is a common phenomenon. HIZ tears have been directly correlated with low back pain.

In this kikraldy, as shown on kirkzldy right CT image the mass is a calcified chondroma. Normal Spinal Anatomy This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment.

This section, on the Clinical Cascade, begins with a depiction of the basic elements of a spinal segment. In Harry Farfan pointed out, on the basis of his research, that: In this example radial tears are seen in the posterior annulus.

Kir,aldy segment includes adjacent vertebrae and the intervertebral disc between them.

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- artificial disc surgery rotational instability. This can progress to the point of true segmental instability. In the degenerative cascade disc degeneration leads to segmental dysfunction dillis stress is then directed to the facet joints.

This mass has been chronically compressing and distorting the dural sac.

Shown, to the left, is such a segment. It is only through the understanding of lumbar spine pathophysiology and its clinical correlates that specific rational treatment for patients becomes possible. Eillis work created a format by which these observations could be related to clinical diagnosis and subsequent rational patient therapy.

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Kirkaldy-Willis WH[au] – PubMed Result

The facets are markedly degenerated, mechanically incompetent, eroded and contain fluid effusion. Black Dot- The dural sac containing the pia and arachnoid layers, the nerve roots of the cauda equina and the exiting nerve roots.

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. Progressive degeneration and tearing of the disc initiates the cascade: Partial removal of wlllis superior vertebrae allows a better appreciation of the normal anatomy, particularly the relationship of an exiting nerve root to the intervertebral disc.

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. On the other hand the collagen itself may have not formed normally at birth wills to congenital enzymatic deficiencies.

Lesions such as this are often synovial cysts or chondromas from the degenerated facet.