You are on page 1of 32

‫פיזיותרפיה במערכת התנועה ‪II‬‬

‫ד"ר יוסף משהראוי‬


‫המעבדה לחקר עמוד השדרה‬
‫החוג לפיזיותרפיה‬
‫אוניברסיטת ת"א‬

‫‪Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.‬‬
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Adaptation of the spine to the upright
position throughout evolution
Development of vertebral curvatures
V.B. wedging shape

Minimal energy
=
Integral component
of our spinal engine

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)Masharawi et al )2003

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Adaptation of the spine to the upright
).position throughout evolution )contin
Morphological changes of the Lx-ZAJ
– Decrease in sup./inf. Length of inf. facets
– Increase in interfacet angle & distance
– Gradual increase in coronal orientation
in human Vs chimpanzees

Processes modification
for muscle attachements

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Vertebral body
A thin )but relatively
stiff) cortical shell
surrounds cancellous
bone
The top and bottom
with deformable &
porous cartilage plate
= endplates
One vertical and two
oblique trabecular
arrangement
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Vertebral body
Different levels have same cancellous
bone therefore vertebral strength depends
on its size/morphology
Decrease in strength with age ) rapid rate
20-40 y.o.)
Definite relationship between strength
)stress of failure) and relative osseous
tissue

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Zygoapophyseal joints
Typical synovial joints

Hyaline cartilage &capsule

Fibroadipose meniscoids

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Biomechanical features of ZAJ

The ZAJ play an important role in stability


and motion control of the spine (Hyun-Yoon and Byung
1997)

ZAJ:3% to 25% of compressive load (Yang and


King 1984)

ZAJ protect the discs from shear forces


and excessive flexion & axial rotation (Grobler et
al 1993, Adams and Hutton 1983)

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Biomechanical features of ZAJ
)).Contin
ZAJ orientation in the transverse plane
affect the degree of rotation in W.B .)Van Schaik 1997,
Cassidy et al 1992)

ZAJ orientation cause rotational coupling


in Lx spine )Ahmed et al 1990)

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)Masharawi et al. )2004, Spine

OVERALL VIEW OF TRANSVERSE FACET ANGLES


(Left & Right, Superior & Inferior)
120
LSTFA 21 ALL
110
RSTFA 22 ALL

100 LITFA 23 ALL

RITFA 24 ALL
90
Means in degrees

80

70

60

50

40

30

20
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5
Level of vertebra

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)Masharawi et al. )2003, In press, Spine

OVERALL VIEW OF LONGITUDINAL FACET ANGLES


(Left, right, superior and inferior )
180

175

170

165
Means in degrees

160

155
LSLFA 25 ALL
RSLFA 26 ALL
150 LILFA 27 ALL
RILFA 28 ALL
145

140
T1 T2 T3 T4 T5 T6 T7 T8 T9 T10 T11 T12 L1 L2 L3 L4 L5
Level of vertebra

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)Masharawi et al. )Spine 2005

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)Masharawi et al. )Spine 2005

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Lumbar Vertebrae

,large bodies
,thick pedicles
flat transverse
processes
in the upper 4)
(vertebrae

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
)The Intervertebral Disc )IVD
The nucleus usually lies eccentrically,
close to the posterior margin of the
disc

In young adults it is comprised of 70 -


90% water with a few cartilage cells

Capable of transmitting applied pressure


.in all directions
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
.Intervertebral disc 1
.Vertebral body 2
.Dura mater 3
.Extradural or epidural space 4
.Spinal cord 5
.Subarachnoid space 6

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
The annulus fibrosus
Comprised of predominantly type I collagen fibers
(designed to resist tension such as occurs during
(rocking or twisting movements

(Arranged in 10-12 sheets (lamellae

Within each lamella the collagen fibers


lie at an angle of ~ 60 degrees

The annulus functions as a ligament in resisting


distraction, bending, sliding and twisting
movements of the intervertebral joint

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
The cartilage endplate
Formed by a 1mm thick layer of cartilage
covering the nucelus pulposus but not
.the entire extent of the annulus

Outer fibers insert into ring apophysis


while inner fibres form a capsule
enclosing the nucleus pulposus

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Nutrition of the intervertebral discs occurs
via diffusion from arteries in the outer
annulus

Some suggestion at as water returns after


being squeezed out by compression, it
carries nutrients with it. (Holm et al
.(1981

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Artist's illustration showing the vascular
supply to the disc space from the
.cartilaginous endplate

segmental radicular = 1
;artery
;interosseous artery = 2
;capillary tuft = 3
.disc anulus = 4

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Normal age related changes
in the disc
Nucleus
Type II collagen of nucleus starts to resemble type
I collagen of annulus

Water content decreases to 74% by 8th decade


)Markolf and Morris 1974

Number of healthy cells decreases

Concentration of proteoglycans decreases

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Age related changes)cont.)
The Annulus
Collagen fibril size decreases

Concentration of elastic fibers in annulus


decreases

Circumferential clefts and fissures form

Water content = 80% first decade, 67% by 30 yo,


increases to 87% by 8th decade )Kramer et al
)1985
Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
…Generally, with age
IVD becomes more convex (loss of
height not a normal age related
(change

Lumbar mobility, after the age of 18 has


been shown to decrease with age
(Hindle et al 1990, Taylor and Twomey
.( 1980

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
…Generally, with age
Studies on older cadavers have found that
release of the posterior elements and
removal of the PIV joints does not great
increase the range of flexion (Twomey and
.(Taylo 1983

Therefore increased stiffness of the IVD is


presumed responsible for the decrease in
.( flexion range (Bogduk and Twomey 1991

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
…Generally, with age
If normal age related changes increase the
stiffness of the IVD, instability would not
seem to be a consequence of normal age
.induced changes

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Anatomical consideration of
).Spondylosis deformans)S.D
Etiology and pathogenesis still unknown

)Load > compression >injury) = wrong


)Load > increase torsion > injury) =
right )Gracovetzky and Lacono 1985)

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Anatomical consideration of
).Spondylosis deformans )S.D
Osteophytes: cortical overgrowth with
subsequent medullary bone
common findings in S.D.)Jones et al 1988, Resnick 1985)
60%-80% of patients over 50y.o. )Resnick 1985)
Men>women )Resnick 1985)
Unequal distribution in the spine

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.
Anatomical consideration of
S.D. ).)contin

Defect in the vertebral rim


Osteoarthritis of ZAJ
Endplate damage/Schmorl’s nodes
Decrease in V.B. heights

Dr. Youssef Masharawi, Spinal Research Lab., Physical Therapy Dept., TAU.