Lumbar Pelvic Hip 1
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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 LITFA 23 ALL
100
RITFA 24 ALL
Means in degrees
90 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
Means in degrees
170
165
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.
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 LITFA 23 ALL
100
RITFA 24 ALL
Means in degrees
90 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
Means in degrees
170
165
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.
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