Massage & Bodywork

January/February 2011

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PATHOLOGY PERSPECTIVES These long, strong ligaments may ossify with age, leading to a decreased range of motion and an increased risk of spinal cord pressure. Finally, the ligamentum flavum, which runs on the posterior aspect of the spinal canal, often thickens with age; this can contribute to stenosis, or narrowing of the vertebral canal. Standard osteoarthritis. More typical presentations of osteoarthritis may occur at the facet joints between the vertebrae, or at the sacroiliac joints. In these areas, common osteoarthritis- related changes occur: cartilage damage, bony adaptation, and muscle splinting in response to pain. SPOndyLOSIS SIGnS And SymPTOmS Spondylosis may not present extreme symptoms. If the bony changes do not press on nerve roots, but grow somewhere that impedes movement, the main symptom is slow, painless, but irreversible stiffening of the spine. When the osteophytes do press on nerve roots, the symptoms include shooting pain, tingling, pins and needles, numbness, and muscle weakness only in those muscles supplied by the affected nerve. SPONDYLOLYSIS: VERTEBRAL LOOSENING Spondylolysis describes a situation with an anatomical separation between the vertebral arch and the vertebral body, usually at L5. This is a surprisingly common anomaly, affecting around 5 percent of the population. It can be a congenital problem present from birth, but it is more likely to be connected to a structural weakness that leads to tiny fractures when a person becomes physically active. The part of the bone that is most vulnerable is called the pars interarticularis: this is the bridge between the pedicle and the lamina. Stress fracture at the vertebral arch Spondylolysis can be a congenital problem, but is more likely a structural weakness that leads to tiny stress fractures. Activities that tend to damage the pars include repetitive twisting and weight bearing, especially when in extension of the spine, like gymnastics, throwing sports (javelin, shot put), weight lifting, and football. Spondylolysis is a frequent cause of low-back pain among adolescents and young adults. It seems shocking to consider that this relatively common condition is usually a stress fracture of the vertebra, which may occur unilaterally or bilaterally. The lesion may heal completely, but in many cases it appears to be knit up only by a mesh of fibrous connective tissue, and the affected vertebra may never fully heal. The fact that spondylolysis is not associated with a risk of paralysis speaks to the strength and adaptability of the human spine. Spondylolysis opens the door to anterior movement of the vertebral body (spondylolisthesis) about half the time. In the rest of cases, the vertebrae stays anatomically in correct 100 massage & bodywork january/february 2011 proximity, and the bony separation may cause no other problems. SPOndyLOLySIS SIGnS And SymPTOmS Not surprisingly, low-back pain is the hallmark of spondylolysis. Pain may be central, but depending on how the healing process goes, it may radiate down one buttock or leg. Pain is elicited with movement, and relieved by rest. It is important to bear in mind that this condition can mimic—and occur simultaneously with—disc problems, so it is important to get as thorough an idea as possible of what exactly is the cause of pain. SPONDYLOLISTHESIS: ANTERIOR SLIPPAGE Spondylolisthesis is a condition in which a structural problem allows one or more vertebral bodies to slip anteriorly. This can involve tiny or large bone fractures at the pars interarticularis, and it can put pressure on nerve roots at the intertransverse foramina or on the spinal cord itself. The facet joints in healthy lumbar vertebrae occur on an essentially coronal plane. The superior facets of one lumbar vertebra contact the front sides of the inferior facets of its upstairs neighbor; this prevents the higher bone from sliding forward. The pars interarticularis is a structural weak spot. Sometimes the pars is underdeveloped, and tiny microfractures allow for the anterior portion of the vertebra to shift forward. Alternatively, if the orientation of the facets is on a sagittal plane, or if the pars interarticularis has to accommodate for extreme shearing forces, the bone may fracture, allowing the vertebral body to slide forward. Tiny microfractures of the pars interarticularis can have several outcomes. They can essentially heal with a false joint that allows permanent hypermobility; they can grow a bony bridge that lengthens the vertebral

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