In which direction does the spinal segment displace?
Last Updated; 1996.10.06
Generally, the decision for the displacement of vertebra is
based on the bone just below it. And from the 2nd cervical to
fifth lumbar, these bones could displace by rotation, tilt, or posterior.
There are rules for representing these displacements, but the explanation for
these is cut off because of its complication.
- Rotation=Left or right shift of spinous process viewed
from posterior to anterior(P-A).
- Tilt=The difference of the height of bilateral transverse
process of vertebra viewed from P-A.
- Posterior or Anterior=Viewed from lateral
2. Tilt : based on the bone just below it
3. Posterior: based on the bone just below it
- is a line drawn down the posterior margins of vertebral bodies.
(It should drawn from body pedicle junction to body pedicle junction without
following any pathological or hyperplastic changes on the body margins.)
Normal George's Line
- should form a smooth gentle, convex anteriorly, unbroken curve, which is the
anterior boundary of the neural canal and gives indication of the integrity
of the spinal canal (below center figure).
Abnormal George's Line
- is a break in the continuity of this line which is indicative of loosening of the
motor unit and may result in a anterior displacement or posterior displacement.
With anterior as well as posterior segmental displacement, a steplike kinking
of the tubelike neural canal occurs.
Consequently, the spinal cord, cauda equina, and/or membranes are slightly too
markedly encroached upon, resulting in neurological insult and distress.
- According to the spinal facet structure, the spinal vertebral bone tends to
displace toward to posterior (except first cervical bone).
See above figure, right side.
In my clinical experience, about 80% of patients complaining of low back pain,
have this posteriority somewhere in lumbar area of the spine.
This malposition is named RETROLISTHESIS or RETROSPONDYLOLISTHESIS, REVERSE
SPONDYLOLISTHESIS, VERTEBRAL RETROPOSITION, SPONDYLOLISTHESIS POSTERIOR,
RETRODISPLACEMENT in the Roentgenographic Diagnostics.
The following literature refers to this posteriority.
- *ANATOMICO-ROENTGENOGRAPHIC STUDIES OF THE SPINE
- Lee A. Hadley, M.D.
Cherles C Thomas Publisher
- *THE RADIOLOGY OF VERTEBRAL TRAUMA
Philadelphia , 1980
This phenomenon was firstly reported in 1929 by Brailsford, Hibbs, Swift.
Accordingly, the honor of first discovery of this phenomenon should be given to
them. However, Dr.Gonstead D.C. asserted first that these posterior
displacements can be corrected manually.
- Incidence of the anterior displacement is much lower than the posterior
displacement because of the spinal facet structure.@This is called
SPONDYLOLISTHESIS or PSEUDOSPONDYLOLISTHESIS by medical orthopedics. See above figure.
"Chiropractic in Japan" Maeda Shigeru, Copyright 1996-; All rights reserved.