Spine Natural History Through Human Life

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Virginie Lafage

Health & Medicine Education

Natural History of the Aging Spine Jean-Pierre C. Farcy, MD. Frank J. Schwab, MD. NICE Spine Course 2007

Importance of the Sagittal Plane ,[object Object],[object Object],Two Structural Curves In Kyphosis Two Non-Structural Curves In Lordosis ,[object Object],[object Object],Vary with pelvic / hip posture stabilized at ambulation age Quantified by the Pelvic Incidence (PI)

Importance of the sagittal plane The four curves in the sagittal plane endure 16 (4x4) times more resistance to load than possible in a straight spine.

The Spine Range of Motion (ROM) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pelvic Differences in Association with Spine Curvatures ,[object Object]

Pelvic Differences in Association with Spine Curvatures ,[object Object],[object Object]

Relationship Between PI and Lumbar Lordosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Spine As A Whole ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

This sketch shows that resistance to loads depends on muscle strength. Muscle tone of the same muscle groups insure balance. Loss of muscle mass in aging places the balance system at risk of failure.

The load sharing of the posterior muscles from the spine to pelvis and femoral bone carry the lion’s share.

Schematics of Spine and Body Balance Schematic of spine and body balance

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],How to Maintain Good Posture and Good Balance

How to Maintain Good Posture and Good Balance ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Global Alignment ,[object Object],[object Object],[object Object]

Morphotypes ,[object Object],[object Object],[object Object]

The Sacrum Inclination Bernhardt M Bridwell KH. Segmental analysis of the sagittal plane alignment of the mormal thoracic and lumbar spines and thoraco lumbar junction. Spine 1989;14:717

End of growth Disc degeneration begins around age 35 Facet degeneration begins around age 50 Unstable spine Stable spine ankylosis stenosis spondylo deformity Most often all together Progressive Degenerative Process

Progressive Degenerative Process ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Age Related Changes 21-40y Group 41-60y Group >60y Group Pelvic Parameters: Sacral Slope decrease Pelvic Tilt increase Spinal Parameters: Global Inclination tilt forward GL Parameters: GL - Heels doesn’t change Pelvis move backward Kyphosis increase * Lordosis decrease Age

Throughout Human Life ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

The Final Result ,[object Object],[object Object],[object Object]

The Degenerative Process ,[object Object],[object Object],[object Object],75 years old female Can be smooth, delayed and pain free in spite of progressive signs of radiological deformity

The Degenerative Process 75 year old female Can be invalidating and painful With signs of radiological deformity

Conclusion ,[object Object],[object Object],[object Object],[object Object]

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