-IBIS-1.5.0-
tx
musculoskeletal system
spinal segmental lesion
diagnoses
definition and etiology
definition:
Loss of motion in one or more joints in the 3-joint complex between two adjacent vertebrae, often with associated soft-tissue dysfunction or visceral effects. Also called somatic dysfunction, or vertebral subluxation.
etiology:
Different schools of thought have different views on this:
osteopathic principles propose the fundamental lesion as segmental malposition impairing spinal circulation, and loss of mobility as the criterion for manipulation
chiropractic principles propose the fundamental lesion as vertebral subluxation causing pressure on the nerve at the intervertebral foramina, and position as the criterion for manipulation
naturopathic principles propose the fundamental lesion as soft tissue/interstitial fluid change causing somatic dysfunction including segmental malposition, and loss of mobility as the criterion for manipulation
In any case, it is clear that spinal segmental lesions or somatic dysfunction may have considerable relationships beyond their immediate structures and surroundings. Three ways in which this may happen are:
viscerosomatic: an irritated, overstimulated, or ischemic organ causes a reflex via the sympathetic nervous system to a region of the spine causing local tissue changes
somatosomatic: an irritated body part such as a shoulder injury, causes a reflex into the spine
somatovisceral: the classic scenario; a spinal segmental lesion impairs the performance of an organ or tissue related to its spinal level
signs and symptoms
signs and symptoms: many and varied, depending on the systems involved
pain, discomfort or loss of motion in the spine
muscle spasms or weakness locally or distal to the lesion
symptoms of end-organ irritation
diagnosis:
some physicians use x-ray studies to determine improper positioning of one vertebrain relation to the next (i.e. rotation, lateral flexion, flexion, or extension malposition)
motion palpation of the spine challenges the joints to determine altered range of motion or end play
static palpation attempts to determine malposition of vertebrae
in some cases, the physician determines the area that needs to be affected (i.e. pelvic organs) and adjusts the corresponding vertebrae (L3, L4)
pain over the vertebral area
tenderness to joint play when challenged by pressure to the spinous process
course and prognosis
Course and prognosis depends on the nature of the dysfunction and how it is treated. Some argue that untreated subluxations will lead to degeneration and even death. Some resolve spontaneously. Quite often, people will develop an area that is their "weak link". If they become fatigued, stressed, overworked that is the area which will give them trouble.
differential diagnosis
local sprain/strain
degenerative joint disease
facet syndrome
other arthritides
neoplasm
footnotes