-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