A Dissertation Submitted to the Faculty of Science University of the Witwatersrand, Johannesburg for the Degree of Master of Science January, 1990 / This is a study of the morphological and functional aspects of A. africanus thoracic and lumbar vertebrae in comparison with those of modern human and anthropoid ape vertebrae. The purpose is to determine if any derived features in the morphology of hominids, as distinct from primitive features shared with non-hominids, were present and if so to what stage of attainment of full erectness such features point. The major results of this study are as follows: (i) There is a difference in the configuration of the lumbar articular facets between pongids, on the one hand, and modern human and A. africanus, on the other hand. This difference suggests that similar stresses operate in these regions in the two hominid groups. (ii) Bony adaptation to a developed lumbar lordosis is present in A. africanus. (iii) Major agreement has been found in the relative dimensions of modern human and A. africanus lumbar vertebrae, in contrast to those of pongid vertebrae. This indicates probable correspondence in the pattern of weight transmission to the pelvis in modern humans and A. africanus. (iv) The decrease of inferior lumbar vertebral body area starts at higher levels in sts 14 (an A. africanus partial skeleton) than in modern man, suggesting a longer curved lower lumbar region in A. africanus. From these results it may be concluded that the trunk was probably carried in a fully erect posture in A. africanus. The bony adaptation thereto, however, may not have been fully developed as in modern man. It is proposed that, in Sts 14, the last two lumbar vertebrae were carried at an angle relative to each other and to the sacrum, in contrast to the abrupt change in direction between L5 and the sacrum in modern man.

This study addressed the lack of knowledge regarding the epidemiology of waking symptoms attributable to the cervico-thoraic spine. Five inter-linked studies were undertaken to investigate the relationships between reports of waking cervical pain, cervical stiffness, headache and scapular pain, cervico-thoracic spine posture in the side lying position and anthropometry. This has culminated in evidence based advice regarding pillow use. / Thesis (PhD)--University of South Australia, 2004.

Thesis (MAppSc) -- University of South Australia, 1997

Thesis (M.S.)--Duquesne University, 2009. / Abstract included in electronic submission form. Title from document title page. Includes bibliographical references (p. 65-71) and index.

M.Tech. / Purpose: Posterior mechanical neck pain is considered a debilitating musculoskeletal problem and is one of the most common reasons for visiting an emergency sector (Murphy, 2000). This study aims to compare the effects of Chiropractic manipulative therapy directed at the thoracic spine to that directed at the cervical spine for the treatment of chronic neck pain with regards to pain, disability and cervical range of motion. Method: This study was a comparative study and consisted of two groups of fifteen. The participants were between the ages of eighteen and forty-five, with a half male to female ratio. The potential participants were examined and accepted according to the inclusion and exclusion criteria. The method of treatment administered to each participant was determined by group allocation. Group 1 received chiropractic spinal manipulative therapy to restriction(s) of the upper thoracic region only. Group 2 received chiropractic spinal manipulative therapy to restriction(s) of the cervical spine only. Objective and subjective findings were based on the above treatment protocols. Procedure: Treatment consisted of six treatment consultations with an additional follow up consultation over a three week period, with two consultations being performed per week interval. Objective and subjective readings were taken at the beginning of the first, fourth and seventh consultations. Subjective readings were taken from the Vernon-Mior Neck Pain and Disability Index as well as from the Numerical Pain Rating Scale (NPRS). Objective readings were taken from measurements taken from the Cervical Range of Motion device (CROM). Analysis of collected data was performed by a statistician. The Chiropractic manipulative techniques used were based on restrictions identified during motion palpation and were applied at the first six consultations, with the seventh consultation consisting of data gathering only. Results: Clinically significant improvements in both Group 1 and Group 2 were seen over the course of the study with regards to cervical spine range of motion, pain and disability. However group 1 showed greater statistically significant improvements in their mean cervical range of motion whereas group 2 showed a greater statistically significant improvement in their subjective readings of pain and disability.

M. Tech. / Although Chiropractors rely on palpation as a clinical tool, its reliability still remains to be proven (O‟Haire and Gibbons, 2000). Motion palpation is based on the assumption that Chiropractors‟ and other manual medicine practitioners‟ static palpation is performed correctly to identify bony anatomical landmarks (O‟Haire and Gibbons, 2000). The most common method taught to chiropractic students on the location of the seventh thoracic spinous process, is to place the patient‟s hand in the small of their back, forcing the inferior angle of the scapula to become more prominent. The horizontal line from the inferior angle of the scapula to the vertebral column is said to be on the seventh thoracic spinous process (T7). Therefore the scapula is a widely used anatomical landmark. One would therefore expect the literature to all be in agreement to the position of this line, but according to the literature consulted, it seems to vary. This study aimed to determine whether palpation of the inferior angle of the scapula was a reliable, accurate and/or a valid method of determining the location of the seventh thoracic spinous process. Sixty participants were marked by three examiners in the seated position, using the inferior angle of the scapula to locate the seventh thoracic spinous process. After being marked by all three examiners, measurements were then made on CT scan films as well as visual assessments by examiners to assess the location of the markers on the thoracic anatomy. The results demonstrated substantial inter-examiner reliability, and poor accuracy in locating the seventh thoracic spinous process. This is disappointing as the ability to palpate spinal levels is a basic skill and the cornerstone of Chiropractic assessment.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, 2014. / Aim: The aim of this study was to evaluate the normal selected radiographic parameters (thoracic kyphosis (TK), anterior vertebral body height (AVBH), posterior vertebral body height (PVBH), intervertebral disc height (IVDH) and interpedicular distance (IPD)) in young to middle-aged males across the four racial groups in Durban. Participants: Eighty young to middle-aged apparently healthy males between the ages of 18-45 years from the White, Black, Indian and Coloured racial groups in Durban. Methodology: After written informed consent was acquired, all participants underwent a case history, physical examination and thoracic orthopaedic examination. An AP and lateral radiograph of the thoracic spine was then obtained. The TK, AVBH, PVBH, IVDH and IPD were assessed using methods described previously. The IBM SPSS version 20 was utilized for the data analysis. Mean, standard deviation (SD) and range are reported for the TK, AVBH, PVBH and IPD for each of the four racial groups. For the IVDH, however, the median for the respective vertebral levels is given. ANOVA testing with Bonferroni post-hoc tests were used to determine overall inter-group variations and compare each group to the other. Pearson’s correlation test was used to determine the relationship between the thoracic kyphosis and the other radiographic parameters that were assessed. Results : The mean, SD, minimum and maximum values of the thoracic kyphosis by racial group There was no significant difference in the TK among the four race groups. Significant differences (p < 0.05) were observed in the AVBH, PVBH, IVDH and IPD between the White, Black, Indian and Coloured males at various thoracic levels. Conclusion: The trends of the various radiographic parameters observed in this study support the argument that these parameters should be based on sex, age and geographic race. These values would be useful for South African spinal health care practitioners in the diagnosis and management of spinal disorders.

Disc degenerative changes are directly or indirectly associated with spinal pain and disability. Literature revealed a high prevalence of disc degeneration in the thoracic region, however thoracic MRI degeneration trends and information on disc biochemical matrix constituents are limited for thoracic discs compared to lumbar and cervical discs. The objective of this thesis was to use MRI to investigate the prevalence of disc degenerative changes affecting the human thoracic spine, and to determine the factors affecting spinal disc biochemical matrix. A 3-point subjective MRI grading scale was used to grade the films. The feasibility of using archived formalin-fixed cadaver material was investigated to analyse collagen and elastin crosslinks. The prevalence of degenerative changes in human thoracic discs and vertebrae (T1 to T12) was determined retrospectively from an audit of 216 MRI cases, using sagittal T1- and T2-weighted MR images. In a subsequent series of ex-vivo studies, human thoracic discs and LF from 26 formalin-fixed and two fresh spines, involving all thoracic levels, were examined macroscopically to determine the degeneration status. Subsequently, disc and ligament tissues were analysed biochemically for collagen (pyridinoline and deoxypyridinoline) and elastin (desmosine and isodesmosine) crosslinks. These crosslinks were extracted from hydrolysed samples by cellulose partition chromatography, and analysed by reverse-phase HPLC. Collagen content was determined using its hydroxyproline content, and proteoglycan content was assayed using a modified DMB assay for chondroitin sulphate. Finally the MRI and macroscopic assessments of thoracic discs, were compared with the biochemical data from two fresh cadaver thoracic spines. The 3-point MRI grading scale had a high inter- (k = 0.57 to 0.78) and intra-rater (k = 0.71 to 0.87) reliability. There were no significant differences in the collagen and elastin content and extent of collagen crosslinks between formalin fixed and unfixed ligament and disc tissues, after 25 weeks of formalin fixation. From the in-vivo MRI series of investigations (n = 216 MRI films), the prevalence of thoracic disc degenerative and vertebral morphological changes revealed significant age, gender and spinal level trends (p < 0.05).Generally, males had a higher propensity for disc degeneration in contrast to females, especially older females, where the trend showed a higher prevalence of osteophytes and vertebral body changes. In particular, the mid and lower thoracic levels have a higher prevalence of degenerative changes, except for osteophytes and anterior vertebral wedging. With increased age, there was a concomitant increase in anterior wedging and bi-concavity and disc degenerative changes except for end-plates. The biochemical investigations on the ex-vivo series of formalin-fixed thoracic discs (n = 303) also revealed significant changes in the disc matrix due to degeneration status, age, gender and spinal regional factors. With increased age, normal disc matrices have significantly lower collagen content and extent of pyridinoline (p < 0.001). In contrast, the degenerated disc matrix revealed significantly higher collagen content and extent of deoxypyridinoline (p < 0.05). These findings suggest that an altered matrix existed in normal ageing discs, which render the disc prone to injury and degeneration over the life span. The higher collagen and deoxypyridinoline in degenerated disc matrices reflects an increase in chondrocyte synthesis, and is also a novel finding, suggesting that they may be used as markers of ageing and degeneration processes. The biochemical investigations on another series of ex-vivo spinal LF tissues (n = 364), revealed that this had a lower collagen and pyridinoline, but significantly higher elastin and deoxypyridinoline compared to spinal discs (p < 0.05). Elastin crosslinks however were difficult to detect in spinal discs, being present in negligible amounts in a few lumbar discs. The elastin crosslinks in the LF were not significantly affected by age, but were significantly higher in calcified, and female ligamentum tissues, and also in the lumbar region (p < 0.05). These MRI prevalence findings enhanced our knowledge of vertebral body and disc degeneration trends in the thoracic region and contributed to the interpretation of MR images for pathology in the human thoracic spine. Information on the associated collagenous and elastic changes in the disc and ligamentum matrices provide original data and insight on the pathogenesis of degeneration in the disc matrix from a biochemical perspective, highlighting gender, age and spinal level influences on the matrix tensile strength and cellular synthetic activities.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2016. / Background: Thoracic spine pain (TSP) is a very common condition and can be just as disabling as cervical and lumbar pain. The causes of thoracic spine pain are numerous, ranging from less serious non-specific mechanical causes to serious specific underlying pathology. Chiropractors used to request routine radiographs as part of their diagnostic work-up, however limited correlation currently exists between radiographical findings and clinical symptoms in non-specific mechanical thoracic spine pain. The overutilization of plain film radiographs worldwide emphasises the need to investigate which clinical conditions in patients with TSP are sent for radiographs and if they were ethically indicated. Literature is currently limited on the role of thoracic spine x-rays and their influence on the management of patients with TSP. Objectives: The objectives of this retrospective study were: 1) to record the consultation at which thoracic spine radiographs were requested by the student or clinician and the reasons therefore, 2) to determine the number of incidental radiographic findings in the selected patients‟ radiographs, 3) to determine the suspected clinical diagnosis and management of the selected patients prior to referral for thoracic spine radiographs, 4) to determine any change in the clinical diagnoses and management following radiographic reporting of the selected patient‟s radiographs, 5) to determine the correlation between the suspected clinical diagnosis and the radiographic diagnosis of patients with thoracic spine pain. Method: The archives of the Chiropractic Day Clinic (CDC) at the Durban University of Technology (DUT) were searched for all available thoracic spine radiographs and corresponding patient files of patients who presented to the clinic with thoracic spine pain from 1 January 1997 to 31 December 2014. The ABCS (Alignment, Bone, Cartilage, Soft tissue) System was utilised to record data of the radiographs without any knowledge of the patient‟s main compliant. The corresponding patient files were then evaluated with selected clinical variables being recorded. Statistical analysis and interpretation included frequency counts, percentages, mean, standard deviation and ranges for the descriptive objectives. The radiographic and clinical diagnoses were then compared in a two-by-two table to determine any possible relationships in diagnoses of patients with thoracic spine pain. Results: Thirty clinical files and their corresponding thoracic spine radiographs were analysed in this study. The mean age of the patients was 43.6 (± 19.1) years with a gender distribution of 40% males and 60% females. Statistical testing using paired t-tests in order to assess the correlation between the clinical and radiological diagnoses was not possible, as the categories were too different. The most frequent primary radiological diagnosis was both old trauma and scoliosis at 33.3%, followed by thoracic spondylosis at 20%. The majority of thoracic spine radiographs were requested at the initial consultation. The most common reasons for radiographic referral were severe, progressive TSP at 58.6%, trauma at 48.3% and persistent, localised TSP for more than four weeks at 37.9%. The diagnosis remained unchanged in 70% of the patients following radiographic examination. However, in 30% of the cases the clinical diagnosis was changed following radiographic examination. Most patients were diagnosed with non-specific mechanical causes of thoracic spine pain. A wide variety of treatment modalities were utilised before and after radiographic examination, including soft tissue therapy, electro modalities, spinal manipulative therapy and dry needling. A total of 66.6% of the patients in the study had changes made to their management protocol following radiographic evaluation. There was a greater use of spinal manipulative therapy, following radiographic evaluation at 56.7% versus only 26.7% of cases prior to radiographic imaging. Conclusion: Thoracic spine radiographs have little impact on the diagnosis and management of patients with thoracic spine pain as the majority of clinical diagnoses were non- specific mechanical causes of thoracic spine pain. Thoracic spine radiographs were influential in the diagnosis and management of 30% of the cases. Thoracic spine radiographs may therefore be over-utilised at the DUT CDC. However, the use of spinal manipulative therapy more than doubled following radiographic evaluation of the thoracic spine in patients with thoracic spine pain. / M

Thesis (M. Tech.) -- Central University of Technology, Free State, 2008 / Motivated by the challenges associated with demonstrating the cervicothoracic junction, a study was conducted at Pelonomi Regional Hospital from May 2006 to June 2007. In this study, two projections of the cervicothoracic junction were done, with the only difference between them being the orientation of the arms. One projection was done using the swimmer’s projection and the other using an adaptation of the swimmer’s projection where the orientation of the arms was reversed. The sample, consisting of 45 patients, was referred from the emergency department and wards. Most of the patients (95.5%) were examined using a computed radiography system providing digital images that were printed using a laser film printer. Other patients were examined using conventional film/screen systems. The objectives of this study were to compare the two imaging techniques with reference to diagnostic quality of the projections, diagnosis of pathology and repeat rate. Radiographers obtained the two projections of the cervical spine; the researcher collected the images and distributed these to three participating radiologists on a rotational basis. The radiologists evaluated the films using a set of criteria; a biostatistician analysed the results of these evaluations. In all the criteria of image quality the swimmer’s projection showed better results. There were also, however, instances where the adapted swimmer’s had better results. The differences in percentages were not significant enough to show any statistical difference between the resultant images of the two techniques. No valid deduction could be made in relation to the demonstration of pathology due to variable instances of pathology evaluated by the radiologists. The repeat rate of the adapted swimmer’s projection compared well with the swimmer’s projection. Though the swimmer’s projection had better results for most of the criteria used in this study, no unequivocal, statistically significant evidence of it demonstrating C7-T1 better could be found. What was evident was the validity of the adapted swimmer’s projection as an alternative under certain conditions. Knowing that there is an alternative method to visualising the C7- T1 junction could be beneficial not only to radiography, but also to our patients. In cases where the swimmer’s projection is not possible due to extremity injuries, an alternative arm orientation can be useful. The alternative can also address the problem regarding multiple repeats of the swimmer’s projection.