Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Background: Various congenital spinal anomalies are common findings in the general population. Their clinical significance is controversial with no definitive association been made between any specific congenital spinal anomaly to any clinical features. Project Design: This research study was designed in the form of a quantitative, non-experimental, empirical clinical survey. Method: Data was obtained from thoracic and lumbar spine radiographs contained in the Chiropractic Day Clinic at the Durban University of Technology from 1 January 1997 to 31 December 2005 and from the corresponding patient files. Through the research procedure, 519 thoracic and lumbar spine radiographs were located in the confines of the Chiropractic Day Clinic. Due to the exclusion criteria of a past or present history of trauma to the thoracic or lumbar spine areas, 147 radiographs were excluded. Objectives 1.To determine the period prevalence (1 January 1997 – 31 December 2005) of congenital thoracic and lumbar spine anomalies. 2.To determine if there is any association between the presenting clinical features and the congenital thoracic and lumbar spine anomalies in general. 3.To determine if there is any association between the presenting clinical features and individual congenital thoracic and lumbar spine anomalies. 4.To compare subjects presenting clinical features with reported clinical features from literature. / M

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

Abstract Osteoporotic vertebral fractures are common among ageing populations worldwide. Although small vertebral size has been established as an independent risk factor for vertebral fracturing, relatively few determinants of vertebral size are currently known. The present study aimed to reveal lifetime factors that associate with midlife vertebral size. Overall physical activity across the lifespan, sports participation in adulthood, occupational physical activities in adulthood, and physical growth in early life were investigated. A subsample of the Northern Finland Birth Cohort Study 1966 was used, with a 46-year follow-up (n = 1,540). Vertebral dimensions were obtained by magnetic resonance imaging of the lumbar spine at the age of 46. The present data showed that high lifelong leisure-time physical activity and active participation in high-impact sports in adulthood were associated with large midlife vertebral size among women, but no such association was detected among men. Occupational physical activities were not associated with vertebral size among either sex. Early-life weight gain predicted large midlife vertebrae among both sexes, and the effect of height gain on vertebral size seemed to be mediated by adult height. The present findings show that the female vertebra in particular seems to benefit from high leisure-time physical activity and active participation in high-impact sports. Regardless of sex, early development also seems to play a role in determining later-life vertebral size. Prospective studies should confirm the causality of the present findings, and further research is needed to shed light on other lifetime factors as determinants of vertebral size. / Tiivistelmä Selkänikaman osteoporoottiset murtumat ovat maailmanlaajuisesti yleinen ikääntyvän väestön vaiva. Pienen nikamakoon tiedetään lisäävän nikamamurtuman riskiä, mutta nikamakokoon vaikuttavia tekijöitä tunnetaan toistaiseksi varsin vähän. Tämän tutkimuksen tavoitteena on selvittää keski-iän nikamakokoon vaikuttavia elinaikaisia tekijöitä. Erityisesti tutkitaan vapaa-ajan liikunnallisuuden, lajikohtaisen harrastusaktiivisuuden, työn liikunnallisten piirteiden sekä lapsuuden ja nuoruuden fyysisen kehityksen yhteyttä nikamakokoon. Tutkimusjoukkona käytetään osaotosta Pohjois-Suomen vuoden 1966 syntymäkohortista (n = 1 540). Seuranta-aika on ollut 46 vuotta, ja selkänikaman koko on määritetty tutkittavista 46 vuoden iässä otetuista lannerangan magneettikuvista. Tutkimusaineistossa naisten elinaikainen vapaa-ajan liikunnallisuus sekä aktiivinen luustoa kuormittavien liikuntalajien harrastaminen ovat yhteydessä suureen nikamakokoon keski-iässä. Miesten liikunnallisuuden ja nikamakoon välillä ei sen sijaan havaittu vastaavaa yhteyttä, eivätkä työn liikunnalliset piirteet olleet yhteydessä nikamakokoon kummallakaan sukupuolella. Varhainen painon kasvu ennusti suurta keski-iän nikamakokoa sukupuolesta riippumatta, ja varhaisen pituuskasvun vaikutus nikamakokoon näytti välittyvän aikuispituuden kautta. Tutkimuksen tulosten perusteella siis erityisesti naiset näyttäisivät hyötyvän vapaa-ajan liikunnallisesta aktiivisuudesta ja luuta kuormittavien lajien harrastamisesta aikuisiällä. Sukupuolesta riippumatta myös lapsuuden ja nuoruuden fyysisellä kehityksellä näyttäisi olevan merkitystä keski-iän nikamakokoon. Tulevaisuudessa prospektiivisten tutkimusasetelmien tulisi vahvistaa tässä tutkimuksessa havaittujen yhteyksien kausaliteetti. Lisäksi tutkimusta tarvittaisiin jatkossa muiden nikamakokoon vaikuttavien elinaikaisten tekijöiden selvittämiseksi.

No description available.

Posterior lumbar spinal dynamic stabilisation devices are intended to relieve the pain of spinal segments while prolonging the lifespan of adjacent intervertebral discs. This study focuses on the design of such a device, one that has the correct stiffness to stabilise the spinal segment by the correct amount. An initial literature survey covers contemporary topics related to the lumbar spine. Included topics are lumbar anatomy and kinematics, pathology of degenerative disc disease and treatment thereof, other spinal disorders such as spondylolisthesis and spinal stenosis, as well as the complications associated with lumbar dynamic stabilisation. The influence of factors such as fatigue and wear, as well as the properties of appropriate biomaterials are considered when determining the basis of the device design and development. Stabilising the spinal segment begins with correct material selection and design. Various designs and biomaterials are evaluated for their stiffness values and other user requirements. The simplest design, a U-shaped spring composed of carbon fibre-reinforced poly-ether-ether-ketone (CFR-PEEK) and anchored by polyaxial titanium pedicle screws, satisfies the most critical user requirements. Acceptable stiffness is achieved, fatigue life of the material is excellent and the device is very imaging-friendly. Due to financial constraints, however, a simpler concept that is cheaper and easier to rapid prototype was chosen. This concept involves a construct primarily manufactured from the titanium alloy Ti6Al4V extra-low interstitial (ELI) and cobalt-chrome-molybdenum (CCM) alloys. The first rapid prototype was manufactured using an additive manufacturing process (3D-printing). The development of the device was performed in three main stages: design, verification and validation. The main goal of the design was to achieve an acceptable stiffness to limit the spinal segmental range of motion (ROM) by a determined amount. The device stiffness was verified through simple calculations. The first prototype’s stiffness was validated in force-displacement tests. Further validation, beyond the scope of this study, will include fatigue tests to validate the fatigue life of the production-ready device. / MIng (Mechanical Engineering), North-West University, Potchefstroom Campus, 2014

Posterior lumbar spinal dynamic stabilisation devices are intended to relieve the pain of spinal segments while prolonging the lifespan of adjacent intervertebral discs. This study focuses on the design of such a device, one that has the correct stiffness to stabilise the spinal segment by the correct amount. An initial literature survey covers contemporary topics related to the lumbar spine. Included topics are lumbar anatomy and kinematics, pathology of degenerative disc disease and treatment thereof, other spinal disorders such as spondylolisthesis and spinal stenosis, as well as the complications associated with lumbar dynamic stabilisation. The influence of factors such as fatigue and wear, as well as the properties of appropriate biomaterials are considered when determining the basis of the device design and development. Stabilising the spinal segment begins with correct material selection and design. Various designs and biomaterials are evaluated for their stiffness values and other user requirements. The simplest design, a U-shaped spring composed of carbon fibre-reinforced poly-ether-ether-ketone (CFR-PEEK) and anchored by polyaxial titanium pedicle screws, satisfies the most critical user requirements. Acceptable stiffness is achieved, fatigue life of the material is excellent and the device is very imaging-friendly. Due to financial constraints, however, a simpler concept that is cheaper and easier to rapid prototype was chosen. This concept involves a construct primarily manufactured from the titanium alloy Ti6Al4V extra-low interstitial (ELI) and cobalt-chrome-molybdenum (CCM) alloys. The first rapid prototype was manufactured using an additive manufacturing process (3D-printing). The development of the device was performed in three main stages: design, verification and validation. The main goal of the design was to achieve an acceptable stiffness to limit the spinal segmental range of motion (ROM) by a determined amount. The device stiffness was verified through simple calculations. The first prototype’s stiffness was validated in force-displacement tests. Further validation, beyond the scope of this study, will include fatigue tests to validate the fatigue life of the production-ready device. / MIng (Mechanical Engineering), North-West University, Potchefstroom Campus, 2014

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban Institute of Technology, 2005 xiii, 70 leaves ; 30 cm / Although studies of manipulation-induced peripheral changes in the muscles have been done, inconsistencies noted by the author’s call for further investigation into the reflex effects of manipulation. Additionally, according to the literature, no effective treatment protocol for the painful shoulder has been found. Therefore this research aimed at addressing these discrepancies by quantifying the immediate effect of cervical spine manipulation in terms of peak torque on rotator cuff musculature in asymptomatic patients with both a cervical spine dysfunction and without. And thus by investigating cervical manipulation to the C4-C7 spinal segment, as a possible added intervention for improving rotator cuff muscle peak torque, a more efficient and effective management protocol for the painful shoulder could be attained. Thus the aims for this study included: 1) To evaluate whether manipulation has an effect on rotator cuff peak torque or not, utilizing the Cybex Orthotron II Isokinetic Rehabilitation System; 2) To ascertain whether manipulation of the specific levels has an effect on the rotator cuff peak torque or not and 3) To ascertain whether the presence or absence

Thesis (M.Tech.: Chiropractic)- Dept. of Chiropractic, Durban Institute of Technology, 2003. 104 leaves / Whiplash injuries are thought to occur in as many as one-fifth of all MVA’s in the United States and Canada. South Africa may have a higher incidence of whiplash injuries due to the exceptionally high road accident rate when compared with international norms (Burger 1996:478). The incidence rate is higher among female subjects and people aged 20-24 years (Teasell and Shapiro 1998: 72, Spitzer et al. 1995). Whiplash injuries or whiplash-associated disorders (WAD) often result in chronic pain with a poor response to conventional therapeutics. Manipulation, exercise and anti-inflammatories have been identified as the options with scientifically established validity in the management of WAD (Spitzer et al. 1995) Patients with WAD have a distortion of the posture control system as a result of disorganised neck proprioceptive activity. It would therefore appear that proprioceptive rehabilitative exercises would benefit WAD sufferers (Revel et al. 1994, Gimse et al. 1996). Spinal manipulation has also been shown to have a significant effect on proprioceptive-dependent abilities in subjects with chronic neck pain (Rogers 1997). This suggests that a combination of manipulation and proprioceptive rehabilitation may offer an improved treatment protocol for WAD (Fitz-Ritson 1995). The purpose of this investigation is to evaluate the relative effectiveness of proprioceptive exercises and cervical spine manipulation compared to manipulation alone, in terms of subjective and objective measures, in the treatment of whiplash-associated disorders.

Dissertation in partial compliance with requirements for the Masters Degree in Technology: Chiropractic, Durban University of Technology, 2010. / The aim of this study was establish if Leander versus Static traction was useful for the treatment of facet syndrome, a common type of mechanical lower back pain seen by chiropractors. Two groups of fifteen participants were chosen on the basis of the inclusion and exclusion criteria. The first objective was to determine if Static linear traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective findings. The second objective was to determine if Leander traction was effective for the treatment of lumbar facet syndrome in terms of subjective and objective clinical findings. Lastly the third objective was to compare the subjective and objective clinical findings for both groups. Design: A randomised, two group parallel controlled clinical trial was carried out between the two sample groups. Participants had to have had chronic lower back pain (> 3months). Thirty symptomatic volunteer participants between 25 and 55 were randomly divided into two equal groups – group A (Leander traction) received 5 treatments over a 2 week period. Similarly, group B (Static linear traction) also received 5 treatments over a 2 week period. Algometer readings, Numerical Pain Rating Scale (NRS101), Pain Severity Scale (PSS) and Oswestery Disabilty Index (ODI) were used as v assessment tools. Subjective and objective clinical findings were taken on the first and second visits (i.e. 48 hours) prior to treatment and immediately after treatment. Another set of subjective and objective readings were taken one week after the fifth treatment in order to gauge the long term effects of both treatments. No treatment was given on the sixth visit. Pressure tolerance measurements using an algometer were taken at the end ranges of motion in Kemp’s test and spinal extension. Outcome measures: SPSS version 15 (SPSS Inc., Chicago, Illinois, USA) was used for statistical analysis of data. A p value of <0.05 was considered as statistically significant. The two groups were compared at baseline in terms of demographics variables and location using Pearson’s chi square tests and ttests as appropriate. Intra-group comparisons were made between all time points. A significant time effect indicated successful treatment intervention. Inter-group comparisons were achieved using repeated measures ANOVA tests for each outcome measured separately. A significant time group interaction effect indicated a significant treatment effect. Profile plots were used to assess the trend and direction of the treatment effect. Results: The results of the study showed that Leander traction and Static linear traction were both effective for treating chronic lumbar facet syndrome and no statistically significant difference was found between subjective and objective clinical findings between the two groups.