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Morphometry of the synovial folds of the lateral atlanto-axial joints: the anatomical basis for understanding their potential role in neck pain

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Abstract

Purpose

Intra-articular synovial folds of the cervical spine are considered to be a potential source of neck pain and disability. The purpose of the present study was to devise and validate a method to determine the normal morphometry of the synovial folds as a basis for understanding their functional and clinical significance.

Methods

Nine cadaver cervical spines were sectioned in the sagittal plane. The presence of the synovial folds at the lateral atlanto-axial joints was determined and their morphology described. Depth of projection, cross-sectional area and volume of the ventral and dorsal synovial folds of the right and left lateral atlanto-axial joints were measured from sagittal sections and compared. The relationship between synovial fold dimensions and subject age and cartilage degeneration were determined. Repeat measurements were made for the calculation of method reliability, and the water displacement method was used to determine method validity.

Results

There was a trend for ventral synovial folds to be larger than dorsal synovial folds. There was no correlation between synovial fold dimensions and age and extent of cartilage degeneration. Measurement reliability ranged from intraclass correlation coefficient 0.95–1.00 (intra-observer), 0.95–1.00 (test–retest) and 0.61–1.00 (inter-observer). Limits of agreement for the sectional and water displacement methods for the measurement of synovial fold volume were −1.04 ± 3.35 mm3.

Conclusions

A reliable method for quantifying synovial fold dimensions was devised. The results of this study provide a basis for the determination and diagnosis of pathologies affecting the synovial folds.

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Ethical standards

All bodies were donated and examined in accordance with the Anatomy Act 1984 (UK).

Acknowledgments

We wish to thank Mr Scott Harris for his support with the statistical analysis. This study was supported by a post-graduate education grant from the European Chiropractors’ Union Research Fund.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centre for Learning Anatomical Sciences, School of Medicine, University of Southampton, Mailpoint 845, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK

    Alexandra L. Webb

  2. Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK

    Hamid Rassoulian

  3. Faculty of Health and Life Sciences, De Montfort University, Leicester, UK

    Barry S. Mitchell

Authors
  1. Alexandra L. Webb
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  2. Hamid Rassoulian
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  3. Barry S. Mitchell
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Corresponding author

Correspondence to Alexandra L. Webb.

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Webb, A.L., Rassoulian, H. & Mitchell, B.S. Morphometry of the synovial folds of the lateral atlanto-axial joints: the anatomical basis for understanding their potential role in neck pain. Surg Radiol Anat 34, 115–124 (2012). https://doi.org/10.1007/s00276-011-0834-6

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  • DOI: https://doi.org/10.1007/s00276-011-0834-6

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