The intra-articular synovial folds of the lateral atlanto-axial joints : an anatomic and magnetic resonance imaging study

Abstract

This thesis reports on methods developed to identify and quantify the normal morphology of the intra-articular synovial folds of the lateral atlanto-axial joints to aid in the identification and quantification of injury to these structures in patients.  A comprehensive critical review of the literature revealed that the potential role of the synovial folds in the generation of neck pain and disability is poorly understood, primarily because of the limited techniques available to identify the synovial folds and to quantify their dimensions.  New anatomical methods to quantify objectively the morphology of the synovial folds in vitro were developed.  The precision and accuracy of these methods were established through a series of validation experiments and a robust statistical analysis of the results.  To address the current difficulty in visualising and quantifying the synovial folds in vivo new methods of magnetic resonance (MR) imaging were developed and validated for precision and accuracy through statistically viable experiments.  This is the first study to develop an MR imaging protocol that enables the synovial folds of the lateral atlanto-axial joints to be visualised in vivo.  The statistical approaches commonly used in similar research for the determination of measurement precision were critically reviewed and their strengths and limitations discussed.  Using these newly developed anatomical and imaging methods, the normal morphology of the synovial folds of the lateral atlanto-axial joints was determined and the results are presented.  Future developments and applications of this work, including applications to investigations of pain and disability affecting the cervical spine, are discussed.

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