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Farrell SF, Cornwall J, Osmotherly PG. Magnetic Resonance Imaging Investigation of Cervical-Spine Meniscoid Composition: A Validation Study. J Manipulative Physiol Ther 2020; 43:579-587. [PMID: 32861523 DOI: 10.1016/j.jmpt.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/30/2019] [Accepted: 10/10/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The composition of cervical-spine meniscoids may have clinical significance in neck-pain conditions, but the accuracy of assessment of meniscoid composition in vivo using magnetic resonance imaging has not been established. The aim of this study was to compare cervical-spine meniscoid composition by magnetic resonance imaging with histologic composition. METHODS Four embalmed cadaveric cervical spines (mean [standard deviation] age, 79.5 [3.7] years; 1 female, 3 male) underwent magnetic resonance imaging, allowing radiologic classification of lateral atlantoaxial- and zygapophyseal-joint (C2-3 to C6-7) meniscoids as either mostly fatty, mixed tissue, or mostly connective tissue. Subsequently, each joint was dissected and disarticulated to allow excision of meniscoids for histologic processing. Each meniscoid was sectioned sagittally, stained with hematoxylin and eosin, examined using light microscopy, and classified as adipose, fibroadipose, or fibrous in composition. Data were analyzed using the kappa statistic with linear weighting. RESULTS From dissection, 62 meniscoids were identified, excised, and processed; 46 of these 62 were visualized with magnetic resonance imaging. For single-rater identifying structures, agreement between assessment of meniscoid composition by magnetic resonance imaging and by microscopy was fair (κ = 0.24; 95% confidence interval, 0.02-0.46; P = .02). CONCLUSION Findings suggest that the accuracy of this method of magnetic resonance imaging assessment of cervical-spine meniscoid composition may be limited. This should be considered when planning or interpreting research investigating meniscoid composition using magnetic resonance imaging.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, National Health and Medical Research Council Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
| | - Jon Cornwall
- Otago Medical School, University of Otago, Dunedin, New Zealand; Institute for Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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Farrell SF, Stanwell P, Cornwall J, Osmotherly PG. Quantitative magnetic resonance imaging assessment of lateral atlantoaxial joint meniscoid composition: a validation study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1180-1187. [PMID: 30604294 DOI: 10.1007/s00586-018-05868-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Lateral atlantoaxial (LAA) joint meniscoid composition may have clinical significance in patients following neck trauma. However, the existing method of radiologically assessing meniscoid composition has an inherent element of subjectivity, which could contribute to measurement variability. The present study sought to investigate the accuracy of two-point Dixon fat/water separation MRI as a quantitative assessment of LAA joint meniscoid composition. METHODS Sixteen LAA joint meniscoids were excised from four cadavers (mean [SD] age 79.5 [3.7] years; one female) following cervical spine MRI (two-point Dixon, T1-weighted VIBE and T2-weighted SPACE sequences). Composition of LAA joint meniscoids was undertaken by (1) histological examination by light microscopy, (2) calculation of fat fraction by Dixon MRI (both in-phase/opposed-phase and fat/water methods), and (3) the existing method of considering VIBE and SPACE signal intensities. Analysis was performed using the kappa statistic with linear weighting. RESULTS Microscopy revealed three, five, and eight meniscoids to be composed of adipose, fibroadipose, and fibrous tissues, respectively. Dixon sequence MRI classified 11 of these meniscoids correctly, with 'substantial' level of agreement (In-phase/Opp-phase kappa statistic = 0.78 [95% CI 0.38, 1.17]; fat/water kappa statistic = 0.72 [95% CI 0.32, 1.11]). Level of agreement between microscopy and the VIBE and SPACE method was 'slight' (kappa statistic = 0.02 [95% CI - 0.34, 0.38]). CONCLUSIONS Findings suggest that Dixon fat/water separation MRI may have superior utility in the assessment of LAA joint meniscoid composition than the existing method of considering VIBE and SPACE signal intensities. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Scott F Farrell
- RECOVER Injury Research Centre, NHMRC Centre for Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia. .,RECOVER Injury Research Centre, Level 7 Oral Health Building, The University of Queensland, Herston Campus, Herston, 4006, QLD, Australia.
| | - Peter Stanwell
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
| | - Jon Cornwall
- Centre for Early Learning in Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand.,Institute for Health Sciences, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Peter G Osmotherly
- School of Health Sciences, The University of Newcastle, Newcastle, Australia
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Farrell SF, Khan S, Osmotherly PG, Sterling M, Cornwall J, Rivett DA. Lateral atlantoaxial joint meniscoid volume in individuals with whiplash associated disorder: A case-control study. Musculoskelet Sci Pract 2018; 33:46-52. [PMID: 29153925 DOI: 10.1016/j.msksp.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/23/2017] [Accepted: 11/08/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic whiplash associated disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. OBJECTIVES This study examined LAA joint meniscoid volume in individuals with chronic WAD who report pain in a distribution consistent with LAA joint pain. DESIGN Case-control study. METHOD Fourteen individuals with chronic WAD with pain in an LAA joint distribution (mean [SD] age 38.1 [10.8] years; six female) and 14 age- and sex-matched pain-free controls (38.0 [10.5] years) underwent cervical spine magnetic resonance imaging. LAA joint images were inspected for meniscoids; meniscoid volume was calculated in mm3 and as a percentage of articular cavity volume. Symptom duration, location and intensity were recorded. Data were analysed using paired t-tests, Wilcoxon signed-rank testing, Spearman's rank testing, linear and logistic regression (α < 0.05). RESULTS Ventral and dorsal meniscoids (n = 112) were found in each LAA joint. Greater dorsal meniscoid volume as a percentage of articular cavity volume was associated with higher pain intensity (odds ratio 1.48, p = 0.03; likelihood ratio test chi-square2 = 6.64, p = 0.04), however no significant differences existed between meniscoid volumes of WAD and control participants. CONCLUSIONS Findings indicate a potential link between dorsal LAA joint meniscoid volume and pain, suggesting larger meniscoid size may have pathoanatomical significance in WAD.
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Affiliation(s)
- Scott F Farrell
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia.
| | - Subaat Khan
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia; School of Medical Science, Griffith University, Parklands Drive, Southport, 4222, QLD, Australia
| | - Peter G Osmotherly
- Discipline of Physiotherapy, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
| | - Michele Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, 4006, QLD, Australia
| | - Jon Cornwall
- Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, 6021, New Zealand; Department of Physiology, University of Otago, 270 Great King St, Dunedin, 9016, New Zealand; Institute for Health Sciences, Zurich University of Applied Science, Technikumstrasse 71, 8401, Winterthur, Zurich, Switzerland
| | - Darren A Rivett
- Discipline of Physiotherapy, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia
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Farrell SF, Osmotherly PG, Cornwall J, Sterling M, Rivett DA. Cervical spine meniscoids: an update on their morphological characteristics and potential clinical significance. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:939-947. [DOI: 10.1007/s00586-016-4915-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 12/04/2016] [Indexed: 12/18/2022]
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Farrell SF, Osmotherly PG, Cornwall J, Rivett DA. Immunohistochemical investigation of nerve fiber presence and morphology in elderly cervical spine meniscoids. Spine J 2016; 16:1244-1252. [PMID: 27298080 DOI: 10.1016/j.spinee.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/18/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Innervation of anatomical structures is fundamental to their capacity to generate nociceptive impulses. Cervical spine meniscoids are hypothesized to be contributors to neck pain; however, their innervation is not comprehensively understood. PURPOSE This study aimed to examine the presence and morphology of nerve fibers within cervical spine meniscoids and adjacent joint capsules. STUDY DESIGN This is a cross-sectional study. PATIENT SAMPLE The sample consists of cervical hemispines of 12 embalmed cadavers (mean [standard deviation] age 82.9 [6.5] years, six female, six left). Either the right or the left half of the cervical spine (hemispine) of each cadaver was included in the sample. So six left sides and six right sides of the cadaver cervical spines made up the 12 hemispines that formed the sample. METHODS Cervical spine meniscoids and adjacent joint capsules were excised from lateral atlantoaxial and cervical zygapophyseal (C2-C3 to C6-C7) joints (n=67), then paraffin embedded. Meniscoids were sectioned sagittally (5 µm), slide mounted, and immunohistochemistry was performed using primary antibodies to neurofilament heavy (NF-H) and pan-neurofilament (Pan-NF) to identify nerve tissue. The study was supported by institutional graduate student funding. The authors have no conflicts of interest to declare. RESULTS Seventy-seven meniscoids (23 lateral atlantoaxial, 54 cervical zygapophyseal) were extracted and processed (154 sections in total). Sixty-four individual nerve fiber bundles were identified (26 NF-H positive, 38 Pan-NF positive) from 14 meniscoids. Nerves immunoreactive to both NF-H and Pan-NF were identified in 13 of 77 meniscoids (10 of 14 lateral atlantoaxial joint) from 11 joints (eight cadavers). Nerves were always located in joint capsules except three exclusively Pan-NF immunoreactive nerve fiber bundles from two adipose meniscoids. CONCLUSIONS The low nerve prevalence in elderly cervical spine meniscoids, with nerves only found in two adipose type meniscoids, suggests these structures may play a minimal role in cervical nociception generation in this demographic. The joint capsules, which were more frequently innervated, appear to be more likely generators of nociception in the elderly. Joint capsule nerves were mostly NF-H positive, indicating potential Aδ-fiber presence.
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Affiliation(s)
- Scott F Farrell
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia.
| | - Peter G Osmotherly
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia
| | - Jon Cornwall
- CS 705 Level 7, Wellington Hospital Clinical Services Block, Graduate School of Nursing, Midwifery and Health Victoria University of Wellington, Wellington 6021, New Zealand; Department of Physiology, University of Otago, 270 Great King St, Dunedin 9016, New Zealand; Centre for Health Sciences, Zurich University of Applied Science, Technikumstrasse 71, 8401 Winterthur, Zurich, Switzerland
| | - Darren A Rivett
- Faculty of Health and Medicine, The University of Newcastle, University Drive, Callghan 2308, NSW, Australia
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Morphology of Cervical Spine Meniscoids in Individuals With Chronic Whiplash-Associated Disorder: A Case-Control Study. J Orthop Sports Phys Ther 2016; 46:902-910. [PMID: 27594664 DOI: 10.2519/jospt.2016.6702] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case-control study. Background Cervical spine meniscoids are thought to contribute to neck pain and hypomobility in individuals with chronic whiplash-associated disorder (WAD); however, their morphology has not been studied in a clinical population. Objectives To investigate cervical spine meniscoid morphology in individuals with chronic WAD. Methods Twenty volunteers with chronic WAD (mean ± SD age, 39.3 ± 11.0 years; 10 female) and 20 age- and sex-matched controls (age, 39.1 ± 10.6 years) underwent cervical spine magnetic resonance imaging. Lateral atlantoaxial and zygapophyseal joints (C2-3 to C6-7) were inspected for meniscoids. Length of meniscoid protrusion was measured and composition (adipose/fibrous/fibroadipose) assessed. Data were analyzed using Wilcoxon signed-rank tests and linear and logistic regression (P<.05). Results Meniscoids were identified in the chronic WAD (n = 317) and control (n = 296) groups. At the lateral atlantoaxial joints, median meniscoid length was greater in the control group (ventral, 6.07 mm; dorsal, 7.24 mm) than the WAD group (ventral, 5.01 mm; P = .06 and dorsal, 6.48 mm; P<.01). At the dorsal aspect of zygapophyseal joints, meniscoids were more frequently fibrous in the chronic WAD group (odds ratio = 2.38, P<.01; likelihood ratio test: χ22, 9.02; P = .01). Conclusion In individuals with chronic WAD, lateral atlantoaxial meniscoids were shorter and dorsal cervical zygapophyseal meniscoids were more fibrous, suggesting alterations in meniscoid composition. This may have pathoanatomical implications in chronic WAD. J Orthop Sports Phys Ther 2016;46(10):902-910. Epub 3 Sep 2016. doi:10.2519/jospt.2016.6702.
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Farrell SF, Osmotherly PG, Cornwall J, Rivett DA. Morphology and morphometry of lateral atlantoaxial joint meniscoids. Anat Sci Int 2015; 91:89-96. [PMID: 25680920 DOI: 10.1007/s12565-015-0276-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 02/03/2015] [Indexed: 11/25/2022]
Abstract
The lateral atlantoaxial joints contain folds of synovium termed meniscoids that may potentially contribute to cervical spine pain; however, the anatomy of these structures has not been comprehensively investigated. The purpose of this study was to explore the morphology and morphometry of lateral atlantoaxial joint meniscoids. Twelve cadaveric hemi-spines (6 female; 6 left; mean 81.5 years, SD 7.3) were obtained for dissection and disarticulation of the lateral atlantoaxial joints. Meniscoids were identified and measurements made of surface area, length, and surrounding articular cartilage degeneration. Tissue was sectioned sagittally, stained with hematoxylin and eosin, and examined by light microscopy. Data were analyzed descriptively and using nonparametric techniques. Ventral and dorsal meniscoids (24 in total) were found in each joint, and could be classified histologically into adipose (32%), fibrous (41%), and fibroadipose (27%) meniscoids. No significant associations were found between meniscoid size and age, histology, cartilage degeneration, or joint position. Meniscoid length in males was significantly greater than in females (P = 0.04). Fibrous meniscoids were noted to be associated with articular cartilage degeneration, and adipose and fibroadipose meniscoids with intact cartilage (P = 0.05). Fibrous meniscoids tended to be located dorsally (78%), whereas adipose meniscoids were mostly located ventrally (86%). Distinct patterns in lateral atlantoaxial joint meniscoid morphology were observed, including the association of fibrous meniscoid composition with dorsal joint position and articular cartilage degeneration. The clinical significance of these patterns remains uncertain, and further research is needed to examine these structures across the lifespan and in cervical pathology.
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Affiliation(s)
- Scott F Farrell
- Faculty of Health and Medicine, The University of Newcastle, HA06 Hunter Building, Callaghan, Newcastle, NSW, 2308, Australia.
| | - Peter G Osmotherly
- Faculty of Health and Medicine, The University of Newcastle, HA06 Hunter Building, Callaghan, Newcastle, NSW, 2308, Australia
| | - Jon Cornwall
- Centre for Society, Governance and Science, Faculty of Law, University of Otago, Dunedin, New Zealand.,Department of Anatomy, University of Otago, Dunedin, New Zealand.,Centre for Health Sciences, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Darren A Rivett
- Faculty of Health and Medicine, The University of Newcastle, HA06 Hunter Building, Callaghan, Newcastle, NSW, 2308, Australia
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The anatomy and morphometry of cervical zygapophyseal joint meniscoids. Surg Radiol Anat 2014; 37:799-807. [PMID: 25527021 DOI: 10.1007/s00276-014-1406-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Meniscoids are folds of synovial membrane that project into the articular cavities of zygapophyseal joints throughout the cervical spine. These structures have been implicated in musculoskeletal neck pain; however, their anatomy has not been extensively investigated. The purpose of this study was to explore the morphometry and composition of the cervical zygapohyseal joint meniscoids. METHODS Twelve adult cadaveric hemi-spines were dissected and their C2-3 to C6-7 zygapophyseal joints disarticulated (six female; six left; mean 81.5 years, SD 7.3 years). Meniscoids were identified and their surface area, protrusion length and articular cartilage degeneration measured. Specimens were then sectioned sagittally, stained with haematoxylin and eosin, and examined with a light microscope. Data were analysed descriptively and using non-parametric hypothesis testing (significance p < 0.05). RESULTS Meniscoids were identified in 86% of zygapophyseal joints examined; 50% contained both ventral and dorsal meniscoids, 7% contained a ventral meniscoid only and 29% contained a dorsal meniscoid only. Meniscoids were classified as adipose (4%), fibrous (74%), or fibroadipose (22%) based upon histological composition. There were no significant associations between meniscoid size (surface area or protrusion length) and gender, position in joint, spinal level, or articular degeneration. Increased articular degeneration was associated with fibrous meniscoid classification. CONCLUSIONS The morphological patterns observed, such as the association of fibrous meniscoids with cartilage degeneration, may provide insight into the significance of the zygapophyseal joint meniscoids in neck pathology. Further investigation is needed to explore the morphological qualities of these structures in a pathological population.
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Thomsen LN, Berg LC, Markussen B, Thomsen PD. Synovial folds in equine articular process joints. Equine Vet J 2012; 45:448-53. [DOI: 10.1111/j.2042-3306.2012.00687.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 09/21/2012] [Indexed: 11/30/2022]
Affiliation(s)
- L. N. Thomsen
- Department of Basic Animal and Veterinary Sciences; Faculty of Life Sciences; University of Copenhagen; Denmark
| | - L. C. Berg
- Department of Basic Animal and Veterinary Sciences; Faculty of Life Sciences; University of Copenhagen; Denmark
| | - B. Markussen
- Department of Mathematical Sciences; Faculty of Science; University of Copenhagen; Denmark
| | - P. D. Thomsen
- Department of Basic Animal and Veterinary Sciences; Faculty of Life Sciences; University of Copenhagen; Denmark
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Jaumard NV, Welch WC, Winkelstein BA. Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 2011; 133:071010. [PMID: 21823749 DOI: 10.1115/1.4004493] [Citation(s) in RCA: 200] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The facet joint is a crucial anatomic region of the spine owing to its biomechanical role in facilitating articulation of the vertebrae of the spinal column. It is a diarthrodial joint with opposing articular cartilage surfaces that provide a low friction environment and a ligamentous capsule that encloses the joint space. Together with the disc, the bilateral facet joints transfer loads and guide and constrain motions in the spine due to their geometry and mechanical function. Although a great deal of research has focused on defining the biomechanics of the spine and the form and function of the disc, the facet joint has only recently become the focus of experimental, computational and clinical studies. This mechanical behavior ensures the normal health and function of the spine during physiologic loading but can also lead to its dysfunction when the tissues of the facet joint are altered either by injury, degeneration or as a result of surgical modification of the spine. The anatomical, biomechanical and physiological characteristics of the facet joints in the cervical and lumbar spines have become the focus of increased attention recently with the advent of surgical procedures of the spine, such as disc repair and replacement, which may impact facet responses. Accordingly, this review summarizes the relevant anatomy and biomechanics of the facet joint and the individual tissues that comprise it. In order to better understand the physiological implications of tissue loading in all conditions, a review of mechanotransduction pathways in the cartilage, ligament and bone is also presented ranging from the tissue-level scale to cellular modifications. With this context, experimental studies are summarized as they relate to the most common modifications that alter the biomechanics and health of the spine-injury and degeneration. In addition, many computational and finite element models have been developed that enable more-detailed and specific investigations of the facet joint and its tissues than are provided by experimental approaches and also that expand their utility for the field of biomechanics. These are also reviewed to provide a more complete summary of the current knowledge of facet joint mechanics. Overall, the goal of this review is to present a comprehensive review of the breadth and depth of knowledge regarding the mechanical and adaptive responses of the facet joint and its tissues across a variety of relevant size scales.
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Affiliation(s)
- Nicolas V Jaumard
- Dept. of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Webb AL, Rassoulian H, Mitchell BS. 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 2011; 34:115-24. [PMID: 21667263 DOI: 10.1007/s00276-011-0834-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/23/2011] [Indexed: 10/18/2022]
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 mm(3). 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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Affiliation(s)
- Alexandra L Webb
- Centre for Learning Anatomical Sciences, School of Medicine, University of Southampton, Mailpoint 845, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Webb AL, Collins P, Rassoulian H, Mitchell BS. Synovial folds - a pain in the neck? ACTA ACUST UNITED AC 2011; 16:118-24. [PMID: 21216653 DOI: 10.1016/j.math.2010.11.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/05/2010] [Indexed: 11/26/2022]
Abstract
The synovial folds of the cervical spine are regarded as a potential source of neck pain and headache, especially following whiplash injury. Damage to the synovial folds following motor vehicle trauma has been well documented in post-mortem studies. However, methods of identifying injury to the synovial folds in the survivors of motor vehicle trauma have proven elusive to date. Recently, it has been made possible to image the synovial folds in vivo using magnetic resonance imaging. This now makes it feasible to investigate the potential involvement of synovial folds in the generation of neck pain and headache and its relief using spinal manipulation. This paper reviews critically the morphology of the synovial folds of the cervical spine that underpins the hypotheses proposed to explain their functional and clinical significance and a new system of naming and classifying the synovial folds is presented. Although there is some evidence to support the contribution of the synovial folds to neck pain, several theories have little or no support and require investigation and further evaluation. These findings have implications for understanding the anatomical basis of neck pain and headache and the rationale for the use of spinal manipulation in their management.
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Affiliation(s)
- Alexandra L Webb
- Centre for Learning Anatomical Sciences, School of Medicine, University of Southampton, Southampton, Mailpoint 845, Southampton General Hospital, Southampton, UK.
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Webb A, Darekar A, Rassoulian H. The influence of age, anthropometrics and range of motion on the morphometry of the synovial folds of the lateral atlanto-axial joints: a pilot study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 20:542-9. [PMID: 20711618 DOI: 10.1007/s00586-010-1553-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 05/23/2010] [Accepted: 08/01/2010] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to investigate the effect of age, anthropometrics and cervical range of motion upon synovial fold volume. Ten healthy female subjects aged 20-40 years were included in the study. Age, height, body mass, dimensions of the head and neck and cervical range of motion of each subject were measured. Magnetic resonance (MR) images of the cervical spine were acquired; the volume of the ventral and dorsal synovial folds of the right and the left lateral atlanto-axial joints was measured using seed growing and thresholding methods. Using Spearman's correlation coefficient, it was determined that there was no correlation between synovial fold volume and age. Synovial fold volume was positively correlated with subject height and neck length but negatively correlated with body mass, body mass index and the circumference of the head and neck. The relationship between synovial fold volume and range of cervical motion varied with the plane of movement. The ability to image the synovial folds of the lateral atlanto-axial joints using MR imaging to determine their normal morphology provides the basis for investigating synovial fold pathology in patients with neck pain and headache.
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Affiliation(s)
- Alexandra Webb
- Centre for Learning Anatomical Sciences, University of Southampton, School of Medicine, Southampton General Hospital, Mailpoint 845, Tremona Road, Southampton, SO16 6YD, UK.
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Synovial folds of the lateral atlantoaxial joints: in vivo quantitative assessment using magnetic resonance imaging in healthy volunteers. Spine (Phila Pa 1976) 2009; 34:E697-702. [PMID: 19730202 DOI: 10.1097/brs.0b013e3181ac8c6d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Analysis of magnetic resonance (MR) images of healthy volunteers. OBJECTIVE To develop and validate an imaging protocol and measurement technique to describe the morphology and quantify the dimensions of the synovial folds of the lateral atlantoaxial joints in vivo. SUMMARY OF BACKGROUND DATA The synovial folds of the lateral atlantoaxial joints are considered to be a potential source of neck pain and headache, especially following whiplash injury. Until recently, it has not been possible to image the synovial folds in vivo and consequently their normal morphology is not fully understood. METHODS MR images of the cervical spine of 17 volunteers (4 male and 13 female) were acquired using a 1.5-tesla scanner. The morphology of the synovial folds at the lateral atlantoaxial joints was described and their presence determined. The volume and cross-sectional area of the ventral and dorsal synovial folds of the right and left lateral atlantoaxial joints were measured and compared. The relationship between the dimensions of the synovial folds and subject age was examined. Twenty synovial folds were measured twice by one observer and once by a second observer for the determination of measurement reliability. RESULTS There was a significant difference in volume (chi [3] = 17.54, P = 0.000) and cross-sectional area (chi [3] = 18.95, P = 0.000) between the ventral and dorsal synovial folds of the left and right lateral atlantoaxial joints. There was no correlation between synovial fold dimensions and age. The reliability of the measurements ranged from intraclass correlation coefficient 0.95 to 0.99 (intraobserver reliability) and intraclass correlation coefficients 0.75 to 0.82 (interobserver reliability). CONCLUSION MR imaging was successfully implemented as a noninvasive method for visualizing the synovial folds of the lateral atlantoaxial joints and quantifying their dimensions in healthy volunteers. The results of this study provide a basis for future studies investigating synovial fold pathology in patients with neck pain and headache.
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