- Title
- Cervical spine meniscoids and their potential role in neck pain and its management
- Creator
- Farrell, Scott Francis
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2016
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The overall aim of the work presented in this thesis was to explore the clinical significance of cervical spine meniscoids in neck pain. Cervical spine meniscoids are folds of synovial membrane that extend between the articular surfaces of joints throughout the cervical spine. These structures are thought to function to improve joint congruence and to ensure the lubrication of articular surfaces with synovial fluid. However, little is known about the role of cervical spine meniscoids in neck pain, as understanding of their morphology is not comprehensive. This body of work comprising five studies sought to investigate the pathoanatomical capacity of cervical spine meniscoids by exploring their morphology and innervation, as well as by investigating meniscoid morphology in vivo in a symptomatic population. Study 1 tested a novel method of facilitating gross dissection of cervical spine meniscoids from 12 lateral atlantoaxial and cervical zygapophyseal joints excised from four cadavers. This investigation was necessary as the bony congruence and extensive ligamentous attachments of the articular pillar make disarticulation of cervical zygapophyseal joints difficult, requiring considerable force to separate joint surfaces, and potentially damaging the delicate cervical spine meniscoids enclosed within. Such damage may jeopardise the accuracy of morphological assessment of cervical spine meniscoids undertaken using dissection. The study found that formic acid demineralisation of cadaveric cervical spines did not alter the morphometry of cervical spine meniscoids. This validated the use of this technique as a viable means of facilitating disarticulation of the lateral atlantoaxial and cervical zygapophyseal joints, by allowing the softened bone to be cut away with a scalpel, such that the joint surfaces could be separated with minimal force. This technique was then utilised in Studies 2 and 3. Study 2 explored the morphology and histology of lateral atlantoaxial joint meniscoids in 12 cadavers using gross dissection and light microscopy. The study resolved points of contention in previous research, including cervical spine meniscoid prevalence and patterns of composition and morphometry. An association was found between articular cartilage degeneration and fibrous meniscoid composition, suggesting a possible link between meniscoid morphology and articular pathology of the lateral atlantoaxial joint. The morphology and histology of cervical zygapophyseal joint meniscoids were investigated in Study 3 in 12 cadavers using gross dissection and light microscopy. Consistent with Study 2, Study 3 also noted an association of fibrous meniscoid composition with articular cartilage degeneration, providing further evidence of a potential relationship between cervical spine meniscoid morphology and articular pathology. Meniscoid size was not found to vary with spinal level, position in joint, articular degeneration or sex in an elderly population. The innervation of cervical spine meniscoids was explored in Study 4 to determine the capacity for meniscoids to generate nociceptive input. This was undertaken using immunohistochemistry with antibodies to neurofilament heavy and pan-neurofilament to identify both myelinated and unmyelinated nerve fibres in 77 cervical spine meniscoids excised from 12 cadavers. Unmyelinated nerve fibres were identified within the bodies of two lateral atlantoaxial joint meniscoids composed of adipose tissue. Myelinated and unmyelinated fibres were observed within joint capsules adjacent to 14 cervical spine meniscoids. These latter findings provide evidence of potential sensory innervation of lateral atlantoaxial and cervical zygapophyseal joint capsules. The identification of nerve fibres exclusively within bodies of two adipose meniscoids perhaps suggests that meniscoid composition may influence the innervation status of cervical spine meniscoids. The fifth and final study investigated cervical spine meniscoid morphology in a living population with known cervical spine pathology. This was undertaken using magnetic resonance imaging to visualise cervical spine meniscoids in 20 people with chronic whiplash associated disorder (WAD) and 20 age and sex-matched pain-free controls. Cervical spine meniscoids were found to be smaller in the lateral atlantoaxial joints and were more frequently fibrous in composition at the dorsal aspect of cervical zygapophyseal joints of the WAD group. It is postulated that such differences may be the result of altered cervical spine kinematics secondary to pain and hypomobility associated with WAD, and could plausibly serve to perpetuate patient symptoms. The body of work comprising this thesis extends current understanding of the clinical significance of cervical spine meniscoids. The question of the prevalence of these structures has been addressed through convergent findings of dissection and imaging studies, thus refuting previous reports that cervical spine meniscoids are rare in adults. Patterns of cervical spine meniscoid morphological variation have been explored in elderly cadavers, noting an association between composition and evidence of articular pathology. Nerve tissue has been identified within cervical spine meniscoids (albeit uncommon) and adjacent joint capsules that is potentially nociceptive in function. Cervical spine meniscoids have been studied in a living population with cervical spine pathology, with results illustrating morphological differences between the meniscoids of people with WAD and a pain-free population. Cumulatively, these findings provide preliminary evidence that cervical spine meniscoids may feasibly be of clinical significance in neck pain, possibly by altering segmental biomechanics or through generating nociceptive input.
- Subject
- cervical spine; clinical anatomy; physiotherapy; whiplash associated disorder; neck pain
- Identifier
- http://hdl.handle.net/1959.13/1314460
- Identifier
- uon:22769
- Rights
- Copyright 2016 Scott Francis Farrell
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 27 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 333 KB | Adobe Acrobat PDF | View Details Download |