Rotation of the atlantico-axial joint, investigated using CT and MRI

The vertebral column is composed of a series of joints, each capable of a specific range of movement. To investigate these movements, a study into the physiological range of rotation at the atlanto-axial joint has been undertaken. The movements and their interpretation under imaging conditions are crucial if any underlying spinal deformity or the consequences of trauma are present in an individual. 28 healthy volunteers were examined using dynamic Magnetic Resonance Imaging with maximum head rotation to the right and left sides in turn. An anatomical specimen of the atlanto-occipital joint was imaged using Computed Tomography with the specimen fixed in varying degrees of rotation. The results indicate that there is a significant but incomplete loss of contact between the articular surfaces of C1 (atlas) and C2 (axis). The range of motion to the right was between 20 and 48.5 degrees (mean 32.4 degrees) and to the left was between 13 and 52.75 degrees (mean 3.2 degrees). Statistical significance between left and right movement was not demonstrated. The instantaneous axis of rotation was examined for the joint and was found to be located within the odontoid peg (dens). These findings indicated that a wide range of movement occurs within the atlanto-axial joint in normal subjects. Furthermore, the appearances under imaging could be misinterpreted as a pathological subluxation. This has implications if the subject with a spinal deformity also has a dysplasia associated with a potential subluxation. The siting of the instantaneous axis of rotation within the odontoid is also important in furthering the understanding of the movement of this joint.