1.  Anatomical Effects Of Rotation On Atlantoaxial Joint And Lumbar Spine Mr. N K Rath 1*, Dr X Yang 2, Dr K Lyons 1, Prof L Nokes 2, Mr M J H McCarthy 1 1. University Hospital of Wales Cardiff 2. Cardiff School of Engineering

3. Back pain  One third of UK population  20% will seek medical attention  Financial burden of 1000 million pounds  90 % of these settle with physiotherapy

4. Background  Paucity of literature on effect of rotation on neural compression  Most of MRI studies have focused on range of motion  Spine coupled motion  Disc failure and prolapse – bending and rotation

5. Objective  To collect normal variant data  Understand the effect of range of motion on lumbar disc deformation and neural foramen  Understand the normal subluxation at atlantoaxial joint

6. Method  Phase 1 pilot study  Ten healthy male volunteers  Signed consent  MRI Cervical and lumbar spine at different rotational position  Radiological evaluation of the MRI scan by senior radiologist

7. Inclusion Criteria  Fit and well male volunteers  Age <20-30  BMI 20-30  Height between 5’6” and 6’  No previous back problems or interventions  No degenerative discs or other abnormalities  Normal endplates, no Modic changes  Complete standard neck and low back pain questionnaire to prove normal PROMs (patient reported outcome measures / scores)

8. MRI  Perform Standard Supine MRI cervical and lumbar Spine T1, T2 Sagittal and T2 Axial cuts 3D acquisition using body coil.  Perform Lower Limb Rotated MRI to Right with Shoulders Supine T1 T2 Sagittal and T2 Axial cuts 3D acquisition using body coil and beanbag to minimize motion artifact.  Perform T1, T2 sagittal and T2 axial cut 3D acquisition for rotation at atlantoaxial joint at neutral, 45 degree and maximum range.

9. Project Update  Ethical approval received from Cardiff school of engineering.  Project passed by ethical approval team of Nuffeild health private hospitals  Price negotiated with Nuffeild health private hospitals  Flyers for volunteer recruitment via Cardiff University under way  Expected date of start of scans 30 th may

10. Thank you WARN…