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      Anatomic, functional, and radiographic review of the ligaments of the craniocervical junction

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          Abstract

          The craniocervical junction (CCJ) is a complex and unique osteoligamentous structure that balances maximum stability and protection of vital neurovascular anatomy with ample mobility and range of motion. With the increasing utilization and improved resolution of cervical magnetic resonance imaging, craniocervical injury is being more accurately defined as a spectrum of injury that ranges in severity from overt craniocervical disassociation to isolated injuries of one more of the craniocervical ligaments, which may also lead to craniocervical instability. Thus, it is vital for the radiologist and neurosurgeon to have a thorough understanding of the imaging anatomy and function of the CCJ.

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          Biomechanics of the craniocervical region: the alar and transverse ligaments.

          P Saldinger, Jürgen E. Schneider, B Rahn … (1987)
          In the treatment of spine fractures and fracture-dislocations, stability of the spine is one of the major objectives. In the craniocervical joint, the alar and transverse ligaments provide much of the stability of the healthy spine. Because the anatomy appears well described, the contribution of each of these structures so far has received little attention. The alar ligament restrains rotation of the upper cervical spine, whereas the transverse ligament restricts flexion as well as anterior displacement of the atlas. A lesion in one or both structures can produce damage to the neural structures and/or cause pain. To investigate the possible role of each of these ligaments, a mechanical and histologic study of the upper cervical spine was made. The bone-ligament-bone complex of the alar and transverse ligaments was subjected to uniaxial mechanical testing in seven specimens. The alar ligaments had an in vitro strength of 200 N, and the transverse ligaments had an in vitro strength of 350 N. Histologic analysis revealed a mainly collagenous nature of these ligaments. Clinical evidence (broken odontoid processes) suggests that the transverse ligament is strong enough to withstand physiologic loads. The alar ligament, on the other hand, due to its lower strength and its axial direction of loading, might be prone to injury and therefore require stabilization of the appropriate vertebra more often than normally is assumed.
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            Anatomy and biomechanics of normal craniovertebral junction (a) and biomechanics of stabilization (b).

            H Menezes, Vincent C. Traynelis (2008)
            A knowledge of the bony configuration, ligamentous attachments, joint articulations, vascular supply, muscle function, and lymphatic drainage as well as the kinetic anatomy of the craniocervical junction is necessary to understand the etiology of abnormalities in this area and their treatment. The craniovertebral junction (CVJ) is the most mobile of the upper cervical spine especially in children. It is uniquely adapted for stability and motion. The bony anatomy and the normal biomechanics of the CVJ in children are presented and subsequently the biomechanics of complex stabilization. Our review of more than 600 children who required stabilization is presented.
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              Ligaments of the craniocervical junction.

              John Naftel, Raymond R. Tubbs, Aaron A Cohen Gadol … (2011)
              The specialized ligaments of the craniocervical junction must allow for stability yet functional movement. Because injury to these important structures usually results in death or morbidity, the neurosurgeon should possess a thorough understanding of the anatomy and function of these ligaments. To the authors' knowledge, a comprehensive review of these structures is not available in the medical literature. The aim of the current study was to distill the available literature on each of these structures into one offering.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Craniovertebr Junction Spine
                Journal ID (iso-abbrev): J Craniovertebr Junction Spine
                Journal ID (publisher-id): JCVJS
                Title: Journal of Craniovertebral Junction & Spine
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0974-8237
                ISSN (Electronic): 0976-9285
                Publication date (Print): Jan-Mar 2021
                Publication date (Electronic): 04 March 2021
                Volume: 12
                Issue: 1
                Pages: 4-9
                Affiliations
                [1]Department of Neuroradiology, University of Florida Health, Jacksonville, FL, USA
                [1 ]Department of Anesthesia, University of Florida Health, Jacksonville, FL, USA
                [2 ]Department of Neurosurgery, University of Florida Health, Jacksonville, FL, USA
                Author notes
                Address for correspondence: Dr. Erik Soule, 655 West 8 th Street, Jacksonville 32209, FL, USA. E-mail: erik.soule@ 123456jax.ufl.edu
                Article
                Publisher ID: JCVJS-12-4
                DOI: 10.4103/jcvjs.JCVJS_209_20
                PMC ID: 8035576
                PubMed ID: 33850375
                SO-VID: 590c5cef-9e9a-4894-b648-c2b41c9fbfcc
                Copyright © Copyright: © 2021 Journal of Craniovertebral Junction and Spine
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 17 December 2020
                Date accepted : 22 December 2020
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Neurology
                Keywords: craniocervical junction,magnetic resonance imaging,trauma
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: craniocervical junction, magnetic resonance imaging, trauma

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