Ligaments of the craniocervical junction

Tubbs, R. Shane; Hallock, Justin D.; Radcliff, Virginia; Naftel, Robert P.; Mortazavi, Martin M.; Shoja, Mohammadali Mohajel; Loukas, Marios; Cohen-Gadol, Aaron

doi:10.3171/2011.1.spine10612

Cited by 150 publications

(133 citation statements)

References 71 publications

(166 reference statements)

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“…The apical ligament was better visualized on sagittal planes and has minimal significance in the stability of CC region [27]. In our study, the mean length of the apical ligament was 0.63 cm (±0.15) which is in agreement with the cadaveric study of Tubbs et al [21] although other studies [23,28] report greater length of the apical ligament.…”

Section: Open Accesssupporting

confidence: 81%

Magnetic resonance imaging of the ligaments of the craniocervical region at 3Tesla magnetic resonance unit: Quantitative and qualitative assessment

Vassiou¹,

Kapsalaki²,

Marinos³

et al. 2012

JBiSE

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Section: Open Accesssupporting

confidence: 81%

Magnetic resonance imaging of the ligaments of the craniocervical region at 3Tesla magnetic resonance unit: Quantitative and qualitative assessment

Vassiou¹,

Kapsalaki²,

Marinos³

et al. 2012

JBiSE

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“…The alar ligaments limit axial rotation and lateral bending to the contralateral side, are often injured in motor vehicle collisions, and could be implicated in whiplash-associated disorders [15]. Failure of the alar ligament allows a 30% increased rotation to the opposite side [16].…”

Section: Etiology Of Atlantoaxial Instabilitymentioning

confidence: 99%

“…The AAJ mechanical properties are determined by ligamentous structures [13,14], most prominent of which are the transverse and alar ligaments [15]. The alar ligaments limit axial rotation and lateral bending to the contralateral side, are often injured in motor vehicle collisions, and could be implicated in whiplash-associated disorders [15].…”

Section: Etiology Of Atlantoaxial Instabilitymentioning

confidence: 99%

Diagnosis of Atlantoaxial Instability Requires Clinical Suspicion to Drive the Radiological Investigation

Henderson¹

2017

J Spine

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“…Posterior to the spinal cord, the capsular joint ligaments and the posterior atlantooccipital membrane provide stability to the CVJ. 7,41 The anterior and posterior atlantooccipital membranes are continuations of the anterior and posterior longitudinal ligaments that run the length of the vertebral column. While the bony and ligamentous structures provide CVJ stability, these articulations allow great freedom of movement, permitting 25% of neck flexion-extension and up to 40° of head rotation.…”

Section: Neurosurg Focus 38 (4):e3 2015mentioning

confidence: 99%

Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

Roy¹,

Miller²,

Holland³

et al. 2015

FOC

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OBJECT The craniovertebral junction (CVJ) is unique in the spinal column regarding the degree of multiplanar mobility allowed by its bony articulations. A network of ligamentous attachments provides stability to this junction. Although ligamentous injury can be inferred on CT scans through the utilization of craniometric measurements, the disruption of these ligaments can only be visualized directly with MRI. Here, the authors review the current literature on MRI evaluation of the CVJ following trauma and present several illustrative cases to highlight the utility and limitations of craniometric measures in the context of ligamentous injury at the CVJ. METHODS A retrospective case review was conducted to identify patients with cervical spine trauma who underwent cervical MRI and subsequently required occipitocervical or atlantoaxial fusion. Craniometric measurements were performed on the CT images in these cases. An extensive PubMed/MEDLINE literature search was conducted to identify publications regarding the use of MRI in the evaluation of patients with CVJ trauma. RESULTS The authors identified 8 cases in which cervical MRI was performed prior to operative stabilization of the CVJ. Craniometric measures did not reliably rule out ligamentous injury, and there was significant heterogeneity in the reliability of different craniometric measurements. A review of the literature revealed several case series and descriptive studies addressing MRI in CVJ trauma. Three papers reported the inadequacy of the historical Traynelis system for identifying atlantooccipital dislocation and presented 3 alternative classification schemes with emphasis on MRI findings. CONCLUSIONS Recognition of ligamentous instability at the CVJ is critical in directing clinical decision making regarding surgical stabilization. Craniometric measures appear unreliable, and CT alone is unable to provide direct visualization of ligamentous injury. Therefore, while the decision to obtain MR images in CVJ trauma is largely based on clinical judgment with craniometric measures used as an adjunct, a high degree of suspicion is warranted in the care of these patients as a missed ligamentous injury can have devastating consequences.

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Ligaments of the craniocervical junction

Cited by 150 publications

References 71 publications

Magnetic resonance imaging of the ligaments of the craniocervical region at 3Tesla magnetic resonance unit: Quantitative and qualitative assessment

Magnetic resonance imaging of the ligaments of the craniocervical region at 3Tesla magnetic resonance unit: Quantitative and qualitative assessment

Diagnosis of Atlantoaxial Instability Requires Clinical Suspicion to Drive the Radiological Investigation

Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

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