Aims and objectives
The tectorial membrane (TM) serves as one of the major stabilizing ligaments of the craniocervical junction (CCJ) (1).
The TM is a 1 mm thick,
superiorly directed extension of the posterior longitudinal ligament (PLL) located ventral to the spinal cord.
Posterior to the dens and other CCJ ligaments,
the TM fans out laterally and the cranial end attaches to the posterior clivus before incorporating with the intracranial dura mater.
Cadaveric studies have found the TM is firmly adherent to the skull base and C2 body,...
Methods and materials
A waiver of informed consent was granted by the IRB-03 chairman atUniversity of Florida Health Jacksonville to retrospectively evaluate the imaging and clinical findings of patients who suffered a TM injury. Sixteen patients (ten adult and six pediatric) with confirmed TM injury on cervical MRI were identified retrospectively by a keyword search of radiology reports using Nuance mPower software between January 2012 and July 2018 using the keywords ‘tectorial membrane’ ‘craniocervical ligament tear/injury,’ and ‘atlanto-occipital disassociation.’ Electronic patient records were reviewed for the following: 1)...
Results
A total of 16 patients were identified with acute traumatic injuries involving the TM.
Ten adult patients and six pediatric patients had mean ages of 39 and 10 years,
respectively.
All injuries involved motor vehicles,
primarily MVAs and pedestrians struck by motor vehicles.
Adult patients were much more likely to undergo surgery to the cervical spine,
with 80% receiving fusion of at least one spinal level,
followed by halo bracing and/or Miami-J collar (MJC) placement.
Length of inpatient stay was considerably longer for adult patients,...
Conclusion
A classification system for TM injuries is proposed based on this data: type 1 - retroclival stripping injury (more common in pediatric patients; associated with REH);
type 2a - subclival disruption at the basion (more common in adults);
type 2b - subclival disruption at the odontoid (more common in adults);
and type 3 - stretching injury of the TM.
The nature,
imaging,
treatment,
and prognosis of TM injury appears to differ between adult and pediatric patients.
Adults tend to suffer type 2 injuries to the...
Personal information
Peter Fiester,
MD
Department of Neuroradiology,
University of Florida Health – Jacksonville
655 W.
8th St.
Jacksonville,
FL,
32209
Phone: +1-904-244-8806
email:
[email protected]
Erik Soule,
MD,
MS
Department of Interventional Radiology,
University of Florida Health – Jacksonville
655 W.
8th St.
Jacksonville,
FL,
32209
Phone: +1-904-244-8806
email:
[email protected]
Patrick Natter,
MD
Department of Neuroradiology,
University of Florida Health – Jacksonville
655 W.
8thSt.
Jacksonville,
FL,
32209
Phone: +1-904-244-8806
email:
[email protected]
Dinesh Rao,
MD
Department of Neuroradiology,
University of Florida Health – Jacksonville
655 W.
8thSt....
References
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Biomechanics of the craniocervical region: the alar and transverse ligaments.
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Tubbs RS,
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et al.
The tectorial membrane: anatomical,
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Clin Anat.
2007 May;20(4):382-6.
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Sun PP,
Poffenbarger GJ,
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Zimmerman RA.
Spectrum of occipitoatlantoaxial injury in young children.
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Gopinathan NR,
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Crawford AH.
Cervical Spine Evaluation in Pediatric Trauma: A...