Keywords:
Musculoskeletal spine, Neuroradiology spine, MR, Education
Authors:
B. Peters, J. Van Goethem, P. M. Parizel; Antwerp/BE
DOI:
10.26044/ecr2019/C-3160
Aims and objectives
The craniocervical junction (CCJ) is a complex of bony and ligamentous structures.
The CCJ has an important function in protecting the content of the cervical spine while still allowing significant mobility of the head and the upper cervical spine.
The CCJ is composed of 2 main joints: the atlanto-occipital and the atlanto-axial joint.
While movement in the atlanto-occipital joint is mainly determined by bony structures,
movement in the atlanto-axial joint is guided by the craniocervical ligaments that function as the main stabilizers (1).
In our study we focus on the main craniocervical ligaments: the transverse ligament (right and left portion) (Fig.1),
the alar ligaments (right and left) (Fig.2),
the tectorial membrane and the posterior atlanto-occipital ligament (Fig.3).
The transverse ligament is the largest and strongest ligament of the CCJ and is the most important stabilizer of the atlantoaxial joint (2).
The transverse ligament attaches to the lateral tubercle of the atlas on both sides and runs posterior to the odontoid process.
It stabilizes the atlanto-axial joint (1).
The alar ligaments stabilize both the atlanto-axial and the atlanto-occipital joint and limit rotation,
lateral bending and forward translation of the head relative to C2.
The alar ligaments run from the base of the skull and insert on the lateral aspect of the odontoid process.
There is still debate in the literature as of the function of the tectorial membrane,
which probably has a function in stabilizing and restricting motion in the atlanto-occipital and the atlant-oaxial joint.
The tectorial membrane is a upward prolongation of the posterior longitudinal ligament which consists of 3 layers and attaches on the basilar groove of the occipital bone.
The role of the posterior atlanto-occipital ligament in atlanto-occipital stability is still unclear.
The origin of the POL is inferiorly on the posterior aspect of the foramen magnum and attaches on the posterior arch of the atlas (1).
Nearly one-third of all traumatic injuries to the cervical spine involve the CCJ (3).
Only little literature is available on this topic and most of the studies are focused on normal anatomy,
biomechanics or ligamentous injury in whiplash associated disorders (WAD) (1,4,5,6).
Lesions to the ligaments of the CCJ are usually attributed to trauma.
To our knowledge,
there is no prospective study available on the expected degenerative changes of the craniocervical ligaments with age in a normal population.
Knowledge of the normal appearance of these ligaments in different age groups is essential if one wants to evaluate pathologic changes due to trauma.
We conducted a prospective study to evaluate age related changes to the craniocervical ligaments.