The transverse occipital ligament

An anatomic, histologic, and radiographic study

Robin Lenz, Garrett D. Moore, Prakash N. Panchani, Anthony C. Dilandro, Fortunato Battaglia, R. Shane Tubbs, Mohammadali Mohajel Shoja, Marios Loukas, Piotr B. Kozlowski, Anthony V. D'Antoni

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background context: The craniocervical region is an osteoligamentous complex that provides structural stability and movement by means of numerous ligaments. Fundamental knowledge of these ligaments is important for physicians who treat patients with disorders of this region to reduce morbidity and mortality. There is a paucity of data in the literature regarding the morphology, function, and classification of the transverse occipital ligament (TOL). Purpose: The purpose of this study was to investigate the prevalence, morphology, and variations of the TOL in a large number of adult human cadavers using dissection, histology, and digital radiography. Study design: Cadaveric laboratory study. Sample: Thirty-two formalin-fixed human adult cadavers were dissected in the study. Fourteen cadavers were found to have a TOL. Outcome measures: Measurements using a digital caliper, high-resolution digital photography, histologic staining with bright-field microscopy, and digital radiography. Methods: The posterior musculature and related soft tissues were dissected and underlying bony elements removed. The TOL was identified, isolated, measured, and then removed for histologic preparation with hematoxylin and eosin staining. Anteroposterior open-mouth digital radiographs of the upper cervical spine with monofilament attached to the TOL were used to demonstrate its relations to the occiput, atlas, and axis. Results: The TOL was present in 14 of 32 (44%) of the dissected cadavers (six male and eight female). Three types of TOLs were identified. Type 1 had bilateral connections to the alar ligaments and had fibers inserting onto the dens. Type 2 also had bilateral connections to the alar ligaments but did not have fibers inserting onto the dens. Type 3 neither had any connections to the alar ligaments nor had fibers that connected to the dens. Male cadavers always had a Type 1 TOL compared with 3 of 8 (38%) female cadavers and this difference was significant (p=.031). The TOL consisted of dense regular connective tissue with parallel arrangements of collagen fibers and interposed fibroblasts. Conclusions: Our data suggest that the TOL is not an anatomic variant and can be classified into three types. Future biomechanical studies can be designed to investigate the function of the TOL, although we hypothesize that it may act as a fulcrum during flexion and extension of the head because it is located between the apical ligament and superior crus of the cruciform ligament. Anteroposterior open-mouth digital radiographs revealed the location of the TOL with respect to the upper two cervical vertebrae. Future research should investigate the radiologic characteristics of the TOL using magnetic resonance imaging.

Original languageEnglish (US)
Pages (from-to)596-602
Number of pages7
JournalSpine Journal
Volume12
Issue number7
DOIs
StatePublished - Jul 1 2012
Externally publishedYes

Fingerprint

Ligaments
Cadaver
Radiographic Image Enhancement
Mouth
Staining and Labeling
Cervical Vertebrae
Atlases
Photography
Hematoxylin
Eosine Yellowish-(YS)
Connective Tissue

Keywords

  • Alar ligament
  • Cervical atlas
  • Craniocervical injury
  • Dens
  • Transverse occipital ligament

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Lenz, R., Moore, G. D., Panchani, P. N., Dilandro, A. C., Battaglia, F., Tubbs, R. S., ... D'Antoni, A. V. (2012). The transverse occipital ligament: An anatomic, histologic, and radiographic study. Spine Journal, 12(7), 596-602. https://doi.org/10.1016/j.spinee.2012.07.005

The transverse occipital ligament : An anatomic, histologic, and radiographic study. / Lenz, Robin; Moore, Garrett D.; Panchani, Prakash N.; Dilandro, Anthony C.; Battaglia, Fortunato; Tubbs, R. Shane; Mohajel Shoja, Mohammadali; Loukas, Marios; Kozlowski, Piotr B.; D'Antoni, Anthony V.

In: Spine Journal, Vol. 12, No. 7, 01.07.2012, p. 596-602.

Research output: Contribution to journalArticle

Lenz, R, Moore, GD, Panchani, PN, Dilandro, AC, Battaglia, F, Tubbs, RS, Mohajel Shoja, M, Loukas, M, Kozlowski, PB & D'Antoni, AV 2012, 'The transverse occipital ligament: An anatomic, histologic, and radiographic study', Spine Journal, vol. 12, no. 7, pp. 596-602. https://doi.org/10.1016/j.spinee.2012.07.005
Lenz R, Moore GD, Panchani PN, Dilandro AC, Battaglia F, Tubbs RS et al. The transverse occipital ligament: An anatomic, histologic, and radiographic study. Spine Journal. 2012 Jul 1;12(7):596-602. https://doi.org/10.1016/j.spinee.2012.07.005
Lenz, Robin ; Moore, Garrett D. ; Panchani, Prakash N. ; Dilandro, Anthony C. ; Battaglia, Fortunato ; Tubbs, R. Shane ; Mohajel Shoja, Mohammadali ; Loukas, Marios ; Kozlowski, Piotr B. ; D'Antoni, Anthony V. / The transverse occipital ligament : An anatomic, histologic, and radiographic study. In: Spine Journal. 2012 ; Vol. 12, No. 7. pp. 596-602.
@article{e6a85c8f97234d14bbaa2f9cc945c1a8,
title = "The transverse occipital ligament: An anatomic, histologic, and radiographic study",
abstract = "Background context: The craniocervical region is an osteoligamentous complex that provides structural stability and movement by means of numerous ligaments. Fundamental knowledge of these ligaments is important for physicians who treat patients with disorders of this region to reduce morbidity and mortality. There is a paucity of data in the literature regarding the morphology, function, and classification of the transverse occipital ligament (TOL). Purpose: The purpose of this study was to investigate the prevalence, morphology, and variations of the TOL in a large number of adult human cadavers using dissection, histology, and digital radiography. Study design: Cadaveric laboratory study. Sample: Thirty-two formalin-fixed human adult cadavers were dissected in the study. Fourteen cadavers were found to have a TOL. Outcome measures: Measurements using a digital caliper, high-resolution digital photography, histologic staining with bright-field microscopy, and digital radiography. Methods: The posterior musculature and related soft tissues were dissected and underlying bony elements removed. The TOL was identified, isolated, measured, and then removed for histologic preparation with hematoxylin and eosin staining. Anteroposterior open-mouth digital radiographs of the upper cervical spine with monofilament attached to the TOL were used to demonstrate its relations to the occiput, atlas, and axis. Results: The TOL was present in 14 of 32 (44{\%}) of the dissected cadavers (six male and eight female). Three types of TOLs were identified. Type 1 had bilateral connections to the alar ligaments and had fibers inserting onto the dens. Type 2 also had bilateral connections to the alar ligaments but did not have fibers inserting onto the dens. Type 3 neither had any connections to the alar ligaments nor had fibers that connected to the dens. Male cadavers always had a Type 1 TOL compared with 3 of 8 (38{\%}) female cadavers and this difference was significant (p=.031). The TOL consisted of dense regular connective tissue with parallel arrangements of collagen fibers and interposed fibroblasts. Conclusions: Our data suggest that the TOL is not an anatomic variant and can be classified into three types. Future biomechanical studies can be designed to investigate the function of the TOL, although we hypothesize that it may act as a fulcrum during flexion and extension of the head because it is located between the apical ligament and superior crus of the cruciform ligament. Anteroposterior open-mouth digital radiographs revealed the location of the TOL with respect to the upper two cervical vertebrae. Future research should investigate the radiologic characteristics of the TOL using magnetic resonance imaging.",
keywords = "Alar ligament, Cervical atlas, Craniocervical injury, Dens, Transverse occipital ligament",
author = "Robin Lenz and Moore, {Garrett D.} and Panchani, {Prakash N.} and Dilandro, {Anthony C.} and Fortunato Battaglia and Tubbs, {R. Shane} and {Mohajel Shoja}, Mohammadali and Marios Loukas and Kozlowski, {Piotr B.} and D'Antoni, {Anthony V.}",
year = "2012",
month = "7",
day = "1",
doi = "10.1016/j.spinee.2012.07.005",
language = "English (US)",
volume = "12",
pages = "596--602",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "7",

}

TY - JOUR

T1 - The transverse occipital ligament

T2 - An anatomic, histologic, and radiographic study

AU - Lenz, Robin

AU - Moore, Garrett D.

AU - Panchani, Prakash N.

AU - Dilandro, Anthony C.

AU - Battaglia, Fortunato

AU - Tubbs, R. Shane

AU - Mohajel Shoja, Mohammadali

AU - Loukas, Marios

AU - Kozlowski, Piotr B.

AU - D'Antoni, Anthony V.

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Background context: The craniocervical region is an osteoligamentous complex that provides structural stability and movement by means of numerous ligaments. Fundamental knowledge of these ligaments is important for physicians who treat patients with disorders of this region to reduce morbidity and mortality. There is a paucity of data in the literature regarding the morphology, function, and classification of the transverse occipital ligament (TOL). Purpose: The purpose of this study was to investigate the prevalence, morphology, and variations of the TOL in a large number of adult human cadavers using dissection, histology, and digital radiography. Study design: Cadaveric laboratory study. Sample: Thirty-two formalin-fixed human adult cadavers were dissected in the study. Fourteen cadavers were found to have a TOL. Outcome measures: Measurements using a digital caliper, high-resolution digital photography, histologic staining with bright-field microscopy, and digital radiography. Methods: The posterior musculature and related soft tissues were dissected and underlying bony elements removed. The TOL was identified, isolated, measured, and then removed for histologic preparation with hematoxylin and eosin staining. Anteroposterior open-mouth digital radiographs of the upper cervical spine with monofilament attached to the TOL were used to demonstrate its relations to the occiput, atlas, and axis. Results: The TOL was present in 14 of 32 (44%) of the dissected cadavers (six male and eight female). Three types of TOLs were identified. Type 1 had bilateral connections to the alar ligaments and had fibers inserting onto the dens. Type 2 also had bilateral connections to the alar ligaments but did not have fibers inserting onto the dens. Type 3 neither had any connections to the alar ligaments nor had fibers that connected to the dens. Male cadavers always had a Type 1 TOL compared with 3 of 8 (38%) female cadavers and this difference was significant (p=.031). The TOL consisted of dense regular connective tissue with parallel arrangements of collagen fibers and interposed fibroblasts. Conclusions: Our data suggest that the TOL is not an anatomic variant and can be classified into three types. Future biomechanical studies can be designed to investigate the function of the TOL, although we hypothesize that it may act as a fulcrum during flexion and extension of the head because it is located between the apical ligament and superior crus of the cruciform ligament. Anteroposterior open-mouth digital radiographs revealed the location of the TOL with respect to the upper two cervical vertebrae. Future research should investigate the radiologic characteristics of the TOL using magnetic resonance imaging.

AB - Background context: The craniocervical region is an osteoligamentous complex that provides structural stability and movement by means of numerous ligaments. Fundamental knowledge of these ligaments is important for physicians who treat patients with disorders of this region to reduce morbidity and mortality. There is a paucity of data in the literature regarding the morphology, function, and classification of the transverse occipital ligament (TOL). Purpose: The purpose of this study was to investigate the prevalence, morphology, and variations of the TOL in a large number of adult human cadavers using dissection, histology, and digital radiography. Study design: Cadaveric laboratory study. Sample: Thirty-two formalin-fixed human adult cadavers were dissected in the study. Fourteen cadavers were found to have a TOL. Outcome measures: Measurements using a digital caliper, high-resolution digital photography, histologic staining with bright-field microscopy, and digital radiography. Methods: The posterior musculature and related soft tissues were dissected and underlying bony elements removed. The TOL was identified, isolated, measured, and then removed for histologic preparation with hematoxylin and eosin staining. Anteroposterior open-mouth digital radiographs of the upper cervical spine with monofilament attached to the TOL were used to demonstrate its relations to the occiput, atlas, and axis. Results: The TOL was present in 14 of 32 (44%) of the dissected cadavers (six male and eight female). Three types of TOLs were identified. Type 1 had bilateral connections to the alar ligaments and had fibers inserting onto the dens. Type 2 also had bilateral connections to the alar ligaments but did not have fibers inserting onto the dens. Type 3 neither had any connections to the alar ligaments nor had fibers that connected to the dens. Male cadavers always had a Type 1 TOL compared with 3 of 8 (38%) female cadavers and this difference was significant (p=.031). The TOL consisted of dense regular connective tissue with parallel arrangements of collagen fibers and interposed fibroblasts. Conclusions: Our data suggest that the TOL is not an anatomic variant and can be classified into three types. Future biomechanical studies can be designed to investigate the function of the TOL, although we hypothesize that it may act as a fulcrum during flexion and extension of the head because it is located between the apical ligament and superior crus of the cruciform ligament. Anteroposterior open-mouth digital radiographs revealed the location of the TOL with respect to the upper two cervical vertebrae. Future research should investigate the radiologic characteristics of the TOL using magnetic resonance imaging.

KW - Alar ligament

KW - Cervical atlas

KW - Craniocervical injury

KW - Dens

KW - Transverse occipital ligament

UR - http://www.scopus.com/inward/record.url?scp=84866057722&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866057722&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2012.07.005

DO - 10.1016/j.spinee.2012.07.005

M3 - Article

VL - 12

SP - 596

EP - 602

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 7

ER -