Spinal Dura Attachments into the Ligamentum Nuchae

Attachments from the Spinal Dura to the Ligamentum Nuchae: Incidence, MRI Appearance, and Strength of Attachment, Kenin S, Humphreys BK, Hubbard B, Cramer GD

Proceedings of the 2000 International Conference of Spinal Manipulation   2000;Sept:202-4

Abstract: The identification of attachments to the posterior spinal dura from the surrounding tissues in the cranio-cervical region by Von Lanz in 1929, may provide the key towards a better understanding of underlying mechanisms involved in chronic benign headaches as well as neck pain of unknown etiology.   The recent findings of connective tissue attachments to the cervical spinal dura from muscles, ligament, and osseous elements have sparked increasing interest among clinicians and anatomists.   However, studies of a large number of specimens or those evaluating the MRI appearance of these attachments have never been published.   This study evaluated these attachments in 30 cadaveric spines and then correlated the MRI appearance of the attachments to their anatomic appearance on 4 of the specimens.

This study identified a consistent connective tissue complex arising from within the substance of the ligamentum nuchae, between the occiput and axis, giving rise to 3 connective tissue bridges.   Two of the connective tissue bridges attached to the posterior spinal dura while the third linked the rectus capitis posterior minor muscle to the ligamentum nuchae.   Of significance were: (1) The attachment between the ligamentum nuchae and dura between C1-C2 are quite robust.   (2) The attachments between the rectus capitis posterior minor and ligamentum nuchae usually exist.   (3) The attachments between the ligamentum nuchae and dura mater can be identified on MRI scans.   These attachments may have clinical significance in cervicogenic headache, vertigo, and flexion-extension (whiplash) injuries, making their MRI appearance clinically important.