Revisiting the clinical anatomy of the alar ligaments
- 526 Downloads
The morphology of the alar ligaments has been inconsistently described, particularly with regard to the existence of an atlantal portion. Despite these inconsistencies, these descriptions have been used to develop physical tests for the integrity of these ligaments in patients with cervical spine problems. The purpose of this study was to describe the detailed macrostructure of the alar ligaments.
The alar ligaments of 11 cervical spine specimens from embalmed adult cadavers were examined by fine dissection. A detailed description of the macrostructure of these ligaments and their attachment sites was recorded. Measurements were performed with respect to ligament dimensions and relations with selected bony landmarks.
No atlantal portion of the alar ligament was viewed in any specimen. The attachment of the ligaments on the odontoid process occurred on its lateral and posterolateral aspects, frequently below the level of the apex. The occipital attachment was on the medial surface of the occipital condyles in close proximity to the atlanto-occipital joints. The orientation of the ligaments was primarily horizontal. The presence of transverse bands extending occiput to occiput with minimal or no attachment to the odontoid process was a common variant.
The absence of findings with respect to the atlantal portion of the alar ligament suggests that it may be considered an anatomical variant, not an essential component for stability of the craniocervical complex. These findings may inform the use and interpretation of clinical tests for alar ligament integrity.
KeywordsAlar ligaments Craniocervical anatomy Clinical stability test
Conflict of interest
- 3.Dvorak J, Dvorak V, Gilliar W, Schneider W, Spring H, Tritschler T (2008) Musculoskeletal manual medicine. diagnosis and treatment. Theime, StuttgartGoogle Scholar
- 4.White AAI, Panjabi MM (1990) Clinical biomechanics of the spine, 2nd edn. J.B. Lippincott Company, PhiladelphiaGoogle Scholar
- 6.Beeton K (1995) Instability in the upper cervical region; clinical presentation, radiological and clinical testing. Manip Physiother 27(1):19–32Google Scholar
- 7.Pettman E (1994) Stress tests of the craniovertebral joints. In: Boyling JD, Palastanga N (eds) Grieve’s modern manual therapy, the vertebral column, 2nd edn. Churchill Livingstone, Edinburgh, pp 529–537Google Scholar
- 8.Torres-Cueco R (2008) Aproximacion clinica a la inestabilidad craneovertebral. In: La Columna cervical: sindromes clinicos y su tratamiento manipulativo. Tomo II, vol 2. Editorial Medica Panamerica, Buenos AiresGoogle Scholar
- 9.Westerhuis P (2007) Cervical instability. In: von Piekartz HJM (ed) Craniofacial pain. neuromusculoskeletal assessment, treatment and management. Butterworth Heinemann Elsevier, Edinburgh, pp 119–147Google Scholar
- 11.Gardner E, Gray DJ, O’Rahilly R (1975) Anatomy. a regional study of human structure, 4th edn. W.B. Saunders Company, PhiladelphiaGoogle Scholar
- 12.Poirier PJ, Nicolas A, Charpy A (1911) Traite d’anatotomie humaine, 3rd edn. Massan, ParisGoogle Scholar
- 17.Zuckerman S (1961) A new system of anatomy. Oxford University Press, LondonGoogle Scholar
- 18.Wood Jones F (ed) (1953) Buchanan’s manual of anatomy, 8th edn. Bailliere Tindall and Cox, LondonGoogle Scholar
- 19.Moore KL, Dalley AFI (2006) Clinically oriented anatomy, 5th edn. Lippincot Williams Wilkins, PhiladelphiaGoogle Scholar
- 20.Last RJ (1978) Anatomy regional and applied, 6th edn. Churchill Livingstone, EdinburghGoogle Scholar
- 23.Romanes GJ (ed) (1972) Cunninghams textbook of anatomy, 11th edn. Oxford University Press, LondonGoogle Scholar
- 25.Driscoll DR (1987) Anatomical and biomechanical characteristics of upper cervical ligamentous structures: a review. J Manipul Physiol Ther 10(3):107–110Google Scholar
- 26.Boszcyk A, Boszcyk B, Putz R, MBenjamin M, Milz S (2003) Expression of a wide range of fibrocartilage molecules at the entheses of the alar ligaments – possible antigenic targets for rheumatoid arthritis? Rheumatology 30(7):1420–1425Google Scholar
- 27.Fick R (1904) Hundbuch der anatomie und Mechanik der Gelenke. Verlag von Gustav Fischer, JenaGoogle Scholar
- 28.Testut L, Latarjet A (1928) Traite d’anatomie humaine, 8th edn. Doin, ParisGoogle Scholar
- 30.Mercer S (2004) Structure and function of the bones and joints of the cervical spine. In: Oatis CA (ed) Kinesiology. the mechanics and pathomechanics of human movement. Lippincott Williams Wilkins, Philadelphia, pp 451–469Google Scholar
- 32.Okazaki K (1995) Anatomical study of the ligaments in the occipito-atlantoaxial complex. J Jpn Orthop Assoc 69:1259–1267Google Scholar