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Spinal injuries
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
Jefferson fractures (Figure 16.2) result from axial loads applied to the head, causing bilateral or multiple fractures of the arch of the atlas. Cord injury is uncommon as the spinal canal is wide at this level. Most cases are stable but transverse ligament damage makes the injury unstable and requiring immobilisation or fixation.
Cervical spine injury
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Strong ligaments and cervical paraspinous muscles stabilize the C-spine, creating a physiologic lordosis (an arch in the spine). The anterior and posterior longitudinal ligaments originate at the occiput and run along the anterior and posterior aspects of the vertebral bodies. Posteriorly, the ligamentum flavum, interspinous, and supraspinous ligaments connect the laminae and stabilize the posterior elements of the vertebrae. A complex array of ligaments also join the C1 and C2 vertebrae to each other and to the occiput. The cruciate ligament attaches the dens to the occiput and the atlas. The transverse ligament of the atlas is the main stabilizer of the dens posteriorly inside the atlas. The right and left alar ligaments project from the dens superiorly to the occipital condyles (Figure 11.2).3
Neuroanatomy overview
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Carolina Sandoval-Garcia, Daniel K. Resnick
The craniocervical region has an additional set of ligaments worth mentioning separately. Given the importance of maintaining stability while allowing for full mobility of the head in relationship to the rest of the body, one of the key ligaments in the occipitocervical junction is the cruciate ligament. The superior and inferior limbs that form this complex offer no significant support, but in turn, the transverse ligament is the strongest found in the cervical spine and maintains the odontoid process anteriorly against the dorsal surface of the anterior arch of C1 while separating it from the spinal cord. The alar ligaments start on the lateral aspects of the odontoid process and attach to the base of the skull and the apical ligament, also known as suspensory or middle odontoid, attaches the tip of the odontoid process to the basion. Dorsally, the posterior atlantooccipital membrane is a thin ligament spanning from foramen magnum to atlas. It is continuous with the posterior atlantoaxial membrane, which in turn becomes ligamentum flavum inferiorly (Tubbs et al., 2011). The ligamentous structures of the craniocervical junction are illustrated in Figure 7.4.
Defining the contemporary epidemiology and return to play for high ankle sprains in the National Football League
Published in The Physician and Sportsmedicine, 2022
Steven F. DeFroda, Blake M. Bodendorfer, Davis A. Hartnett, John D. Milner, Daniel S. Yang, Zachary S. Silber, Brian Forsythe
Ankle sprains are one of the most prevalent injuries in the National Football League (NFL), second only to knee injuries [1]. High ankle sprains, or syndesmotic injuries, are notorious in professional football players. They take longer to heal than low ankle sprains, leading to prolonged disability and missed playing time [2]. These injuries affect the distal tibiofibular syndesmosis, which is comprised of the anterior-inferior tibiofibular ligament (AITFL), interosseus ligament (IOL), posterior-inferior tibiofibular ligament (PITFL), and inferior transverse ligament [2]. The deltoid ligament confers stability by restricting lateral talar translation, which is often an accompanying injury to syndesmotic injuries [3]. High ankle sprains are more common in high-impact sports, such as football, rugby, or hockey, and remain a persistent source of missed playing time amongst elite athletes [4]. The injury typically results from forced dorsiflexion and external rotation of the foot relative to the ankle and tibia.
Surgical treatment of neglected C2 odontoid process fracture with anterior atlantoaxial dislocation
Published in British Journal of Neurosurgery, 2021
Vladimir Klimov, Murodzhon Kosimshoev, Aleksey Evsyukov, Vitaly Stepanenko, Jamil Rzaev
The patient kept his head bent slightly forward. No neurological deficit was found. A radiograph of the cervical spine (Figure 1(B)) revealed an old fracture through the base of the odontoid. In the lateral projection (Figure 1(A)), the ventral and angular displacement of the dens was observed to be 14 mm anterior with an angular deformation of approximately 60°. CT (Figure 1(C,D)), demonstrated a fracture of the odontoid base with anterior displacement. According to the Anderson-D'Alonzo classification, this injury was identified as a displaced type II fracture. Under Steel’s rule,9 the spinal cord occupied less than 1/3 of the axial canal area. According to MRI (Figure 2(A,B)), a rupture of the atlas transverse ligament was felt to be present. CT angiography was performed for screw placement planning and it identified an aberrant vertebral artery at the level of C2 classified as type III, according to R. Shane Tubbs10 (Figure 1(E,F)).
Integrity of the tectorial membrane is a favorable prognostic factor in atlanto-occipital dislocation
Published in British Journal of Neurosurgery, 2020
Gil Kimchi, Gahl Greenberg, Vincent C. Traynelis, Christopher D. Witiw, Nachshon Knoller, Ran Harel
The underlying instability in AOD is often attributed to rupture of the tectorial membrane and alar ligaments.2 The craniocervical junction is supported anteriorly by a ligamentous complex that comprises two distinct groups;12 the first includes the atlanto-condylar articulation, the cruciate ligament and the anterior atlanto-occipital ligament. This group provides stability chiefly to the atlanto-cranial and the atlanto-dental complexes. The second group of ligaments provides stability to the cranium-odontoid complex. It consists of the tectorial membrane, the apical ligament and the alar ligaments. Of special importance within that group is the tectorial membrane; this strong collagenous continuum of the posterior longitudinal ligament lies posteriorly to the transverse ligament and connects the dorsum of the dens to the clivus. Its primary role is to resist hyperextension, although it may also serve to limit hyperflexion as well.13 The prominent role of the tectorial membrane in craniocervical stabilization is well elucidated in a cadaver study,14 in which the authors removed the alar and transverse ligaments and applied various manipulations on the CCJ. They revealed that the tectorial membrane acts as the ‘second line of defense’ by preventing the odontoid process from translating posteriorly and consequently compressing the spinal canal.