Myodural bridge

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The myodural bridge or miodural ligament is a bridge of connective tissue that extends between the suboccipital muscles and the cervical spinal dura mater, [1] the outer membrane that envelops the spinal cord. It provides a physical connection between the musculoskeletal and nervous systems, and the circulation of cerebrospinal fluid. [2] Its importance has been highlighted by various authors. [3] [4]

Contents

The myodural bridge is mainly formed by muscular and tendinous components. This bridge originates in the deep layers of the suboccipital muscles, specifically in the rectus capitis posterior minor muscle, and extends to join the dura mater of the cervical spinal cord. This structural connection forms a continuous link from the base of the skull to the top of the cervical spine. Recent studies postulate the existence and functional importance of the myodural bridge in mammals. [5]

This membranous anatomical structure was discovered in the mid-90s. [1] [6] [7] According to forensic studies conducted, this ligament has various patterns of insertion although the general consensus is that it primarily adheres to the occipital bone, to the rectus capitis posterior minor muscle, to the posterior arch of the atlas bone, and to the dura mater. [8] [7] The term "Miodural Bridge Complex" postulates it as a new functional structure. [9]

It is a relevant anatomical structure due to its role in the biomechanics and physiology of the human body. [10] [11] [12]

Physiological functions

Among its physiological functions are the biomechanical stabilization of the atlantooccipital joint and the dura mater, [10] the regulation of cerebrospinal fluid, [13] mediation in nociceptive transduction, [14] [15] [16] monitoring of dura mater tension, and sensorimotor regulation in the cervical region [14] (coordination of movements and sensory perception). The myodural bridge is also involved in proprioceptive transmission, [14] preventing obstructions of the subarachnoid space [17] and the cerebromedullary cistern. [5]

Pathophysiology and clinical relevance

The myodural bridge displays physiological reciprocities with the suboccipital muscles, which include the inferior oblique capitis (OCI), [18] the rectus capitis posterior major (RCPM), and the rectus capitis posterior minor (RCPm), in addition to the posterior atlanto-occipital membrane and several meningo-vertebral structures. [19] [20] This may lead the myodural bridge to exert torque, traction, or shortening on the dura mater, creating abnormal tension that can result in head protrusion, [21] headaches, [1] [22] [23] and vertigo of cervicogenic origin. [21] Pathomechanical or physiological abnormalities of the myodural bridge can affect the blood volume in the suboccipital cavernous sinuses, [24] leading to cognitive disorders associated with cerebrospinal fluid (CSF) dysfunctions. [13] It has also been proposed as an etiological factor in the symptoms associated with Arnold-Chiari type I disease. [25] [26]

The role of the posterior cervical musculature in sensorimotor control, cervicocephalic pain, and spinal cord stabilization goes through biomechanical and anatomical interactions with the miodural bridge. There are soft tissue anatomical connections that cross the cervical epidural space and link the suboccipital muscle fascia with the dura mater. The myodural bridge provides both passive and active anchoring to the spinal cord. [19] It is also involved in the dura mater tension monitoring system to prevent dural folds and maintain the permeability of the spinal cord. [14] Modulation of dura mater tension can be initiated through a sensory reflex to the contractile muscle tissues. Unanticipated movements, such as hyperflexion-extension injuries, stimulate the deep suboccipital muscles and transmit traction forces through the miodural bridge to the cervical dura mater.

Related Research Articles

<span class="mw-page-title-main">Atlas (anatomy)</span> First cervical vertebra of the spine which supports the skull

In anatomy, the atlas (C1) is the most superior (first) cervical vertebra of the spine and is located in the neck.

<span class="mw-page-title-main">Neck</span> Part of the body on many vertebrates that connects the head with the torso

The neck is the part of the body on many vertebrates that connects the head with the torso. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. The structures of the human neck are anatomically grouped into four compartments: vertebral, visceral and two vascular compartments. Within these compartments, the neck houses the cervical vertebrae and cervical part of the spinal cord, upper parts of the respiratory and digestive tracts, endocrine glands, nerves, arteries and veins. Muscles of the neck are described separately from the compartments. They bound the neck triangles.

<span class="mw-page-title-main">Suboccipital nerve</span>

The suboccipital nerve is the dorsal primary ramus of the first cervical nerve (C1). It exits the spinal cord between the skull and the first cervical vertebra, the atlas.

<span class="mw-page-title-main">Dura mater</span> Outermost layer of the protective tissues around the central nervous system (meninges)

In neuroanatomy, dura mater is a thick membrane made of dense irregular connective tissue that surrounds the brain and spinal cord. It is the outermost of the three layers of membrane called the meninges that protect the central nervous system. The other two meningeal layers are the arachnoid mater and the pia mater. It envelops the arachnoid mater, which is responsible for keeping in the cerebrospinal fluid. It is derived primarily from the neural crest cell population, with postnatal contributions of the paraxial mesoderm.

<span class="mw-page-title-main">Obliquus capitis inferior muscle</span>

The obliquus capitis inferior muscle is a muscle in the upper back of the neck. It is one of the suboccipital muscles. Its inferior attachment is at the spinous process of the axis; its superior attachment is at the transverse process of the atlas. It is innervated by the suboccipital nerve. The muscle rotates the head to its side.

<span class="mw-page-title-main">Obliquus capitis superior muscle</span>

The obliquus capitis superior muscle is a small muscle in the upper back part of the neck. It is one of the suboccipital muscles. It attaches inferiorly at the transverse process of the atlas ; it attaches superiorly at the external surface of the occipital bone. The muscle is innervated by the suboccipital nerve.

<span class="mw-page-title-main">Vertebral artery</span> Major arteries of the neck

The vertebral arteries are major arteries of the neck. Typically, the vertebral arteries originate from the subclavian arteries. Each vessel courses superiorly along each side of the neck, merging within the skull to form the single, midline basilar artery. As the supplying component of the vertebrobasilar vascular system, the vertebral arteries supply blood to the upper spinal cord, brainstem, cerebellum, and posterior part of brain.

<span class="mw-page-title-main">Rectus capitis posterior major muscle</span> Tendon

The rectus capitis posterior major is a muscle in the upper back part of the neck. It is one of the suboccipital muscles. Its inferior attachment is at the spinous process of the axis ; its superior attachment is onto the outer surface of the occipital bone on and around the side part of the inferior nuchal line. The muscle is innervated by the suboccipital nerve. The muscle acts to extend the head and rorate the head to its side.

<span class="mw-page-title-main">Rectus capitis posterior minor muscle</span> Tendon

The rectus capitis posterior minor is a muscle in the upper back part of the neck. It is one of the suboccipital muscles. Its inferior attachment is at the posterior arch of atlas; its superior attachment is onto the occipital bone at and below the inferior nuchal line. The muscle is innervated by the suboccipital nerve. The muscle acts as a weak extensor of the head.

<span class="mw-page-title-main">Occipital artery</span>

The occipital artery is a branch of the external carotid artery that provides arterial supply to the back of the scalp, sternocleidomastoid muscles, and deep muscles of the back and neck.

<span class="mw-page-title-main">Inferior thyroid artery</span> Artery of the neck

The inferior thyroid artery is an artery in the neck. It arises from the thyrocervical trunk and passes upward, in front of the vertebral artery and longus colli muscle. It then turns medially behind the carotid sheath and its contents, and also behind the sympathetic trunk, the middle cervical ganglion resting upon the vessel.

<span class="mw-page-title-main">Deep cervical vein</span>

The deep cervical vein is the vena comitans of the deep cervical artery. The vein is formed in the suboccipital region by the convergence of communicating branches of the occipital vein, veins draining the suboccipital muscles, and veins from the venous plexuses that surround cervical nerves. The vein and corresponding artery then pass in between the semispinalis capitis muscle and the semispinalis colli muscle. The vein passes anterior-ward in between the transverse process of the 7th cervical vertebra and the nek of the first rib to terminate in the vertebral vein.

<span class="mw-page-title-main">Mastoid foramen</span> Hole in the back of the temporal bone

The mastoid foramen is a hole in the posterior border of the temporal bone. It transmits an emissary vein between the sigmoid sinus and the suboccipital venous plexus, and a small branch of the occipital artery, the posterior meningeal artery to the dura mater.

<span class="mw-page-title-main">Suboccipital triangle</span>

The suboccipital triangle is a region of the neck bounded by the following three muscles of the suboccipital group of muscles:

<span class="mw-page-title-main">Sternalis muscle</span>

The sternalismuscle is an anatomical variation that lies in front of the sternal end of the pectoralis major parallel to the margin of the sternum. The sternalis muscle may be a variation of the pectoralis major or of the rectus abdominis.

<span class="mw-page-title-main">Posterior atlantooccipital membrane</span> Membrane at the base of the skull

The posterior atlantooccipital membrane is a broad but thin membrane extending between the to the posterior margin of the foramen magnum above, and posterior arch of atlas below. It forms the floor of the suboccipital triangle.

<span class="mw-page-title-main">Posterior branches of cervical nerves</span>

The posterior branches of cervical nerves branch from the dorsal rami of the cervical nerves.

<span class="mw-page-title-main">Cervical spinal nerve 1</span> Spinal nerve of the cervical segment

The cervical spinal nerve 1 (C1) is a spinal nerve of the cervical segment. C1 carries predominantly motor fibres, but also a small meningeal branch that supplies sensation to parts of the dura around the foramen magnum.

<span class="mw-page-title-main">Cervical spinal nerve 2</span> Spinal nerve of the cervical segment

The cervical spinal nerve 2 (C2) is a spinal nerve of the cervical segment. It is a part of the ansa cervicalis along with the C1 and C3 nerves sometimes forming part of superior root of the ansa cervicalis. it also connects into the inferior root of the ansa cervicalis with the C3.

<span class="mw-page-title-main">Denticulate ligaments</span>

Denticulate ligaments are lateral projections of the spinal pia mater forming triangular-shaped ligaments that anchor the spinal cord along its length to the dura mater on each side. There are usually 21 denticulate ligaments on each side, with the uppermost pair occurring just below the foramen magnum, and the lowest pair occurring between spinal nerve roots of T12 and L1. The denticulate ligaments are traditionally believed to provide stability for the spinal cord against motion within the vertebral column.

References

  1. 1 2 3 Hack, Gary D.; Koritzer, Richard T.; Robinson, Walker L.; Hallgren, Richard C.; Greenman, Philip E. (December 1995). "Anatomic Relation between the Rectus Capitis Posterior Minor Muscle and the Dura Mater". Spine. 20 (23): 2484–2485. doi:10.1097/00007632-199512000-00003. ISSN   0362-2436. PMID   8610241. S2CID   26183189.
  2. ↑ Zheng, Nan; Yuan, Xiao-Ying; Li, Yun-Fei; Chi, Yan-Yan; Gao, Hai-Bin; Zhao, Xin; Yu, Sheng-Bo; Sui, Hong-Jin; Sharkey, John (2014-08-01). Cappello, Francesco (ed.). "Definition of the To Be Named Ligament and Vertebrodural Ligament and Their Possible Effects on the Circulation of CSF". PLOS ONE. 9 (8): e103451. Bibcode:2014PLoSO...9j3451Z. doi: 10.1371/journal.pone.0103451 . ISSN   1932-6203. PMC   4118883 . PMID   25084162.
  3. ↑ Sillevis, Rob; Hogg, Russell (2020-08-10). "Anatomy and clinical relevance of sub occipital soft tissue connections with the dura mater in the upper cervical spine". PeerJ. 8: e9716. doi: 10.7717/peerj.9716 . ISSN   2167-8359. PMC   7425638 . PMID   32864219.
  4. ↑ Ma, Yue; Tang, Wei; Gong, De-Zheng; Li, Xing-Yi; Zhang, Jing-Hui; Sun, Jia-Hui; Wang, Bing; Zhang, Ying; Chen, Yu-Xiao; Zhang, Zhi-Hong; Zheng, Nan; Okoye, Chukwuemeka Samuel; Chi, Yan-Yan; Wu, Cheng-Wei; Yu, Sheng-Bo (2021-04-13). "The morphology, biomechanics, and physiological function of the suboccipital myodural connections". Scientific Reports. 11 (1): 8064. Bibcode:2021NatSR..11.8064M. doi:10.1038/s41598-021-86934-4. ISSN   2045-2322. PMC   8044117 . PMID   33850172.
  5. 1 2 Zheng, Nan; Chi, Yan-Yan; Yang, Xiao-Han; Wang, Nan-Xing; Li, Yi-Lin; Ge, Yang-Yang; Zhang, Lan-Xin; Liu, Tai-Yuan; Yuan, Xiao-Ying; Yu, Sheng-Bo; Sui, Hong-Jin (June 2018). "Orientation and property of fibers of the myodural bridge in humans". The Spine Journal. 18 (6): 1081–1087. doi:10.1016/j.spinee.2018.02.006. PMID   29477753. S2CID   3525093.
  6. ↑ Kahkeshani, Kourosh; Ward, Peter J. (May 2012). "Connection between the spinal dura mater and suboccipital musculature: Evidence for the myodural bridge and a route for its dissection-A review". Clinical Anatomy. 25 (4): 415–422. doi:10.1002/ca.21261. PMID   22488993. S2CID   46340225.
  7. 1 2 Yuan, Xiao-Ying; Yu, Sheng-Bo; Li, Yun-Fei; Chi, Yan-Yan; Zheng, Nan; Gao, Hai-Bin; Luan, Bing-Yi; Zhang, Zhao-Xi; Sui, Hong-Jin (March 2016). "Patterns of attachment of the myodural bridge by the rectus capitis posterior minor muscle". Anatomical Science International. 91 (2): 175–179. doi:10.1007/s12565-015-0282-1. ISSN   1447-073X. PMID   25859757. S2CID   41934705.
  8. ↑ Humphreys, B.K.; Kenin, Shahar; Hubbard, Bradley B.; Cramer, Gregory D. (March 2003). "Investigation of connective tissue attachments to the cervical spinal dura mater". Clinical Anatomy. 16 (2): 152–159. doi:10.1002/ca.10109. ISSN   0897-3806. PMID   12589671. S2CID   8572387.
  9. ↑ Zheng, Nan; Chung, Beom Sun; Li, Yi-Lin; Liu, Tai-Yuan; Zhang, Lan-Xin; Ge, Yang-Yang; Wang, Nan-Xing; Zhang, Zhi-Hong; Cai, Lin; Chi, Yan-Yan; Zhang, Jian-Fei; Samuel, Okoye Chukwuemeka; Yu, Sheng-Bo; Sui, Hong-Jin (February 2020). "The myodural bridge complex defined as a new functional structure". Surgical and Radiologic Anatomy. 42 (2): 143–153. doi:10.1007/s00276-019-02340-6. ISSN   0930-1038. PMID   31563971. S2CID   203568684.
  10. 1 2 Palomeque-del-Cerro, Luis; Arráez-Aybar, Luis A.; Rodríguez-Blanco, Cleofás; Guzmán-García, Rafael; Menendez-Aparicio, Mar; Oliva-Pascual-Vaca, Ángel (2017-01-01). "A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge". Spine. 42 (1): 49–54. doi:10.1097/BRS.0000000000001655. ISSN   0362-2436. PMID   27116115. S2CID   22898078.
  11. ↑ Song, Yang; Lai, Hua-Xun; Song, Ting-Wei; Gong, Jin; Liu, Bo; Chi, Yan-Yan; Yue, Chen; Zhang, Jing; Sun, Shi-Zhu; Zhang, Cheng-Hong; Tang, Wei; Fan, Ning; Yu, Wei-Hua; Wang, Yi-Fei; Hack, Gary D. (2023-08-17). "The growth and developmental of the myodural bridge and its associated structures in the human fetus". Scientific Reports. 13 (1): 13421. Bibcode:2023NatSR..1313421S. doi:10.1038/s41598-023-40709-1. ISSN   2045-2322. PMC   10435443 . PMID   37591924.
  12. ↑ Sun, Mei-Yu; Sui, Hong-Jin; Eteer, Khalid; Yu, Sheng-Bo; Hu, Jia-Ni (2020-09-01). "Utilization of MR imaging in myodural bridge complex with relevant muscles: current status and future perspectives". Journal of Musculoskeletal & Neuronal Interactions. 20 (3): 382–389. ISSN   1108-7161. PMC   7493449 . PMID   32877974.
  13. 1 2 Chae, Hyocheong; Lee, Joohyun; Ryu, Myungseok (2022-12-30). "Treatment Approaches for Cognitive Disorders Associated with CSF Circulation". Journal of Korean Medical Society of Soft Tissue. 6 (2): 89–95. doi: 10.54461/JKMST.2022.6.2.89 . ISSN   2713-6590. S2CID   255298027.
  14. 1 2 3 4 Enix, Dennis E.; Scali, Frank; Pontell, Matthew E. (June 2014). "The cervical myodural bridge, a review of literature and clinical implications". The Journal of the Canadian Chiropractic Association. 58 (2): 184–192. ISSN   0008-3194. PMC   4025088 . PMID   24932022.
  15. ↑ Scali, Frank; Pontell, Matthew E.; Enix, Dennis E.; Marshall, Ewarld (May 2013). "Histological analysis of the rectus capitis posterior major's myodural bridge". The Spine Journal. 13 (5): 558–563. doi:10.1016/j.spinee.2013.01.015. PMID   23406969.
  16. ↑ Hu, J. W.; Vernon, H.; Tatourian, I. (1995). "Changes in neck electromyography associated with meningeal noxious stimulation". Journal of Manipulative and Physiological Therapeutics. 18 (9): 577–581. ISSN   0161-4754. PMID   8775018.
  17. ↑ Shafique, Shiza; Rayi, Appaji (2023), "Anatomy, Head and Neck, Subarachnoid Space", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32491453 , retrieved 2023-10-22
  18. ↑ Pontell, Matthew E.; Scali, Frank; Marshall, Ewarld; Enix, Dennis (May 2013). "The obliquus capitis inferior myodural bridge". Clinical Anatomy. 26 (4): 450–454. doi:10.1002/ca.22134. ISSN   0897-3806. PMID   22836789. S2CID   28930934.
  19. 1 2 Scali, Frank; Ohno, Ai; Enix, Dennis; Hassan, Sherif (2022-05-30). "The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures". Cureus. 14 (5): e25484. doi: 10.7759/cureus.25484 . ISSN   2168-8184. PMC   9170425 . PMID   35686279.
  20. ↑ Dean, N.A.; Mitchell, B.S. (May 2002). "Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region". Clinical Anatomy. 15 (3): 182–185. doi:10.1002/ca.10001. ISSN   0897-3806. PMID   11948951. S2CID   1423675.
  21. 1 2 Sung, Yun-Hee (2022-12-05). "Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness". Medicina. 58 (12): 1791. doi: 10.3390/medicina58121791 . ISSN   1648-9144. PMC   9786116 . PMID   36556992.
  22. ↑ Kitamura, Kei; Cho, Kwang Ho; Yamamoto, Masahito; Ishii, Michitake; Murakami, Gen; Rodríguez-Vázquez, José Francisco; Abe, Shin-Ichi (October 2019). "Suboccipital myodural bridges revisited: Application to cervicogenic headaches". Clinical Anatomy. 32 (7): 914–928. doi:10.1002/ca.23411. ISSN   0897-3806. PMID   31116454. S2CID   162169899.
  23. ↑ Hack, Gary D.; Hallgren, Richard C. (January 2004). "Chronic Headache Relief After Section of Suboccipital Muscle Dural Connections: A Case Report". Headache: The Journal of Head and Face Pain. 44 (1): 84–89. doi:10.1111/j.1526-4610.2004.04015.x. ISSN   0017-8748. PMID   14979889. S2CID   15204549.
  24. ↑ Zhang, Xu-Hui; Gong, Jin; Song, Yang; Hack, Gary D.; Jiang, Si-Meng; Yu, Sheng-Bo; Song, Xue; Zhang, Jing; Yang, Heng; Cheng, Jing; Sui, Hong-Jin; Zheng, Nan (July 2023). "An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex". Clinical Anatomy. 36 (5): 726–736. doi: 10.1002/ca.24048 . ISSN   0897-3806. PMID   37096831. S2CID   258310417.
  25. ↑ Labuda, Rick; Nwotchouang, Blaise Simplice Talla; Ibrahimy, Alaaddin; Allen, Philip A.; Oshinski, John N.; Klinge, Petra; Loth, Francis (January 2022). "A new hypothesis for the pathophysiology of symptomatic adult Chiari malformation Type I". Medical Hypotheses. 158: 110740. doi:10.1016/j.mehy.2021.110740. PMC   8730378 . PMID   34992329.
  26. ↑ Shao, Belinda; Poggi, Jonathan A.; Amaral-Nieves, Natalie; Wojcik, Daniel; Ma, Kevin L.; Leary, Owen P.; Klinge, Petra M. (2022-12-15). "Compromised Cranio-Spinal Suspension in Chiari Malformation Type 1: A Potential Role as Secondary Pathophysiology". Journal of Clinical Medicine. 11 (24): 7437. doi: 10.3390/jcm11247437 . ISSN   2077-0383. PMC   9788407 . PMID   36556053.
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