Spine - 2026-05-15 - Journal Article
The Cervical Ligamentum Flavum and Cervicodural Ligaments: Anatomical Insights With Potential Relevance to Cervicogenic Headache.
Iwanaga J, Reina MA, Hama S, Kikuchi K, Uchikado H, Ottone NE, Maulucci CM, Keshavarzi S, Komune N, Dumont AS, Tubbs RS
Topics
Key Takeaway
Ligamentum flavum is consistently absent at C0-C1 in all 12 cadaveric specimens, replaced by novel atlantodural and axiodural ligaments connecting C1-C2 posterior elements directly to the dura.
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Summary
This cadaveric study examined the detailed anatomy of the cervical ligamentum flavum and craniocervical junction using gross dissection and Masson trichrome histology in 12 adult specimens. LF was consistently present C2-C7 with a midline vascular gap, but absent at C0-C1; instead, previously undescribed atlantodural and axiodural ligaments connected the C1 posterior arch and C2 lamina to the dura, forming a thickened dural region containing myodural bridge muscle fibers. These cervicodural ligaments are proposed as a structural basis for cervicogenic headache transmission.
Key Limitation
The small, uncharacterized specimen cohort (n=12, no demographic or pathologic data) prevents determination of whether these cervicodural ligaments vary with age, degeneration, or prior surgical disruption.
Original Abstract
STUDY DESIGN
Anatomic and histologic study of human cadaveric specimens.
OBJECTIVE
To clarify the detailed anatomy of the cervical ligamentum flavum (LF), evaluate its presence at the craniocervical junction, and describe novel cervicodural ligaments with potential clinical implications.
SUMMARY OF BACKGROUND DATA
The cervical ligamentum flavum is clinically important yet remains anatomically controversial, particularly regarding its presence and morphology at C1.
MATERIALS AND METHODS
Twelve adult cadaveric necks were examined (six gross dissections, six histologic analyses). Specimens were sectioned coronally, sagittally, and axially. The Masson trichrome staining was used to identify ligamentous structures and their relationships with adjacent tissues.
RESULTS
A distinct LF was consistently present between C2 and C7 vertebrae, attaching to adjacent laminae, blending laterally with the capsular ligament, and posteriorly with the interspinous ligament. No LF was identified at C0-C1. Instead, fibrous connections extended from the posterior arch of C1 and the lamina of C2 to the dura, forming previously undescribed atlantodural and axiodural ligaments. These cervicodural ligaments created a thickened dural region at C1-C2 and contained muscle fibers corresponding to the myodural bridge. A midline gap was observed between the right and left LF, traversed by vascular structures supplying the posterior cervical elements.
CONCLUSIONS
The cervical LF is absent at C0-C1 ( i.e., posterior atlanto-occipital membrane), where novel cervicodural ligaments connect C1-C2 to the dura. These findings refine the surgical anatomy of the craniocervical junction and may provide an anatomic basis for cervicogenic headache.