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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]

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

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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

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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.

References

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  1. ^ a b c 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. ^ a b 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. ^ a b 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. ^ a b 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. ^ a b 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. ^ a b c d 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. ^ a b 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. ^ a b 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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