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Abstract
INTRODUCTION Cervicogenic headache, first proposed as a distinct headache in 1983, is a secondary headache to a primary cervical musculoskeletal disorder. Research into physical impairments was integral to clinical diagnosis and to develop and test research informed conservative management as the first line approach. PURPOSE This narrative presents an overview of the body of cervicogenic headache research from our laboratory which was undertaken in the context of a broad program of research into neck pain disorders. IMPLICATIONS Early research validated manual examination of the upper cervical segments against anaesthetic nerve blocks, which was vital to clinical diagnosis of cervicogenic headache. Further studies identified reduced cervical motion, altered motor control of the neck flexors, reduced strength of flexor and extensor muscles, and occasional presentation of mechanosensitivity of the upper cervical dura. Single measures are variable and not reliable in diagnosis. We proved that a pattern of reduced motion, upper cervical joint signs and impaired deep neck flexor function accurately identified cervicogenic headache and differentiated it from migraine and tension-type headache. The pattern was validated against placebo controlled diagnostic nerve blocks. A large multicentre clinical trial determined that a combined program of manipulative therapy and motor control exercise is effective in the management of cervicogenic headache and outcomes are maintained in the long term. More specific research into cervical related sensorimotor controlled is warranted in cervicogenic headache. Further adequately powered clinical trials of current research informed multimodal programs are advocated to further strengthen the evidence base for conservative management of cervicogenic headache.
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Affiliation(s)
- Gwendolen Jull
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia.
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2
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Song X, Gong J, Yu SB, Yang H, Song Y, Zhang XH, Zhang J, Hack GD, Li TL, Chi YY, Zheng N, Sui HJ. The relationship between compensatory hyperplasia of the myodural bridge complex and reduced compliance of the various structures within the cranio-cervical junction. Anat Rec (Hoboken) 2023; 306:401-408. [PMID: 35808865 PMCID: PMC10084404 DOI: 10.1002/ar.25040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/24/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
The myodural bridge complex (MDBC) is described as a functional anatomic structure that involves the dense connective tissue fibers, muscles, and ligaments in the suboccipital region. It has recently been proposed that the MDBC can influence cerebrospinal fluid (CSF) circulation. In the present study, bleomycin (BLM), a type of antibiotic that is poisonous to cells, was injected into the posterior atlanto-occipital interspace (PAOiS) of rats to induce fibrous hyperplasia of structures in PAOiS. Sagittal sections of tissues obtained from the posterior-occipital region of the rats were stained utilizing the Masson Trichrome staining method. Semiquantitative analysis evidenced that the collagen volume fraction of collagen fibers of the MDBC, as well as the sum of the area of the spinal dura mater and the posterior atlanto-occipital membrane in the BLM group were significantly increased (p < .05) compared to that of the other groups. This finding illustrates that the MDBC fibers as well as other tissues in the PAOiS of rats in the BLM group developed fibrotic changes which reduced compliance of the spinal dura mater. Indeed, the sectional area of the rectus capitis dorsal minor muscle in the BLM group was measured to be increased. These changes may further restrict CSF flow. The present research provides support for the recent hypothesis proposed by Labuda et al. concerning the pathophysiology observed in symptomatic adult Chiari malformation Type I patients, that there exists a relationship between the altered compliance of the anatomic structures within the craniocervical region and the resultant compensatory hyperplasia of the MDBC.
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Affiliation(s)
- Xue Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jin Gong
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Heng Yang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Yang Song
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Xu-Hui Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jing Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland, USA
| | - Tai-Lai Li
- The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
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Suboccipital Muscles, Forward Head Posture, and Cervicogenic Dizziness. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121791. [PMID: 36556992 PMCID: PMC9786116 DOI: 10.3390/medicina58121791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Dizziness or vertigo can be caused by dysfunction of the vestibular or non-vestibular systems. The diagnosis, treatment, and mechanism of dizziness or vertigo caused by vestibular dysfunction have been described in detail. However, dizziness by the non-vestibular system, especially cervicogenic dizziness, is not well known. This paper explained the cervicogenic dizziness caused by abnormal sensory input with references to several studies. Among head and neck muscles, suboccipital muscles act as stabilizers and controllers of the head. Structural and functional changes of the suboccipital muscles can induce dizziness. Especially, myodural bridges and activation of trigger point stimulated by abnormal head posture may be associated with cervicogenic dizziness.
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Li C, Yue C, Liu ZC, Gong J, Wei XS, Yang H, Gilmore C, Yu SB, Hack GD, Sui HJ. The relationship between myodural bridges, hyperplasia of the suboccipital musculature, and intracranial pressure. PLoS One 2022; 17:e0273193. [PMID: 36054096 PMCID: PMC9439232 DOI: 10.1371/journal.pone.0273193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
During mammalian evolution, the Myodural Bridges (MDB) have been shown to be highly conserved anatomical structures. However, the putative physiological function of these structures remains unclear. The MDB functionally connects the suboccipital musculature to the cervical spinal dura mater, while passing through the posterior atlanto-occipital and atlanto-axial interspaces. MDB transmits the tensile forces generated by the suboccipital muscles to the cervical dura mater. Moreover, head movements have been shown to be an important contributor to human CSF circulation. In the present study, a 16-week administration of a Myostatin-specific inhibitor, ACE-031, was injected into the suboccipital musculature of rats to establish an experimental animal model of hyperplasia of the suboccipital musculature. Using an optic fiber pressure measurement instrument, the present authors observed a significant increase in intracranial pressure (ICP) while utilizing the hyperplasia model. In contrast, surgically severing the MDB connections resulted in a significant decrease in intracranial pressure. Thus, these results indicated that muscular activation of the MDB may affect CSF circulation, suggesting a potential functional role of the MDB, and providing a new research perspective on CSF dynamics.
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Affiliation(s)
- Chan Li
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Chen Yue
- Department of Gynecology and Obstetrics, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhao-Chang Liu
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Jin Gong
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Xiao-Song Wei
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Heng Yang
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Campbell Gilmore
- Medical School, St. George’s University of London, London, United Kingdom
| | - Sheng-Bo Yu
- Department of Anatomy, Dalian Medical University, Dalian, China
| | - Gary D. Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, Maryland, United States of America
- * E-mail: (HJS); (GDH)
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, China
- * E-mail: (HJS); (GDH)
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Scali F, Ohno A, Enix D, Hassan S. The Posterior Atlantooccipital Membrane: The Anchor for the Myodural Bridge and Meningovertebral Structures. Cureus 2022; 14:e25484. [PMID: 35686279 PMCID: PMC9170425 DOI: 10.7759/cureus.25484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Sheet plastination has provided evidence that the posterior atlantooccipital membrane attaches to the dura's posterior sleeve at the cerebrospinal junction. These findings contradict the traditional anatomical description of this membrane extending from the atlas' posterior arch to the foramen magnum. METHODS A total of 16 plastinated cadavers were studied to evaluate the in situ and gross configuration of the posterior atlantooccipital membrane. Fifteen cadavers underwent sheet plastination, and one head was hemisected and plastinated. In all specimens, stereomicroscopy was used to evaluate the posterior atlantooccipital membrane and related structures within the intervertebral and epidural spaces. RESULTS In all 16 specimens, the posterior atlantooccipital membrane extending from the occiput, merged with the craniocervical dura mater, and formed a membrane-dura complex that ended at the level of the third cervical vertebra. The superior and inferior myodural bridge coalesced with their respective vertebrodural ligaments and fused with the posterior atlantooccipital membrane at their respective interspaces. CONCLUSION The median aspect of the posterior atlantooccipital membrane does not directly communicate with the posterior arch of the atlas. Instead, the posterior atlantooccipital membrane converges with the craniocervical dura mater and terminates at the level of the third cervical vertebra. This membrane-dura complex serves as a common attachment site for the myodural and vertebrodural structures.
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Affiliation(s)
- Frank Scali
- Medical Education and Anatomy, California University of Science and Medicine, Colton, USA
| | - Ai Ohno
- Medicine, California University of Science and Medicine, Colton, USA
| | - Dennis Enix
- Research, Independent Investigator, Ballwin, USA
| | - Sherif Hassan
- Medical Education and Anatomy, California University of Science and Medicine, Colton, USA
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Wang J, Li Y, Wang M, Yang S. Localization of the Center of the Intramuscular Nerve Dense Region of the Suboccipital Muscles: An Anatomical Study. Front Neurol 2022; 13:863446. [PMID: 35463128 PMCID: PMC9019081 DOI: 10.3389/fneur.2022.863446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to determine the body surface puncture position and depth of the center of the intramuscular nerve dense region in the suboccipital muscle to provide morphological guidance for accurate botulinum toxin A injection to treat headaches caused by increased suboccipital muscle tension. Methods Twenty-four cadavers aged 66.5 ± 5.3 years were studied. The curve line connecting occipital eminence or mastoid process and spinous process of the 7th cervical vertebrae was considered the longitudinal reference line (L) and horizontal reference line (H), respectively. Sihler's staining, barium sulfate labeling, and CT were employed. The body surface projection point of the center of the intramuscular nerve dense region was designated as P. The projection of the center of the intramuscular nerve dense region was in the opposite direction across the transverse plane and was recorded as P'. The intersections of the vertical line through point P and lines L and H were designated as PL and PH. The percentage position of the PH and PL points on the H and L lines and the depths of the center of intramuscular nerve dense regions were identified. Results Sihler's staining showed one intramuscular nerve-dense region in each suboccipital muscle. The PH of the center of the intramuscular nerve dense region was located at 51.40, 45.55, 20.55, and 43.50%. The PL was located at 31.38, 30.08, 16.91, and 52.94%. The depth of the center of the intramuscular nerve dense region was at 22.26, 22.54, 13.14, and 27.30%. These percentage values are all the means. Conclusion Accurately defining the body surface position and depth of the center of intramuscular nerve dense region in suboccipital muscles will help to improve botulinum toxin A to target localization efficiency for treating tension-type headache.
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Affiliation(s)
- Jie Wang
- Department of Pain, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yanrong Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Meng Wang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
| | - Shengbo Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, China
- *Correspondence: Shengbo Yang
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Zhang ZX, Gong J, Yu SB, Li C, Sun JX, Ding SW, Ma GJ, Sun SZ, Zhou L, Hack GD, Zheng N, Sui HJ. A specialized myodural bridge named occipital-dural muscle in the narrow-ridged finless porpoise (Neophocaena asiaeorientalis). Sci Rep 2021; 11:15485. [PMID: 34326428 PMCID: PMC8322066 DOI: 10.1038/s41598-021-95070-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
A dense bridge-like tissue named the myodural bridge (MDB) connecting the suboccipital muscles to the spinal dura mater was originally discovered in humans. However, recent animal studies have revealed that the MDB appears to be an evolutionarily conserved anatomic structure which may have significant physiological functions. Our previous investigations have confirmed the existence of the MDB in finless porpoises. The present authors conducted research to expound on the specificity of the MDB in the porpoise Neophocana asiaeorientalis (N.asiaeorientalis). Five carcasses of N.asiaeorientalis, with formalin fixation, were used for the present study. Two of the carcasses were used for head and neck CT scanning, three-dimensional reconstructions, and gross dissection of the suboccipital region. Another carcass was used for a P45 plastination study. Also, a carcass was used for a histological analysis of the suboccipital region and also one was used for a Scanning Electron Microscopy study. The results revealed that the MDB of the N.asiaeorientalis is actually an independent muscle originating from the caudal border of the occiput, passing through the posterior atlanto-occipital interspace, and then attaches to the cervical spinal dura mater. Thus the so called MDB of the N.asiaeorientalis is actually an independent and uniquely specialized muscle. Based on the origin and insertion of this muscle, the present authors name it the ‘Occipital-Dural Muscle’. It appears that the direct pull of this muscle on the cervical spinal dura mater may affect the circulation of the cerebrospinal fluid by altering the volume of the subarachnoid space via a pumping action.
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Affiliation(s)
- Zhao-Xi Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jin Gong
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Chan Li
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Jing-Xian Sun
- College of Fisheries and Life Science, Dalian Ocean University, Dalian, China
| | - Shuai-Wen Ding
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Guo-Jun Ma
- Department of Engineering Mechanics, Dalian University of Technology, Dalian, China
| | - Shi-Zhu Sun
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Lin Zhou
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Gary D Hack
- Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China. .,Dalian Hoffen Preservation Technique Institution, Dalian, China.
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The morphology, biomechanics, and physiological function of the suboccipital myodural connections. Sci Rep 2021; 11:8064. [PMID: 33850172 PMCID: PMC8044117 DOI: 10.1038/s41598-021-86934-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
The myodural bridge (MDB) connects the suboccipital musculature to the spinal dura mater (SDM) as it passed through the posterior atlanto-occipital and the atlanto-axial interspaces. Although the actual function of the MDB is not understood at this time, it has recently been proposed that head movement may assist in powering the movement of cerebrospinal fluid (CSF) via muscular tension transmitted to the SDM via the MDB. But there is little information about it. The present study utilized dogs as the experimental model to explore the MDB’s effects on the CSF pressure (CSFP) during stimulated contractions of the suboccipital muscles as well as during manipulated movements of the atlanto-occiptal and atlanto-axial joints. The morphology of MDB was investigated by gross anatomic dissection and by histological observation utilizing both light microscopy and scanning electron microscopy. Additionally biomechanical tensile strength tests were conducted. Functionally, the CSFP was analyzed during passive head movements and electrical stimulation of the suboccipital muscles, respectively. The MDB was observed passing through both the dorsal atlanto-occipital and the atlanto-axial interspaces of the canine and consisted of collagenous fibers. The tensile strength of the collagenous fibers passing through the dorsal atlanto-occipital and atlanto-axial interspaces were 0.16 ± 0.04 MPa and 0.82 ± 0.57 MPa, respectively. Passive head movement, including lateral flexion, rotation, as well as flexion–extension, all significantly increased CSFP. Furthermore, the CSFP was significantly raised from 12.41 ± 4.58 to 13.45 ± 5.16 mmHg when the obliques capitis inferior (OCI) muscles of the examined specimens were electrically stimulated. This stimulatory effect was completely eliminated by severing the myodural bridge attachments to the OCI muscle. Head movements appeared to be an important factor affecting CSF pressure, with the MDB of the suboccipital muscles playing a key role this process. The present study provides direct evidence to support the hypothesis that the MDB may be a previously unappreciated significant power source (pump) for CSF circulation.
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Chen C, Yu SB, Chi YY, Tan GY, Yan BC, Zheng N, Sui HJ. Existence and features of the myodural bridge in Gentoo penguins: A morphological study. PLoS One 2021; 16:e0244774. [PMID: 33831002 PMCID: PMC8031436 DOI: 10.1371/journal.pone.0244774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 12/03/2022] Open
Abstract
Recent studies have evidenced that the anatomical structure now known as the myodural bridge (MDB) connects the suboccipital musculature to the cervical spinal dura mater (SDM). In humans, the MDB passes through both the posterior atlanto-occipital and the posterior atlanto-axial interspaces. The existence of the MDB in various mammals, including flying birds (Rock pigeons and Gallus domesticus) has been previously validated. Gentoo penguins are marine birds, able to make 450 dives per day, reaching depths of up to 660 feet. While foraging, this penguin is able to reach speeds of up to 22 miles per hour. Gentoo penguins are also the world’s fastest diving birds. The present study was therefore carried out to investigate the existence and characteristics of the MDB in Gentoo penguin (Pygoscelis papua), a non-flying, marine bird that can dive. For this study, six Gentoo penguin specimens were dissected to observe the existence and composition of their MDB. Histological staining was also performed to analyze the anatomic relationships and characteristic of the MDB in the Gentoo penguin. In this study, it was found that the suboccipital musculature in the Gentoo penguin consists of the rectus capitis dorsalis minor (RCDmi) muscle and rectus capitis dorsalis major (RCDma) muscle. Dense connective tissue fibers were observed connecting these two suboccipital muscles to the spinal dura mater (SDM). This dense connective tissue bridge consists of primarily type I collagen fibers. Thus, this penguin’s MDB appears to be analogous to the MDB previously observed in humans. The present study evidences that the MDB not only exists in penguins but it also has unique features that distinguishes it from that of flying birds. Thus, this study advances the understanding of the morphological characteristics of the MDB in flightless, marine birds.
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Affiliation(s)
- Cheng Chen
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Sheng-bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Yan-yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
| | - Guang-yuan Tan
- Haichang Ocean Park Holdings., Ltd, Biological Conservation Center, Shanghai, China
| | - Bao-cheng Yan
- Haichang Ocean Park Holdings., Ltd, Biological Conservation Center, Shanghai, China
| | - Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
- * E-mail: (HJS); (NZ)
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, China
- Dalian Hoffen Preservation Institution, Dalian, China
- * E-mail: (HJS); (NZ)
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Abstract
Osteopathic medicine is a medical specialty that enjoys a high level of recognition and increasing popularity among patients. High-quality education and training are essential to ensure good and safe patient treatment. At a superficial glance, osteopathy could be misunderstood as a myth; accurately considered, osteopathic medicine is grounded in medical and scientific knowledge and solid theoretical and practical training. Scientific advances increasingly confirm the empirical experience of osteopathy. Although more studies on its efficacy could be conducted, there is sufficient evidence for a reasonable application of osteopathy. Current scientific studies show how a manually executed osteopathic intervention can induce tissue and even cellular reactions. Because the body actively responds to environmental stimuli, osteopathic treatment is considered an active therapy. Osteopathic treatment is individually applied and patients are seen as an integrated entity. Because of its typical systemic view and scientific interpretation, osteopathic medicine is excellently suited for interdisciplinary cooperation. Further work on external evidence of osteopathy is being conducted, but there is enough knowledge from the other pillars of evidence-based medicine (EBM) to support the application of osteopathic treatment. Implementing careful, manual osteopathic examination and treatment has the potential to cut healthcare costs. To ensure quality, osteopathic societies should be intimately involved and integrated in the regulation of the education, training, and practice of osteopathic medicine.
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Affiliation(s)
- Kilian Dräger
- , Beim Andreasbrunnen 7, 20249, Hamburg, Deutschland.
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Sun MY, Han X, Wang MY, Ning DX, Xu B, Xie LZ, Yu SB, Sui HJ. Relationship between the sectional area of the rectus capitis posterior minor and the to be named ligament from 3D MR imaging. BMC Musculoskelet Disord 2020; 21:101. [PMID: 32059665 PMCID: PMC7023802 DOI: 10.1186/s12891-020-3123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the maximal sectional area (SA) of the rectus capitis posterior minor (RCPmi) muscle and its potential correlation with to be named ligament (TBNL) in the suboccipital area using 3D MR imaging. Methods A total of 365 subjects underwent sagittal 3D T2WI MR imaging of the RCPmi and TBNL. Among them, 45 subjects were excluded due to a particular clinical history or poor image quality. Finally, 320 subjects met the inclusion criteria, including 138 men and 182 women. The 624 RCPmi muscles were classified into positive and negative groups according to their attachment to the TBNL. Two experienced radiologists manually measured the maximum SA of the RCPmi muscle on the parasagittal image with a 30° deviation from the median sagittal plane. The correlations between the SA and the subject’s age, height, BMI, gender, handedness, and age-related disc degeneration were tested by Spearman analysis. The SA differences between different groups were compared using independent samples t-test. Results A total of 123 RCPmi-TBNL attachments were identified in the positive group, while 501 RCPmi muscles were identified in the negative group. The SA of the 624 RCPmi muscles was 62.71 ± 28.72 mm2 and was poorly correlated with the subject’s age, BMI, or handedness, with no correlation with age-related disc degeneration. A fair correlation was found between the SA and the body height in the whole group, and poor correlation in each male/female group. The SA of the RCPmi muscle in males was significantly bigger than that in women ([75.54 ± 29.17] vs. [52.74 ± 24.07] mm2). The SA of RCPmi muscle in the positive group was significantly smaller than that in the negative group ([55.95 ± 26.76] mm2 vs. [64.37 ± 28.97] mm2). Conclusions Our results revealed a significantly smaller SA of the RCPmi in subjects with RCPmi-TBNL attachment. Besides, a larger SA of the RCPmi was correlated with the male gender. These findings suggest that the SA of the RCPmi ought to be interpreted with care for each patient since there could be considerable variations.
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Affiliation(s)
- Mei-Yu Sun
- Department of radiology, the first affiliated hospital of Dalian Medical University, Dalian, China
| | - Xu Han
- Department of radiology, the first affiliated hospital of Dalian Medical University, Dalian, China
| | - Meng-Yao Wang
- Department of radiology, the first affiliated hospital of Dalian Medical University, Dalian, China
| | - Dian-Xiu Ning
- Department of radiology, the first affiliated hospital of Dalian Medical University, Dalian, China
| | - Bin Xu
- Department of radiology, the first affiliated hospital of Dalian Medical University, Dalian, China
| | | | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, People's Republic of China
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, 116044, People's Republic of China.
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Zheng N, Chung BS, Li YL, Liu TY, Zhang LX, Ge YY, Wang NX, Zhang ZH, Cai L, Chi YY, Zhang JF, Samuel OC, Yu SB, Sui HJ. The myodural bridge complex defined as a new functional structure. Surg Radiol Anat 2019; 42:143-153. [PMID: 31563971 DOI: 10.1007/s00276-019-02340-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The connective tissue between suboccipital muscles and the cervical spinal dura mater (SDM) is known as the myodural bridge (MDB). However, the adjacent relationship of the different connective tissue fibers that form the MDB remains unclear. This information will be highly useful in exploring the function of the MDB. METHODS The adjacent relationship of different connective tissue fibers of MDB was demonstrated based upon three-dimensional visualization model, P45 plastinated slices and histological sections of human MDB. RESULTS We found that the MDB originating from the rectus capitis posterior minor muscle (RCPmi), rectus capitis posterior major muscle (RCPma) and obliquus capitis inferior muscle (OCI) in the suboccipital region coexists. Part of the MDB fibers originate from the ventral aspect of the RCPmi and, together with that from the cranial segment of the RCPma, pass through the posterior atlanto-occipital interspace (PAOiS) and enter into the posterior aspect of the upper cervical SDM. Also, part of the MDB fibers originate from the dorsal aspect of the RCPmi, the ventral aspect of the caudal segment of the RCPma, and the ventral aspect of the medial segment of the OCI, enter the central part of the posterior atlanto-axial interspace (PAAiS) and fuse with the vertebral dura ligament (VDL), which connects with the cervical SDM. CONCLUSIONS Our findings prove that the MDB exists as a complex structure which we termed the 'myodural bridge complex' (MDBC). In the process of head movement, tensile forces could be transferred possibly and effectively by means of the MDBC. The concept of MDBC will be beneficial in the overall exploration of the function of the MDB.
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Affiliation(s)
- Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Beom Sun Chung
- Department of Anatomy, Ajou University School of Medicine, Worldcup-ro 164, Suwon, 443-749, Republic of Korea
| | - Yi-Lin Li
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Tai-Yuan Liu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Lan-Xin Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Yang-Yang Ge
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Nan-Xing Wang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Zhi-Hong Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Lin Cai
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Jian-Fei Zhang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Okoye Chukwuemeka Samuel
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, 9 West Section, Lushun South Road, Dalian, People's Republic of China.
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Kapp A, Paethke M, Baqué M, Nebel R. Baseline of upper teeth: (a) Control organ for spatial navigation? (b) Weak point for misaligned posture and pain? Med Hypotheses 2019; 133:109391. [PMID: 31525635 DOI: 10.1016/j.mehy.2019.109391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/03/2019] [Indexed: 10/26/2022]
Abstract
Our observations question both the current doctrine of spatial orientation as processed by vestibular, visual and proprioceptive impressions as well as the horizontal alignment of the eye axis. Indeed our observations suggest spatial orientation as a physically based, largely mechanically transmitted interaction between individual and environment. It is controlled by an interface defined by the baseline of upper teeth. It simultaneously constitutes both body and environment acting as an integral part of that environment. Consequently, the baseline of upper teeth is part of the aforementioned environment. Instead of the eye axis during spatial orientation it aligns the true horizontal absolutely. This was tested by fixing a cross to upper teeth. While walking, running and jumping it did not deviate by more than 2° from the external axis. Subsequently, we inclined the baseline of upper teeth by inserting an asymmetric wafer so that it angulated the eye axis. Immediately, head, visual and vestibular axes tilted unstably with misaligned body posture. Only the indicative cross remained stably aligned to the external axes. The person felt "upright", not noticing his posture had changed. He was then instructed to straighten his shoulders and trunk until his posture was objectively nearly upright again. The voluntary correction caused the indicative cross to tilt. The person felt uneven while being more upright. We concluded that the automatic posture works by "synchronizing" the baseline of upper teeth to the external axis and that the synchronized position is supported by the vestibular system. Benefit of an interface is that the body's movements in the environment simultaneously happen within the baseline of upper teeth. Therein the vectors of the body and the environment are calculated to remain in balance. This model introduces the transmission of the vector information to postural muscles by the dura mater, controlled by tension between C0-C2. The information is skewed by bony dislocations between C0-C2 caused by an inclination of the interface. The resulting misalignments of posture are foreseeable and specifically correspond to the type of inclination. They occur in a broad section of the population. Diagnosed as muscular weakness, they may cause therapy resistant common diseases like back and joint pain after 5-10 years. Following our observations, the inclination of the baseline of upper teeth originates from inattentive changes in the length of upper teeth in dental treatment. Multiple treatments optimizing teeth length in long term patients improved the patients' situation.
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Affiliation(s)
- Anne Kapp
- Independent Researchers, Christstraße 36 , Berlin 14197 Germany.
| | - Marianne Paethke
- Independent Researchers, Kreuznacher Str. 66, Berlin 14197, Germany.
| | - Manfred Baqué
- Independent Researchers, Kreuznacher Str. 66, Berlin 14197, Germany.
| | - Ruth Nebel
- Independent Researchers, Steinrueckweg 8, Berlin 14197 , Germany.
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14
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McElroy A, Rashmir A, Manfredi J, Sledge D, Carr E, Stopa E, Klinge P. Evaluation of the Structure of Myodural Bridges in an Equine Model of Ehlers-Danlos Syndromes. Sci Rep 2019; 9:9978. [PMID: 31292490 PMCID: PMC6620297 DOI: 10.1038/s41598-019-46444-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/25/2019] [Indexed: 11/28/2022] Open
Abstract
Myodural bridges have been described in various species as connective tissue structures “bridging” small cranio-cervical muscles to the dura. Myodural bridges are thought to stabilize the dural sac during head and neck movements and promote cerebrospinal fluid motion; however, their role in neurological diseases has not yet been established. We report ultrasonographic visualization, necropsy, histopathologic and ultrastructural findings of myodural bridges in horses with hereditary equine regional dermal asthenia (HERDA), an equine model of Ehlers-Danlos syndromes. Five HERDA and 5 control horses were studied. Post-mortem examination and ultrasonographic studies (3 HERDA and 4 controls) demonstrated that the atlanto-occipital and atlanto-axial myodural bridges are dynamic structures “moving” the dura. En block resection of the myodural bridges (4 HERDA and 5 controls) was accomplished and histopathology showed myofiber degeneration in 3 HERDA horses and 1 control. Ultrastructural examination revealed loosely packed collagen fibrils with abnormal orientation in all HERDA horses compared to mild abnormalities in 2 controls. Our study provides necropsy and ultrasonographic evidence of the dynamic aspect of the myodural bridges as dural sac stabilizers. Myodural bridges may be pathologically altered in connective tissue disease as evidenced by the ultrastructural morphology in the HERDA myodural bridge.
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Affiliation(s)
- Abigail McElroy
- Michigan State University College of Veterinary Medicine, Large Animal Clinical Sciences, East Lansing, MI, USA.
| | - Ann Rashmir
- Michigan State University College of Veterinary Medicine, Large Animal Clinical Sciences, East Lansing, MI, USA
| | - Jane Manfredi
- Michigan State University College of Veterinary Medicine, Pathobiology and Diagnostic Investigation, East Lansing, MI, USA
| | - Dodd Sledge
- Michigan State University Veterinary Diagnostic Laboratory, Lansing, MI, USA
| | - Elizabeth Carr
- Michigan State University College of Veterinary Medicine, Large Animal Clinical Sciences, East Lansing, MI, USA
| | - Edward Stopa
- Rhode Island Hospital, Departments of Pathology and Neurosurgery, Providence, RI, USA
| | - Petra Klinge
- Rhode Island Hospital, Department of Neurosurgery, Providence, RI, USA
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15
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Kitamura K, Cho KH, Yamamoto M, Ishii M, Murakami G, Rodríguez-Vázquez JF, Abe SI. Suboccipital myodural bridges revisited: Application to cervicogenic headaches. Clin Anat 2019; 32:914-928. [PMID: 31116454 DOI: 10.1002/ca.23411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 12/26/2022]
Abstract
There seems to be no complete demonstration of the suboccipital fascial configuration. In 30 human fetuses near term, we found two types of candidate myodural bridge: (1) a thick connective tissue band running between the rectus capitis posterior major and minor muscles (rectus capitis posterior major [Rma], rectus capitis posterior minori [Rmi]; Type 1 bridge; 27 fetuses); and (2) a thin fascia extending from the upper margin of the Rmi (Type 2 bridge; 20 fetuses). Neither of these bridge candidates contained elastic fibers. The Type 1 bridge originated from: (1) fatty tissue located beneath the semispinalis capitis (four fetuses); (2) a fascia covering the multifidus (nine); (3) a fascia bordering between the Rma and Rmi or lining the Rma (13); (4) a fascia covering the inferior aspect of the Rmi (three); and (5) a common fascia covering the Rma and obliquus capitis inferior muscle (nine). Multiple origins usually coexisted in the 27 fetuses. In the minor Type 2 bridge, composite fibers were aligned in the same direction as striated muscle fibers. Thus, force transmission via the thin fascia seemed to be effective along a straight line. However, in the major Type 1 bridges, striated muscle fibers almost always did not insert into or originate from the covering fascia. Moreover, at and near the dural attachment, most composite fibers of Type 1 bridges were interrupted by subdural veins and dispersed around the veins. In newborns, force transmission via myodural bridges was likely to be limited or ineffective. The postnatal growth might determine a likely connection between the bridge and headache. Clin. Anat. 32:914-928, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Kei Kitamura
- Department of Histology and Developmental Biology, Tokyo Dental College, Tokyo, Japan
| | - Kwang Ho Cho
- Department of Neurology, Wonkwang University School of Medicine and Hospital, Institute of Wonkwang Medical Science, Iksan, Jeonbuk, South Korea
| | | | | | - Gen Murakami
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan.,Division of Internal Medicine, Jikoukai Home Visits Clinic, Sapporo, Japan
| | | | - Shin-Ichi Abe
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
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Kuć J, Szarejko KD, Aleksandrowicz K, Gołębiewska M. The role of soft tissue mobilization in reducing orofacial and general complaints in a patient with Kimmerle anomaly and temporomandibular joint disorder: A case report. Cranio 2019; 39:74-87. [DOI: 10.1080/08869634.2018.1560616] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna Kuć
- Department of Prosthodontics, Medical University of Bialystok, Bialystok, Poland
| | | | - Krzysztof Aleksandrowicz
- Department of Health Care Sciences, History of Physical Medicine and Balneology, Medical University of Wroclaw, Wroclaw, Poland
| | - Maria Gołębiewska
- Department of Prosthodontics, Medical University of Bialystok, Bialystok, Poland
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17
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Abstract
Recent studies have identified that the myodural bridge (MDB) is located between the suboccipital muscles and cervical dura mater in the posterior atlanto-occipital interspace within humans. The myodural bridge has been considered to have a significant role in physiological functions. However, there is little information about the myodural bridge in marine mammals; we conducted this study to investigate and examine the morphology of the myodural bridge in a sperm whale. We also aim to discuss the physiological functions of the myodural bridge. In this study, a 15.1-meter long sperm whale carcass was examined. Multiple methods were conducted to examine the bridges of the sperm whale which included dissection, P45 plastination and histological analysis. This study confirmed the existence of the myodural bridge in the sperm whale and shows there are two types of the bridge in the sperm whale: one type was the occipital-dural bridge (ODB), the other type was the MDB. A large venous plexus was found within the epidural space and this venous plexus is thought to contain a great amount of blood when in deep water and thus the movements of suboccipital muscles could be a unique power source that drives cerebrospinal fluid circulation.
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18
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Orientation and property of fibers of the myodural bridge in humans. Spine J 2018; 18:1081-1087. [PMID: 29477753 DOI: 10.1016/j.spinee.2018.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/24/2018] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Studies over the past 20 years have revealed that there are fibrous connective tissues between the suboccipital muscles, nuchal ligament, and cervical spinal dura mater (SDM). This fibrous connection with the SDM is through the posterior atlanto-occipital or atlantoaxial interspaces and is called the myodural bridge (MDB). Researchers have inferred that the MDB might have important functions. It was speculated that the function of MDB might be related to proprioception transmission, keeping the subarachnoid space and the cerebellomedullary cistern unobstructed, and affecting the dynamic circulation of the cerebrospinal fluid. In addition, clinicians have found that the pathologic change of the MDB might cause cervicogenic or chronic tension-type headache. Previous gross anatomical and histologic studies only confirmed the existence of the MDB but did not reveal the fiber properties of the MDB. This is important to further mechanical and functional research on the MDB. PURPOSE Multiple histologic staining methods were used in the present study to reveal the various origin and fiber properties of the MDB. Muscles and ligaments participating in forming the MDB at the posterior atlanto-occipital or atlantoaxial interspaces were observed, and the fiber properties of the MDB were confirmed. The present study provides a basis for speculating the tensile force values of the MDB on the SDM and a morphologic foundational work for exploring the physiological functions and clinical significances of the MDB. STUDY DESIGN Anatomical and histologic analyses of suboccipital structures that communicate with the SDM at the posterior atlanto-occipital or atlantoaxial interspaces were carried out. METHODS Multiple histologic staining methods were used to evaluate the histologic properties and composition of the MDB at the posterior atlanto-occipital or atlantoaxial interspaces in five formalin-fixed head-neck human specimens. RESULTS The results show that the MDB traversing the atlanto-occipital interspace originated from the rectus capitis posterior minor (RCPmi). The MDB traversing the atlantoaxial interspace originated mainly from the RCPmi, rectus capitis posterior major, and obliquus capitis inferior. These fibers form the vertebral dural ligament in the atlantoaxial interspace and connect with SDM. The MDB is mainly formed by parallel running type I collagen fibers; thus, suboccipital muscle could pull SDM strongly through the effective force propagated by the MDB during head movement. CONCLUSIONS Myodural bridge is mainly formed by parallel running type I collagen fibers; thus, it can transmit the strong pull from the diverse suboccipital muscles or ligaments during head movement. The results of the present study will serve as a basis for further biomechanical and functional MDB research.
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19
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A simplified ultrasonography-guided approach for neurotoxin injection into the obliquus capitis inferior muscle in spasmodic torticollis. J Neural Transm (Vienna) 2018; 125:1037-1042. [DOI: 10.1007/s00702-018-1866-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/20/2018] [Indexed: 12/20/2022]
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20
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Zheng N, Yuan XY, Chi YY, Liu P, Wang B, Sui JY, Han SH, Yu SB, Sui HJ. The universal existence of myodural bridge in mammals: an indication of a necessary function. Sci Rep 2017; 7:8248. [PMID: 28811472 PMCID: PMC5557938 DOI: 10.1038/s41598-017-06863-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/20/2017] [Indexed: 11/09/2022] Open
Abstract
The “myodural bridge” was described in literatures as a dense fibrous tissue connecting the sub-occipital musculature with the spinal dura mater in human studies. Now the concept of “myodural bridge” was perceived as an exact anatomical structure presumably essential for critical physiological functions in human body, and might exist in other mammals as well. To determine the existence of the “myodural bridge” in other mammals and to lay a foundation for the functional study, we examined representatives in five different mammalian orders. Based on the anatomical dissections, P45 plastinated sections and histological sections, we found that a dense fibrous tissue connected the rectus capitisdorsalis minor and the spinal dura mater through the dorsal atlanto-occipital interspace with or without the medium of the posterior atlanto-occipital membrane. These observed connective tissues were very similar to the “myodural bridge” previously described in humans. We proposed that the “myodural bridge”, as an evolutionally conserved structure, presents in many other mammals. Moreover, we believed that the “myodural bridge” might be a homologous organ in mammals. Thus, this study could provide an insight for our understanding the physiological significance of the “myodural bridge”, especially in human.
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Affiliation(s)
- Nan Zheng
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Pei Liu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Bing Wang
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Jia-Ying Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China
| | - Seung-Ho Han
- Department of Anatomy, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sheng-Bo Yu
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China.
| | - Hong-Jin Sui
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P.R. China. .,Dalian Hoffen Preservation Technique Institution, Dalian, P.R. China.
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21
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A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater: The Myodural Bridge. Spine (Phila Pa 1976) 2017; 42:49-54. [PMID: 27116115 DOI: 10.1097/brs.0000000000001655] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. SUMMARY OF BACKGROUND DATA Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. METHODS Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non-post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements. RESULTS Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater. CONCLUSION There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders. LEVEL OF EVIDENCE N/A.
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22
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Xu Q, Yu SB, Zheng N, Yuan XY, Chi YY, Liu C, Wang XM, Lin XT, Sui HJ. Head movement, an important contributor to human cerebrospinal fluid circulation. Sci Rep 2016; 6:31787. [PMID: 27538827 PMCID: PMC4990938 DOI: 10.1038/srep31787] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/26/2016] [Indexed: 11/23/2022] Open
Abstract
The suboccipital muscles are connected to the upper cervical spinal dura mater via the myodural bridges (MDBs). Recently, it was suggested that they might work as a pump to provide power for cerebrospinal fluid (CSF) circulation. The purpose of this study was to investigate effects of the suboccipital muscles contractions on the CSF flow. Forty healthy adult volunteers were subjected to cine phase-contrast MR imaging. Each volunteer was scanned twice, once before and once after one-minute-head-rotation period. CSF flow waveform parameters at craniocervical junction were analyzed. The results showed that, after the head rotations, the maximum and average CSF flow rates during ventricular diastole were significantly increased, and the CSF stroke volumes during diastole and during entire cardiac cycle were significantly increased. This suggested that the CSF flow was significantly promoted by head movements. Among the muscles related with head movements, only three suboccipital muscles are connected to the upper cervical spinal dura mater via MDBs. It was believed that MDBs might transform powers of the muscles to CSF. The present results suggested that the head movements served as an important contributor to CSF dynamics and the MDBs might be involved in this mechanism.
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Affiliation(s)
- Qiang Xu
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China.,Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, 116021, China
| | - Sheng-Bo Yu
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Nan Zheng
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Xiao-Ying Yuan
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Yan-Yan Chi
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Cong Liu
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China.,Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, 116021, China
| | - Xue-Mei Wang
- Department of Radiology, Dalian Municipal Central Hospital, Dalian, 116033, China
| | - Xiang-Tao Lin
- Shandong Medical Imaging Research Institute, School of Medicine, Shandong University, Jinan, 250021, China
| | - Hong-Jin Sui
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
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23
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Yuan XY, Yu SB, Liu C, Xu Q, Zheng N, Zhang JF, Chi YY, Wang XG, Lin XT, Sui HJ. Correlation between chronic headaches and the rectus capitis posterior minor muscle: A comparative analysis of cross-sectional trail. Cephalalgia 2016; 37:1051-1056. [PMID: 27534669 DOI: 10.1177/0333102416664775] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective We aimed to investigate the morphological changes and potential correlation between chronic headaches and the rectus capitis posterior minor muscle (RCPmi). Methods Comparison of RCPmi between patients with chronic headaches and healthy adult volunteers were collected using magnetic resonance imaging (MRI) and Mimics software. Results Among the 235 MRI images analyzed, the data between the two groups were considered statistically significant. The number of males was larger than that of females ( p < 0.001) and the headache group showed greater hypertrophy than the control group in both males ( p < 0.001) and females ( p = 0.001). Conclusions Chronic headaches were correlated with the RCPmi. Patients with chronic headaches suffered from more obvious hypertrophy than that of the control group. Additionally, it was supposed that RCPmi hypertrophy may be one pathogenesis of the chronic headaches.
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Affiliation(s)
- Xiao-Ying Yuan
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Sheng-Bo Yu
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Cong Liu
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China.,2 Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, P. R. China
| | - Qiang Xu
- 2 Department of Radiology, The 403 Affiliated Hospital of Chinese PLA General Hospital, Dalian, P. R. China
| | - Nan Zheng
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Jian-Fei Zhang
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Yan-Yan Chi
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
| | - Xu-Gang Wang
- 3 Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian, P. R. China
| | - Xiang-Tao Lin
- 4 Shangdong Medical Imaging Research Institute, School of Medicine, Shandong University, Jinan, P. R. China
| | - Hong-Jin Sui
- 1 Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian, P. R. China
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Zhang JH, Tang W, Zhang ZX, Luan BY, Yu SB, Sui HJ. Connection of the Posterior Occipital Muscle and Dura Mater of the Siamese Crocodile. Anat Rec (Hoboken) 2016; 299:1402-8. [PMID: 27507762 DOI: 10.1002/ar.23445] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/06/2015] [Accepted: 08/20/2015] [Indexed: 11/07/2022]
Abstract
The myodural bridge was proposed initially in 1995. The myodural bridge is a connective tissue bridge that connects a pair of deep muscles at the suboccipital region to the dura mater. There have been numerous studies concerning the morphology and function of the myodural bridge. To determine whether a myodural bridge exists in reptiles, six Siamese crocodiles were investigated using gross anatomy dissection and P45 sheet plastination technologies. As a result, we demonstrated that the posterior occipital muscles of the Siamese crocodile are directly or indirectly connected to the proatlas, atlas, and intermembrane between them. Multiple trabeculae existing in the posterior epidural space extended from the ventral surface of the proatlas, atlas, and intermembrane between them to the dorsal surface of the spinal dura mater. This study showed that the posterior occipital muscle in the suboccipital region of the Siamese crocodile is connected to the spinal dura mater through the proatlas, atlas, and the trabeculae. In conclusion, a myodural bridge-like structure exists in reptiles. This connection may act as a pump to provide cerebrospinal fluid (CSF) circulation at the occipitocervical junction. We hypothesize that a physiologic role of the Siamese crocodile's myodural bridge may be analogous to the human myodural bridge. Anat Rec, 299:1402-1408, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jing-Hui Zhang
- Department of Anatomy College of Basic Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Wei Tang
- Department of Anatomy College of Basic Medicine, Dalian Medical University, Dalian, Liaoning, China
| | - Zhao-Xi Zhang
- First Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Bing-Yi Luan
- Dalian Hoffen Bio-Technique Co., Ltd, Dalian, Liaoning, China
| | - Sheng-Bo Yu
- Department of Anatomy College of Basic Medicine, Dalian Medical University, Dalian, Liaoning, China.
| | - Hong-Jin Sui
- Department of Anatomy College of Basic Medicine, Dalian Medical University, Dalian, Liaoning, China.
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Scali F, Pontell ME, Nash LG, Enix DE. Investigation of meningomyovertebral structures within the upper cervical epidural space: a sheet plastination study with clinical implications. Spine J 2015. [PMID: 26210227 DOI: 10.1016/j.spinee.2015.07.438] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Over the past two decades, soft-tissue structures communicating with the dura mater within the epidural space have become the focus of many anatomical and histopathologic studies. The relationship between these bridging structures has yet to be evaluated in situ. PURPOSE This is the first study that used E12 sheet plastination to investigate the epidural space of the upper cervical spine in situ and its associated bridging structures. Given the complexity of this space, this study may prove useful to clinical anatomists and surgeons who operate within this region. STUDY DESIGN Anatomical and microscopic analyses of structures that communicate with the dura mater within the upper cervical region were carried out. METHODS Gross dissection in conjunction with microscopy was used to evaluate bridging communications of the upper cervical spine in 10 cadavers. To evaluate the in situ arrangement of these structures, E12 sheet plastination was used on 13 cadavers. RESULTS In all 23 specimens, suboccipital fascia coalesced with the dorsal meningovertebral ligament of the atlas, and inserted directly into the posterior surface of the dura as a single but separable laminar layer. At the level of the atlantoaxial interspace, suboccipital fasciae combined and coalesced with the dorsal meningovertebral ligament of the atlas and the axis. These structures inserted into the posterior surface of the dura mater as a single but separable layer. Microscopy validated these findings and E12 sheet plastination revealed the in situ organization of these soft-tissue structures. E12 sheet plastination also provided new information on dural arrangement at the craniocervical junction, which was observed to be composed of periosteum from the occiput but consisted mainly of deep fascia from the rectus capitis posterior minor. CONCLUSIONS E12 sheet plastination has provided in situ visualization of bridging structures within the cervical epidural space and offers new insight into these structures, as well as the composition and arrangement of the posterior atlantooccipital membrane and cerebrospinal dura at the craniocervical junction. This study aims to expand on the anatomical understanding of the upper cervical region while defining structures that may reduce neurosurgical complications, and aid in the understanding of the pathophysiology of certain neurogenic disorders.
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Affiliation(s)
- Frank Scali
- American University of the Caribbean School of Medicine, 1 University Drive at Jordan Rd, Cupecoy, St. Maarten.
| | - Matthew E Pontell
- Department of Surgery, Drexel University College of Medicine, 245 N 15th St, Philadelphia, PA, USA
| | - Lance G Nash
- Department of Anatomical Sciences, American University of the Caribbean School of Medicine, 1 University Drive at Jordan Rd, Cupecoy, St. Maarten
| | - Dennis E Enix
- Division of Research, Logan University, 1851 Schoettler Rd, Chesterfield, MO 63017, USA
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Taylor FR, Cooper WM, Kaniecki RG. Abstracts and Citations. Headache 2015. [DOI: 10.1111/head.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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