What Are the Different Neck Ligaments?

It refers to the elastic membrane layer that spreads back from the spinous process of the cervical spine to the triangular plate in the neck. The ligament is often considered to be homologous to the supraspinous ligament and the interspinous ligament of the cervical spine. It attaches upward to the occipital protuberance and the occipital condyle, reaching down to the 7th cervical spine process and continuing to the supraspinous ligament. Double-layer dense elastic fiber compartment.

It refers to the elastic membrane layer that spreads back from the spinous process of the cervical spine to the triangular plate in the neck. The ligament is often considered to be homologous to the supraspinous ligament and the interspinous ligament of the cervical spine. It attaches upward to the occipital protuberance and the occipital condyle, reaching down to the 7th cervical spine process and continuing to the supraspinous ligament. Double-layer dense elastic fiber compartment.

Chinese name

Collar ligament

Foreign name

ligamentum nuchae

Anatomical definition and location of the term ligament

On both sides of the midline of the human neck, they are arranged in order from shallow to deep: trapezius (layer 1); small rhomboid muscles and upper and posterior serratus (layer 2); head muscles (layer 3); head half Achilles muscle (Layer 4); posterior head rectus muscle, oblique inferior head and cervical hemi-spinalis muscle (Layer 5); posterior head rectus muscle and rotator muscle (Layer 6), etc. The trapezius muscle, the head clamp muscle, and the hemi-spinalis muscle are present in almost all layers, while other muscles are only localized, such as the posterior large rectus muscle, the posterior small rectus muscle, and the inferior oblique muscle above the level of the vertebrae, that is, under the occipital Area, called the suboccipital muscle group.

In the midline region of the human neck, there are structurally rich but uneven connective tissues between the muscle groups on both sides. People often refer to the whole or partial structure of this area as LN. The realm of this area is as follows: the lateral border is the split surface near the midline of the muscle groups on both sides; the upper border is the extraoccipital bulge and occipital condyle of the occipital bone; the lower border is the spinous processes and superior spinal ligaments of the 6th and 7th cervical vertebrae; The anterior boundary is the posterior atlantic nodule, the second to fifth cervical spinous processes, and the posterior atlantooccipital membrane, posterior atlantoaxial membrane, and ligamentum flavum; the posterior margin is free, that is, the superficial layer of deep fascia on the left and right sides and The trapezius tendon is interlaced at the posterior midline. The 40th edition of Grignard anatomy [1] prefers to define the entire area as LN. It is considered that LN is a complex of tendon structure and fascia between the left and right muscle groups behind the neck. In the true sense, the reason is that LN does not connect adjacent bones, nor does it have a typical ligament structure. Earlier studies suggested that LN is a double-layer fibroelastic structure in the midline of the collar, a ligament junction between vertebrae, and the muscle space of the paravertebral muscle in the collar. There are also studies that expand the location of LN to both sides, and propose that the fascia located on the deep side of the head hemispinal muscle also belongs to the structure of LN, and it reaches and attaches to the occipitotemporal suture as the flanks of LN.

The function of the term ligament

The results show that human LN is a fascia system with complex structure and rich content that exists between the muscle groups on both sides. LN plays an important role in antagonizing head forward flexion [20]. As far as attachment position is concerned, LN has a leverage advantage in antagonizing head and neck forward flexion because its attachment point is far from the axis of motion [21]. Fresh human neck biomechanical studies have also shown that after LN removal, cervical spine flexion amplitude increased by 52% and tangent stiffness decreased by 27%. The basic mechanical principles of LN still exist in humans, although its role is weakening.

In humans, LN plays a more important role in maintaining head and cervical spine stability, such as stabilizing the head while maintaining cervical curvature and cervical spine. It is also pointed out in the literature that the trapezius and small rhomboid muscles connect the shoulder strap of the upper limb to the cervical spine through LN, and the head clamp muscle connects the head movement to the cervical spine through LN. It can be seen that in complex head, neck and shoulder movements, the cervical spine may be the axis of movement. In addition, Johnson and others believe that LN directly transmits muscle force to the lower cervical spine (C6, C7). LN mainly acts on the lower cervical spine and does not participate in the complex stabilization system of the upper cervical spine. Johnson et al. Calculated that the maximum force generated by the trapezius muscle on the occipital bone was 15N, while the maximum force generated by C7 was 150N. It can be seen that in the head, neck and shoulder movement axis, the lower cervical spine may play a greater role. In addition, LN has proprioceptor distribution, which may affect neck muscle activity. The connection between LN and dura mater may help to understand the biomechanical properties of cervical spine and the unknown biological functions of LN. Sui Hongjin and others speculated that this connection may be related to the cerebrospinal fluid circulation and may also help explain the cause of some cervical headaches. The results of the functional study of the ligament show that human LN is a complex structure and rich fascia system that exists between the muscle groups on both sides. LN plays an important role in antagonizing head forward flexion. In terms of attachment position, LN has a leverage advantage in antagonizing head and neck forward flexion because its attachment point is far from the axis of motion. Fresh human neck biomechanical studies have also shown that after LN removal, cervical spine flexion amplitude increased by 52% and tangent stiffness decreased by 27%. The basic mechanical principles of LN still exist in humans, although its role is weakening. In humans, LN plays a more important role in maintaining head and cervical spine stability, such as stabilizing the head while maintaining cervical curvature and cervical spine. It is also pointed out in the literature that the trapezius and small rhomboid muscles connect the shoulder strap of the upper limb to the cervical spine through LN, and the head clamp muscle connects the head movement to the cervical spine through LN. It can be seen that in complex head, neck and shoulder movements, the cervical spine may be the axis of movement. In addition, Johnson and others believe that LN directly transmits muscle force to the lower cervical spine (C6, C7). LN mainly acts on the lower cervical spine and does not participate in the complex stabilization system of the upper cervical spine. Johnson et al. Calculated that the maximum force generated by the trapezius muscle on the occipital bone was 15N, while the maximum force generated by C7 was 150N. It can be seen that in the head, neck and shoulder movement axis, the lower cervical spine may play a greater role. In addition, LN has proprioceptor distribution, which may affect neck muscle activity. The connection between LN and dura mater may help to understand the biomechanical properties of cervical spine and the unknown biological functions of LN. Sui Hongjin and others speculated that this connection may be related to the cerebrospinal fluid circulation and may also help explain the cause of some cervical headaches.

The clinical significance of the term ligament

LN, especially the dorsal part, is the place where the dorsal fascia accumulates, especially in C6 and C7. LN tendinitis can be seen clinically. This clinical phenomenon shows that LN controls the balance of the head like a tendon, and it is prone to wear and tear at the attachment of spinous processes. Non-tumorous masses can appear in the soft tissue damage at the lowest part of LN, and fibrocartilage metaplasia can occur. LN fibrochondral pseudotumor is a hard or soft nodule with stubborn and unclear neck pain, which is often misdiagnosed as sesamoid bone [28]. The sesamoids are generally oval or round, and they are common in the posterior margin of LN. 80% of the sesamoids are at the C5 / C6 or C6 / C7 level. The incidence rate is 11.3% for men and 3.5% for women. The mechanism of sesamoid formation is speculated to be related to the increase in mechanical pressure between the spinous process tip and LN during neck flexion. LN sesamoids are usually painless and require no treatment. In addition, excessive pulling of LN resulted in avulsion fracture of C6, C7 or T1 spinous process, which is clinically called Clayshoveller's fracture. Chronic LN injury often leads to LN degeneration, and the long-term excessive stress is the main reason. The pathological changes of LN degeneration occur during long-term chronic strain. It is gradual and usually manifests as abnormalities such as LN morphology, density, and elasticity. LN calcification is the final result of LN degeneration. LN degeneration is closely related to the occurrence of cervical spondylosis. Takeshita et al. Believe that the degeneration of LN may increase the instability of the cervical spine and further exacerbate the degeneration of the cervical skeletal-muscular system. The local final calcification of LN can play a brake and increase stability on the cervical spine, which is conducive to slowing the development of cervical spondylosis. Clinical X-ray studies confirmed that LN calcification was present in 23.96% of patients with cervical spondylosis and 27.69% of LN calcification in the CT and ultrasound cases.