School of Medicine, American University of the Caribbean, 1 University Drive at Jordan Road, Cupecoy, St. Maarten.
Spine J. 2013 May;13(5):558-63. doi: 10.1016/j.spinee.2013.01.015. Epub 2013 Feb 11.
In recent literature, a soft-tissue communication between the rectus capitis posterior major (RCPma) muscle and the cervical dura mater has been identified. To the best of our knowledge, this communication has yet to be validated from a histological perspective nor has it been examined for neural tissue.
The purpose of this study was to examine the composition and true continuity of the communication between the RCPma and the dura mater at a microscopic level. The communication was also inspected for the presence of proprioceptive neurons.
An anatomical and histological analysis of a novel structure in the atlantoaxial interspace.
Gross dissection was performed on 11 cadavers to remove the RCPma, the soft-tissue communication, and a section of posterior cervical dura mater as one continuous unit. Paraffin embedding and sectioning followed by hematoxylin and eosin staining was conducted to validate the connection. Staining with antineurofilament protein fluorescent antibodies was performed to identify proprioceptive neural tissue on one specimen, and all findings were recorded via photographic documentation.
Histological investigation revealed a tendinous matrix inserting into both the RCPma and the posterior aspect of the cervical dura mater in all 11 specimens. In the one specimen examined for neural tissue, antineurofilament protein fluorescence revealed proprioceptive neurons within the communication. Immunoperoxidase staining demonstrated the insertion of these neurons into both the dura mater and the belly of the RCPma.
The existence of a true connection between the RCPma and the cervical dura mater provides new insight in understanding the complex anatomy of the atlantoaxial interspace. The presence of a neural component within this connection suggests that it may serve another function aside from simply anchoring this muscle to the dura mater. Such a connection may be involved in monitoring dural tension and may also play a role in certain cervicogenic pathologies. This study also supports previous reports that no true membrane joins the posterior arch of the atlas to the laminae of the axis and contradicts the conventional belief that the ligamentum flavum joins these two structures.
最近的文献中已经确定了头后直肌大（RCPma）和颈硬脊膜之间存在软组织的连通。据我们所知，从组织学的角度来看，这种连通尚未得到验证，也没有检查过神经组织。
本研究的目的是在微观水平上检查 RCPma 和硬脊膜之间的连通的组成和真正连续性。还检查了连通中是否存在本体感觉神经元。
对寰枢关节间隙中的一个新结构进行解剖学和组织学分析。
对 11 具尸体进行大体解剖，以去除 RCPma、软组织连通和一段后颈硬脊膜，作为一个连续的单位。进行石蜡包埋和切片，然后进行苏木精和伊红染色以验证连接。对一个标本进行抗神经丝蛋白荧光抗体染色，以识别本体感觉神经组织，并通过摄影记录所有发现。
组织学研究显示，在所有 11 个标本中，一条腱性基质插入 RCPma 和颈硬脊膜的后表面。在一个检查神经组织的标本中，抗神经丝蛋白荧光显示连通内存在本体感觉神经元。免疫过氧化物酶染色显示这些神经元插入硬脊膜和 RCPma 的腹部。
RCPma 和颈硬脊膜之间存在真正的连接，为理解寰枢关节间隙的复杂解剖结构提供了新的认识。在这个连通中存在神经成分表明，它可能除了将这块肌肉固定在硬脊膜上之外还有其他功能。这种连接可能参与监测硬脑膜张力，并在某些颈源性疾病中发挥作用。本研究还支持了先前的报告，即没有真正的膜将寰椎后弓与枢椎椎板连接起来，并与传统观念相矛盾，即黄韧带将这两个结构连接起来。
