Alar + Transverse Ligament Injury

• the alar + transverse ligament stabilize the head on the neck
• injury to the alar or transverse ligaments can result in instability + risk compromise of the brainstem + spinal cord
• the upper cervical spine (C0-3) lack the articular stablity of the segments below
• passive structures (alar + transverse lig) are largely responsible for the stability of the upper cervical region
• the transverse ligament is stronger than the alar ligament
• transverse ligament function:

  • prevent anterior to posterior sliding of the head on the neck with cervical flexion + extension
• rupture of the transverse ligament allows the head to slide forward on the neck with cervical flexion --> causes entrapment of the brainstem + can result in spinal cord damage
• a force of about 85 kg is required to rupture the transverse ligament
• both alar ligaments must be ruptured before dislocation of the C1/2 segment is possible
• cervical spine subluxations are observed in 43-86% of patients who have RA + occur more in men
• OA subluxations occur in up to 39% of patients with RA
• common signs + symptoms of transverse + alar ligament injury:

  • hesitancy to move head or neck in any direction
  • when moving head, may experience:
  • diplopia
  • dysarthria
  • dysphasia
  • dizziness
  • drop attacks
  • tinnitus
  • HA
  • blurry vision
  • nausea
  • lump in throat
  • difficulty concentrating
  • bilateral paresthesias in hand or feet