Intersegmental Kinematics of the Upper Cervical Spine: Normal Range of Motion and Its Alteration After Alar Ligament Transection

Abstract

Study design: Biomechanical study using cadaveric cervical spines.

Objective: To evaluate joint mobility and stiffness at the craniovertebral junction.

Summary of background data: Data on the intersegmental kinematics of the craniovertebral joints are available in the literature with a widespread range of values. The effect that alar ligament injuries have on intersegmental kinematics remains unclear and requires further biomechanical investigation.

Methods: Ten occipito-atlanto-axial (C0-C1-C2) human specimens were articulated to flexion, extension, bilateral lateral bending, and bilateral axial rotation. The moment-rotation response was continuously tracked through the entire range of motion before and after unilateral alar ligament transection of the right side.

Results: The intersegmental (C0-C1/C1-C2) moment-rotation response was continuously quantified in full flexion (7.2 ± 6.6°/12.1 ± 5.8°), extension (11.1 ± 6.4°/3.0 ± 2.8°), lateral bending to the right (3.1 ± 2.2°/1.6 ± 1.2°) and left sides (3.3 ± 1.6°/2.1 ± 1.5°), and axial rotation to the right (1.2 ± 3.5°/32.3 ± 9.3°) and left sides (2.7 ± 2.6°/25.3 ± 8.3°). Unilateral alar ligament transection increased the range of motion of C0-C2 in the three planes of movement; however, intersegmental motion alterations were not always observed.

Conclusion: Increases in the range of extension and lateral bending at C0-C1, which had not been reported previously, were observed. Further, the range of rotation on the right and left sides increased, in conjunction with the increased ranges at C0-C1 and C1-C2.Level of Evidence: N/A.