Original ArticleGerber's Ligament—A Forgotten Structure of the Craniocervical Junction
Introduction
Friedrich Andreas Gerber (1797–1872) was a physician and professor of anatomy, pathology, and physiology at the University of Berne in Switzerland.1 He authored several textbooks on human and veterinary medicine, focusing on histology and anatomy. His name lives on eponymously in Gerber's ligament, which is an accessory band of the ascending band of the cruciform ligament attaching onto the apex of the dens (Figure 1). However, this ligament has more or less been lost to history.2 As all the ligaments stabilizing the upper cervical spine are important in maintaining proper alignment,3, 4 we performed an anatomic study to better elucidate this structure.
Section snippets
Materials and Methods
Dissection of the craniocervical junction was performed in 15 fresh frozen cadavers (7 male and 8 female). Mean age at death was 71 years (range, 66–93 years). With the specimens in the prone position and following removal of the brain and upper spinal cord, the posterior half of the posterior cranial fossa was removed with an oscillating bone saw. The spinal dura mater and dura mater overlying the clivus were removed along with the tectorial membrane. Next, the cruciform ligament, in
Results
Gerber's ligament was identified in 7 specimens (46.7%) (Figures 2 and 3). This structure arose anteriorly from the junction of the superior band (present in all specimens) and transverse part of the cruciform ligament. Gerber's ligament was always found to be just deep to the superior band of the cruciform ligament but traveled more anteriorly to attach onto the posterior aspect of the dens approaching, but not attaching onto, its apex. Mean width was 7 mm (range, 6–8 mm), and mean length was
Discussion
The ligaments of the craniocervical junction are of vital importance. Therefore, knowledge of these structures is essential for clinicians who treat patients with neck injuries. As we have shown,5, 6, 7, 8, 9 many small accessory ligaments exist. Included in these is Gerber's ligament, which was identified in about half of our dissections and, when present, serves as an additional tether of the cruciform ligament onto the axis.
The 2 most well-known and important ligaments of the craniocervical
Conclusions
Gerber's ligament is a variant ligament of the craniocervical junction. Although small compared with surrounding stronger ligaments, it is important to study such lesser known ligaments of the craniocervical junction to better understand complications that may arise from injuries to this area as well as the overall biomechanics of the region.
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Cited by (1)
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2021, Acta Anatomica Sinica
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.