Elsevier

World Neurosurgery

Volume 124, April 2019, Pages e707-e709
World Neurosurgery

Original Article
Gerber's Ligament—A Forgotten Structure of the Craniocervical Junction

https://doi.org/10.1016/j.wneu.2018.12.198Get rights and content

Background

Ligaments of the craniocervical junction play a critical role in stabilizing this region. Gerber's ligament has more or less been forgotten and, to our knowledge, never studied.

Methods

Dissection of the craniocervical junction was performed in 15 fresh frozen cadavers. In the prone position, the posterior elements of the upper cervical vertebrae and occiput were removed. After removing the contents of the spinal canal and posterior cranial fossa, the dura mater and tectorial membrane were reflected. The superior band of the cruciform ligament was reflected. When Gerber's ligament was identified, its attachments and morphometry were recorded. Lastly, Gerber's ligament was observed while range of motion of the craniocervical junction was performed.

Results

Gerber's ligament was identified in 7 specimens (46.7%). This structure arose anteriorly from the junction of the superior band 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 length was 11 mm, and mean width was 7 mm. Thickness of the ligament was 0.5–1.1 mm. The ligament was found to become taut with minimal rotation of the atlantoaxial joint and extension of the craniocervical junction.

Conclusions

A good understanding of all ligaments of the craniocervical junction is important to surgeons and physicians treating patients with injury to the upper cervical spine.

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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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.

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