Download Anatomic Relation Between the Rectus Capitis Posterior

Anatomic Relation Between the Rectus Capitis Posterior Minor and the
Dura Matter
Spine
December 1, 1995; Vol. 20; No. 23; pp. 2484-2486
Gary Hack DDS, Richard Koritzer DDS PhD, Walker Robinson MD, Richard Hallgren
PhD, Philip Greenman DO
BACKGROUND FROM DAN MURPHY, From
Article Review 37-09: Anatomy and Physiology of Headache
Biomedicine and Pharmacotherapy
1995, Vol. 49, No. 10, 435-445
N Bogduk
It is known that the spinal dura matter is innervated with nociceptors that arise
from the upper cervical nerve roots; this innervation allows the spinal dura to be
the generator of pain, primarily headache.
The 4 suboccipital muscles are innervated by the posterior primary rami of the C1
nerve root
KEY POINTS FROM THIS STUDY
1)
The Rectus Capitis Posterior Minor Muscle arises from the posterior arch of the
atlas (C1) and inserts at the inferior nuchal line of the occiput.
2)
Deep to the Rectus Capitis Posterior Minor Muscle is the Posterior AtlantoOccipital Membrane, which is “intimately attached to the underlying spinal dura.”
3)
These authors carefully and meticulously dissected 11 human cadavers to
investigate if there is a connection between the Rectus Capitis Posterior Minor
Muscle and the spinal dura mater.
4)
Dense connective tissue attached the Rectus Capitis Posterior Minor Muscle to
the Posterior Atlanto-Occipital Membrane at the atlanto-occipital junction.
5)
“A [dense] connective tissue bridge between the Rectus Capitis Posterior
Minor Muscle and the dorsal spinal dura at the atlanto-occipital junction was
observed in every specimen.”
6)
The connective tissue bridge was arranged perpendicular to the dura.
7)
Head and neck extension of all cadavers produced infolding of the Posterior
Atlanto-Occipital Membrane/dura complex, “which appeared to be resisted by this
connective tissue bridge.” When the head and neck are extended, the spinal dura
folds inward toward the spinal cord.
8)
“The connective tissue bridge may help resist dural infolding during head and
neck extension.”
9)
Upper cervical spinal trauma causes atrophy of the Rectus Capitis Posterior
Minor Muscle, which could compromise the resistance of dura infolding that occurs
during head/neck extension. Thus, the dura could be irritated/injured/inflamed.
Point of View
Scott Haldeman, MD, PhD, [DC]
Dr. Haldeman notes:
1)
Injury or pathology affecting the cervical spine can cause headaches.
2)
The dura mater is a pain sensitive structure, capable of generating cervical
headaches.
3)
Suboccipital muscle problems can influence the pain sensitive dura matter to
generate headache.
4)
Massage, manipulation, and biofeedback directed to the cervical spine may be
valuable in treating this headache mechanism.
COMMENTS FROM DAN MURPHY
The primary finding of this article is that the Rectus Capitis Posterior Minor Muscle
attaches to a connective tissue bridge that passes between Occiput-C1 and attaches
to the dura mater. Because the dura is innervated with nociceptors, dysfunction or
chronic contraction stress of this muscle can cause headache.
The primary finding of Article Review 18-13 is that both the Rectus Capitis Posterior
Major Muscle and the Obliquus Capitis Inferior attach to a connective tissue bridge
that passes between C1-C2 and attaches to the dura mater. Because the dura is
innervated with nociceptors, dysfunction or chronic contraction stress of these
muscles can also cause headache.
I suggest that chronic contraction stress in any of these three muscles that exists
as a consequence of loss of cervical lordosis could cause chronic irritation to the
dura mater resulting in chronic headache.