The external occipital crest is a vertical midline ridge on the outer surface of the occipital bone, running down from the external occipital protuberance toward the back edge of the foramen magnum. It gives attachment to the ligamentum nuchae, the tough midline ligament at the back of the neck. The inferior nuchal lines branch off its middle on each side.
| Articulations | |
|---|---|
| Landmarks |
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| Ossification | Part of the occipital squama below the highest nuchal line, which ossifies in cartilage; the crest develops further with neck muscle and ligament pull. |
The midline along the external occipital crest is a relatively bloodless plane between the left and right neck muscles, which surgeons follow in midline suboccipital approaches to the posterior cranial fossa and craniovertebral junction. It is a reliable landmark when placing occipital plates for occipitocervical fusion, because the bone is thickest close to the midline. Pain over this region may arise from the attachments of the ligamentum nuchae and neck extensor muscles.
A fracture of the back of the skull from a fall or blow, which may extend toward the foramen magnum and requires assessment for posterior fossa bleeding and venous sinus injury.
Overstretching of the midline neck ligament attached to the crest, as in whiplash, causing pain at the base of the skull.
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