The tectorial membrane (the superior continuation of the PLL at the craniovertebral junction) connects the body of the axis to the clivus of the occiput, providing the posterior vertebral body constraint at the skull base level.
Acts as the primary posterior ligamentous restraint at the craniovertebral junction, limiting atlantoaxial and occipito-atlantal flexion, and protecting the cervicomedullary junction from cord compression in hyperflexion injuries.
Tectorial membrane disruption from high-energy craniocervical trauma produces cervicomedullary junction instability, which may be fatal or produce devastating neurological injury. MRI demonstrates tectorial membrane signal change and craniovertebral alignment loss.
High-energy craniovertebral junction injury tearing the tectorial membrane, producing atlantoaxial or occipito-atlantal instability requiring halo immobilisation or craniocervical fusion.
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