The tectorial membrane is the upward continuation of the posterior longitudinal ligament from the body of C2 to the clivus, spanning the posterior surface of the dens and the atlantoaxial articulation. It lies behind the cruciform ligament, covering the dens ligaments on the side facing the spinal canal. It limits flexion at the craniovertebral junction, and its disruption in high-energy injuries contributes to craniocervical instability.
| Origin | Posterior surface of the C2 body and dens |
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| Insertion | Basilar part of the occipital bone (clivus), just above the anterior margin of the foramen magnum |
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Limits flexion and extension at the craniovertebral junction and covers the dens and cruciform ligament posteriorly.
The tectorial membrane is assessed on sagittal MRI at the craniocervical junction, where it normally appears as a continuous low-signal band behind the dens; disruption shows as discontinuity or high signal. It is one of the key ligaments (alongside the transverse, alar, and apical ligaments) assessed in craniocervical junction injury. Disruption in high-energy trauma produces craniocervical instability that may be fatal or cause devastating cervicomedullary injury.
Tectorial membrane disruption contributing to craniocervical instability in high-energy cervical trauma requiring occipitocervical fusion.
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