["Isolated injury" of the alar ligaments: MRI diagnosis and surgical therapy]

Spinal distortions caused by traffic collisions play a large role in medical expert opinions. Prolonged or chronic conditions present particular difficulties. The radiologist E. Volle developed and published a system for the classification of isolated injuries of the alar ligaments. As a result, surgery on the craniocervical junction was carried out in a large number of patients and the results published on multiple occasions. This article describes the anatomy of the alar ligaments, complicated injuries, the concept of the isolated lesion of the alar ligaments and their surgical management. German and international publications are evaluated.

It was impossible to substantiate isolated injuries to alar ligaments. According to current knowledge, the published results are based on a misinterpretation of MRI findings. These results are to be considered as artefacts. There is no anatomical correlation for the classification of isolated injuries to alar ligaments. Surgical stabilisation due to an allegedly isolated injury to the alar ligaments is therefore not indicated. This statement does not apply to injuries sustained in high-speed trauma in combination with complex injuries of the atlanto-occipital and atlanto-dental-joint (joint capsules, atlanto-occipital membrane) with clear signs of instability.