The myodural bridge complex: a comprehensive review of morphology, physiology, developmental biology and pathology

The myodural bridge complex (MDBC) is a phylogenetically conserved composite anatomical structure that anchors the suboccipital musculature and nuchal ligament to the spinal dura mater (SDM) at the cranio-cervical junction, with species-specific morphological adaptations across vertebrates. Physiological functions of the MDBC include hypothesized mediation of cerebrospinal fluid (CSF) circulation dynamics, stabilizing the SDM during head movements to prevent dural folding, and transmitting proprioceptive signals from suboccipital musculature to the central nervous system. Clinical evidence increasingly links MDBC pathological alterations to a spectrum of cranio-cervical disorders, such as chronic cervicogenic headaches, Chiari malformation Type I, cervicogenic dizziness, and Ehlers-Danlos syndrome-associated symptoms. A comprehensive understanding of MDBC structure and function is critical to unraveling its putative mechanistic role in CSF homeostasis and cranio-cervical biomechanics, thereby providing novel insights for the diagnosis and management of related neurological conditions. This review systematically summarizes current knowledge of the MDBC in terms of its morphology, physiology, developmental biology and pathology.