A Systematic Review of the Soft-Tissue Connections Between Neck Muscles and Dura Mater

Study Design: Systematic review. Objective: To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater. Summary of Background Data: Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported. Methods: Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non–post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal or Cadaveric Studies Scale. A different third researcher resolved disagreements. Results. Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication.