The Morphology and Clinical Significance of the Extraforaminal Ligaments at the Cervical Level

Shi, Benchao; Zheng, Xuefeng; Zhang, Hui; Sun, Chao; Cao, Yanlin; Jin, Anmin; Ding, Zhengnian

doi:10.1097/brs.0000000000000668

Cited by 19 publications

(31 citation statements)

References 14 publications

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“…Both of these structures are protected against pulling out (avulsion) by fibrous attachments binding the spinal nerves to the transverse processes and the ganglia to the IVFs. 2,4,5,8,9,12,15,[18][19][20][21]26,27 The IVF in the subaxial cervical spine is limited by the following: 1) the inferior part of the superjacent vertebral body, the uncovertebral joint, and the posterolateral part of the anulus fibrosus anteriorly; 2) adjacent pedicles inferiorly and superiorly; and 3) the medial aspect of the facet joint posteriorly. Outside the foramina arise the transverse processes directed laterally and forward; each consists of an anterior and a posterior part.…”

Section: Discussionmentioning

confidence: 99%

“…18,31 The attachments of the BP roots to the spine have been investigated in order to elucidate the mechanism of traction injuries. 9,15,21,26,27,31 In 1951 Frykholm observed that the epineurium of the cervical spinal nerve and ganglion is firmly anchored in the groove of the underlying transverse process. Moreover, the ligaments descending from the transverse processes of C4-6 reinforce the epineurial sheaths of the trunks lying below.…”

Section: Discussionmentioning

confidence: 99%

“…15 In 2015 Shi et al described the radiating ligaments situated outside the IVF in the C2-T1 spinal segment. 21 These ligaments are further grouped into 4 categories: 1) superior, originating from the cranial transverse process and joining the upper part of the nerve sheath lying below; 2) inferior (the most significant), originating from the anterior and posterior tubercle of the transverse process, they pass parallel to the nerve and connect the cranial nerve to the groove of the transverse process; 3) anterior, originating from the capsule of the uncovertebral joint; and finally, 4) posterior radiating ligaments branching off of the capsule of the facet joint. All groups of the radiating ligaments fuse with the periradicular sheath of the cervical spinal nerve.…”

Section: Discussionmentioning

confidence: 99%

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The distribution of brachial plexus lesions after experimental traction: a cadaveric study

Zapałowicz¹,

Radek²

2018

Journal of Neurosurgery: Spine

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OBJECTIVEThe objective of the present study was to determine experimentally the distribution of lesions caused in the cadaveric brachial plexus (BP) by excessive stretching. The authors attempted to delineate the correlation between the direction of stretching and sites of lesions.METHODSFifteen specimens (each comprised the spinal segment C4–T2 with 2 BPs) were harvested from adult cadavers. Each BP was stretched in a mechanical testing machine at a constant speed of 200 mm/min. Specimens were divided into 3 groups: in group A the BPs were stretched caudally at a 45° angle to the spinal midline; in group B they were stretched perpendicularly to the spinal midline; and in group C the stretching was caudally parallel to the midline. Lesions of each BP were identified and analyzed. A graph of load against dislocation was registered when stretching to delineate the maximal force (Fmax), defined as the maximum load at which BP failure occurs.RESULTSBased on macroscopic examination, 140 sites of mechanical damage were identified in 30 BPs. Preganglionic injuries (63.6% of lesions), defined as avulsions of the spinal ganglia with their rootlets, were found in 89 spinal nerves. In group B—in which specimens were stretched perpendicularly to the spinal segment—preganglionic injuries were significantly more frequent (41 avulsed spinal nerves) than in groups A and C (21 and 27 avulsed spinal nerves, respectively). Postganglionic lesions equivalent to neurotmesis were found in 51 sites (36.4% of all lesions) along spinal nerves, trunks, divisions, and cords. Postganglionic lesions in group B were much less frequent (8) as compared with groups A and C (24 and 19, respectively).CONCLUSIONSPredominance of preganglionic lesions suggests that attachments of the BP to the spine are more susceptible to traction than postganglionic elements. Preganglionic lesions were mainly produced in C7, C8, and T1 spinal nerves, suggesting their weaker attachment to the spine than in the case of C5 and C6 nerves. Preganglionic lesions were highly correlated with a traction perpendicular to the spine, whereas postganglionic lesions were provoked mainly by traction directed at 45° caudally or by means of caudal traction parallel to the midline. This discrepancy implies a relationship between mechanical resistance of pre- and postganglionic elements of the BP and the vector of force.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The distribution of brachial plexus lesions after experimental traction: a cadaveric study

Zapałowicz¹,

Radek²

2018

Journal of Neurosurgery: Spine

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“…The ventral and dorsal extraforaminal ligaments also consist of a superior and inferior part. The inferior ventral and dorsal ligaments are attached to each other [28,43].…”

Section: Extraforaminal Ligaments Of the Cervical Spinal Nervesmentioning

confidence: 99%

“…The posterior side of the transforaminal ligaments is strongly adherent to the spinal nerve sheath. Usually, an intervertebral foramen contains no more than one transforaminal ligament [43].…”

Section: Extraforaminal Ligaments Of the Cervical Spinal Nervesmentioning

confidence: 99%

Clinical anatomy and clinical significance of the cervical intervertebral foramen: a review

Sioutas

Kapetanakis²

2016

Folia Morphol

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Anatomic morphology and clinical significance of intraforaminal ligaments of the cervical spine

et al. 2019

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The cause of cervical spondylotic radiculopathy could be related to the intraforaminal ligaments (IFLs) of the cervical spine. The aim of this study is to identify and describe the IFLs and assess their clinical significance. Six intact cervical spine specimens from adult embalmed cadavers were dissected to expose the cervical nerve roots and their surrounding intraforaminal tissues fully. From the C1‐C2 to the C7‐T1 intervertebral foramina (IVF), the connective structures between each nerve root and its surrounding foraminal wall were examined under a surgical microscope. The morphology, number, and attachment points of the IFLs of each segment were documented, and the length, width, or diameter and thickness of the ligaments were measured with a vernier caliper. IFLs were observed in all 84 IVFs of the cervical spine. According to their locations, they can be divided into two categories: the first is entrance‐zone IFLs, which are radially distributed around the nerve root; the second is mid‐zone IFLs, which are thin, strip‐shaped fibrous tissues intertwined around the nerve roots, the number of ligaments being considerable but difficult to quantify. Ligament structures have been identified in the IVF of the cervical spine. Under physiological conditions, they could be protective in maintaining the position, shape, and function of nerve roots. However, under pathological conditions, the IFLs of the cervical spine could aggravate the symptoms of cervical nerve root radicular pain associated with other types of compression. Clin. Anat. 32:654–660, 2019. © 2019 Wiley Periodicals, Inc.

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The Morphology and Clinical Significance of the Extraforaminal Ligaments at the Cervical Level

Cited by 19 publications

References 14 publications

The distribution of brachial plexus lesions after experimental traction: a cadaveric study

The distribution of brachial plexus lesions after experimental traction: a cadaveric study

Clinical anatomy and clinical significance of the cervical intervertebral foramen: a review

Anatomic morphology and clinical significance of intraforaminal ligaments of the cervical spine

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