The terminal insertional segments and communications of the vertebral nerve in the human cervical region

Abstract

Twenty-four cadavers (48 sides) were used to clarify the terminal insertional segment and communications of the vertebral nerve in the cervical region under a surgical microscope. After displacing the prevertebral muscles (longus colli and longus capitis) laterally, the ventral parts of the transverse foramen of vertebrae (from C2 to C6) were removed, and the insertional segment and communicates of the vertebral nerve surrounding the vertebral artery were observed. The results showed: (1) the vertebral nerve ascended along the ventral or mediodorsal vertebral artery and terminated mainly at C3 (22/36 sides) but not terminated at C4 or C5 only; (2) the superficial communicates from the cervical sympathetic trunk ran in a proximal and distal direction when the fibers entered the anterior branches of the cervical nerves. The fibers running to the proximal direction communicated with the vertebral nerve in the part of transverse foramen; (3) motor and/or sensory rami supplying the prevertebral muscles, corpus vertebrae and intervertebral discs could pass through an "arched-shaped" fiber bundle on the ventral surface of the vertebral artery. In conclusion, the vertebral nerve and the fibers surrounding the vertebral artery could be considered as a stable deep pathway of cervical sympathetic nerves. The deep pathway (vertebral nerve and its branches) with the superficial pathways (cervical sympathetic trunk and its branches) formed a sympathetic nervous "plexus" in the cervical region. This sympathetic nervous "plexus" may be involved in the effects of cervical ganglionic blockade.

Translaminar screw fixation of the cervical spine in Asian population: feasibility and safety consideration based on computerized tomographic measurements

“…The vertebral artery and venous plexus are well protected within the transverse foramen periosteum [18]. The location of cervical sympathetic plexus is fairly distant from possible injury by the translaminar screw [24]. Based on these reports, the risk of iatrogenic neurovascular injury following translaminar screw insertion is minimal.…”

Nerve Fiber Connection between the Cervical Spinal Ganglia and Cervical Sympathetic Ganglia: An In Vivo Anatomic Study in Rabbits

“…Hinoki found that over-excitation of the cervical sympathetic nerves and proprioceptors are related to the clinical entity of cervical vertigo 11) . Numerous sympathetic nerve endings on the surface of the vertebral artery control the flow of blood in the artery 6,7,15,16) . When the sympathetic nerve ending is stimulated abnormally, the vertebral artery may go into spasm, and this can cause posterior circulation ischemia and induce cervical vertigo 8,17) .…”