Tina Stegmann1, Hanno Steinke2, Philipp Pieroh3,4, Faramarz Dehghani4, Anna Völker3, Mathias Jakob Groll5, Thomas Wolfskämpf1, Michael Werner6, Julia Kollan7, Andreas Hinz8, Mario Leimert9. 1. Institute of Anatomy, University of Leipzig, Liebigstrasse 13, 04103, Leipzig, Germany. 2. Institute of Anatomy, University of Leipzig, Liebigstrasse 13, 04103, Leipzig, Germany. Steinke@medizin.uni-leipzig.de. 3. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany. 4. Department of Anatomy and Cell Biology, Martin-Luther-University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany. 5. Department of Neurosurgery, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany. 6. Fraunhofer Institute for Machine Tools and Forming Technology IWU, Nöthnitzer Str. 44, 01187, Dresden, Germany. 7. Faculty of Natural Science, Pharmaceutical Technology and Biopharmaceutics, Martin-Luther-University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120, Halle (Saale), Germany. 8. Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany. 9. Department for Interdisciplinary Spine Surgery, AKG Klinik Hohwald GmbH, Hohwaldstrasse 40, 01844, Neustadt in Sachsen, Germany.
Abstract
PURPOSE: In our aging society, the prevalence of degenerative spinal diseases rose drastically within the last years. However, up till now, the origin of cervical pain is incompletely understood. While animal and small cadaver studies indicate that a complex system of sensory and nociceptive nerve fibers in the anterior (ALL) and posterior longitudinal ligament (PLL) at the level of the intervertebral disc might be involved, there is a lack of data exploring whether such a network exists and is equally distributed within the cervical vertebrae (VB). We, therefore, aimed to investigate the spatial distribution of the mentioned nerve networks in human tissue. METHODS: We performed macroscopic (Sihler staining, Spalteholz technique, and Plastination) and microscopic (immunohistochemistry for PGP 9.5 and CGRP) studies to characterize spatial differences in sensory and nociceptive innervation patterns. Therefore, 23 human body donors were dissected from level C3-C6. RESULTS: We could show that there is a focal increase in sensory and nociceptive nerve fibers at the level of C4 and C5 for both ALL and PLL, while we observed less nerve fiber density at the level of C3 and C6. An anatomical vicinity between nerve and vessels was observed. CONCLUSION: To our knowledge, these findings for the first time report spatial differences in sensory and nociceptive nerve fibers in the human cervical spine at VB level. The interconnection between nerves and vessels supports the importance of the perivascular plexus. These findings might be of special interest for clinical practice as many patients suffer from pain after cervical spine surgery.
PURPOSE: In our aging society, the prevalence of degenerative spinal diseases rose drastically within the last years. However, up till now, the origin of cervical pain is incompletely understood. While animal and small cadaver studies indicate that a complex system of sensory and nociceptive nerve fibers in the anterior (ALL) and posterior longitudinal ligament (PLL) at the level of the intervertebral disc might be involved, there is a lack of data exploring whether such a network exists and is equally distributed within the cervical vertebrae (VB). We, therefore, aimed to investigate the spatial distribution of the mentioned nerve networks in human tissue. METHODS: We performed macroscopic (Sihler staining, Spalteholz technique, and Plastination) and microscopic (immunohistochemistry for PGP 9.5 and CGRP) studies to characterize spatial differences in sensory and nociceptive innervation patterns. Therefore, 23 human body donors were dissected from level C3-C6. RESULTS: We could show that there is a focal increase in sensory and nociceptive nerve fibers at the level of C4 and C5 for both ALL and PLL, while we observed less nerve fiber density at the level of C3 and C6. An anatomical vicinity between nerve and vessels was observed. CONCLUSION: To our knowledge, these findings for the first time report spatial differences in sensory and nociceptive nerve fibers in the human cervical spine at VB level. The interconnection between nerves and vessels supports the importance of the perivascular plexus. These findings might be of special interest for clinical practice as many patients suffer from pain after cervical spine surgery.
Authors: Owoicho Adogwa; Aladine A Elsamadicy; Victoria D Vuong; Ankit I Mehta; Raul A Vasquez; Joseph Cheng; Carlos A Bagley; Isaac O Karikari Journal: Global Spine J Date: 2017-05-31