On the importance of the innervation of the human cervical longitudinal ligaments at vertebral level

  • Tina Stegmann
  • Hanno SteinkeEmail author
  • Philipp Pieroh
  • Faramarz Dehghani
  • Anna Völker
  • Mathias Jakob Groll
  • Thomas Wolfskämpf
  • Michael Werner
  • Julia Kollan
  • Andreas Hinz
  • Mario Leimert
Original Article



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.


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.


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.


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.


Cervical anterior longitudinal ligament Cervical posterior longitudinal ligament Pain PGP 9.5 CGRP Autonomic nerve system 



We thank Charlotte Kulow for reading the manuscript as a native speaker. We also thank Isabel N. Schellinger and Marco Kuhlen. This research was funded by Landeszuwendung of SMWK (Saxonian Ministry of Science and Art).

Author contribution

TS: dissection, histological and immunohistochemical staining, data collection, data analysis, and manuscript writing. HS: project development and manuscript writing. PP: protocol development, advice in histology and immunohistochemistry, and manuscript editing. FD: advice in histology and immunohistochemistry. AV: clinical advice and spinal surgeon. MJG: clinical advice and neurosurgeon. TW: dissection. MW: biomechanical advice. JK: protocol development and immunohistochemistry. AH: data analysis/management. ML: project development and manuscript editing.


This research was funded by Landeszuwendung of SMWK (Saxonian Ministry of Science and Art, 100096796).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

276_2019_2316_MOESM1_ESM.pptx (40 kb)
Online Fig. 1: Comorbidities of the body donors are given in this table. Hypertension and the history of carcinoma have been most prevalent. Diabetes or smoking have not been so frequent. (PPTX 40 kb)
276_2019_2316_MOESM2_ESM.pptx (149 kb)
Online Table 1: Mean age and ICD-code numbers off all body donors which were used for immunohistochemistry. (PPTX 149 kb)
276_2019_2316_MOESM3_ESM.pptx (149 kb)
Online Table 2: This table gives an overview of how many cervical columns have been dissected and how many probes and following slices were stained. This is the base to calculate the relative frequencies for the certain segment and ligament. (PPTX 149 kb)
276_2019_2316_MOESM4_ESM.pptx (52 kb)
Online Table 3. In this table are the positive numbers of immunoreactive slices for each gender related to the total number of observed slices (number in brackets) for each cervical level. The relative frequencies have not shown any main differences between male or female tissue. (PPTX 51 kb)
276_2019_2316_MOESM5_ESM.pptx (40 kb)
Supplementary material 5 (PPTX 40 kb)


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Tina Stegmann
    • 1
  • Hanno Steinke
    • 1
    Email author
  • Philipp Pieroh
    • 2
    • 3
  • Faramarz Dehghani
    • 3
  • Anna Völker
    • 2
  • Mathias Jakob Groll
    • 4
  • Thomas Wolfskämpf
    • 1
  • Michael Werner
    • 5
  • Julia Kollan
    • 6
  • Andreas Hinz
    • 7
  • Mario Leimert
    • 8
  1. 1.Institute of Anatomy, University of LeipzigLeipzigGermany
  2. 2.Department of Orthopedics, Trauma and Plastic SurgeryUniversity of Leipzig Medical CenterLeipzigGermany
  3. 3.Department of Anatomy and Cell BiologyMartin-Luther-University Halle-WittenbergHalle (Saale)Germany
  4. 4.Department of NeurosurgeryUniversity of Leipzig Medical CenterLeipzigGermany
  5. 5.Fraunhofer Institute for Machine Tools and Forming Technology IWUDresdenGermany
  6. 6.Faculty of Natural SciencePharmaceutical Technology and Biopharmaceutics, Martin-Luther-University Halle-WittenbergHalle (Saale)Germany
  7. 7.Department of Medical Psychology and Medical SociologyUniversity of Leipzig Medical CenterLeipzigGermany
  8. 8.Department for Interdisciplinary Spine SurgeryAKG Klinik Hohwald GmbHNeustadt in SachsenGermany

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