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