The tendinous septum of the semispinalis capitis muscle spatially separates the dorsal ramus between C3 and C4
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Local anesthetic injection into the medial head of the semispinalis capitis muscle can anesthetize the greater occipital nerve (GON) and third occipital nerve (TON) simultaneously (greater and third occipital nerve block: GTO block). Alternatively, inter-semispinal plane (ISP) block can anesthetize the dorsal rami of the cervical spinal nerves from C4 to T4. The GON, TON, and the dorsal rami of the inferior level cannot be blocked with a single injection. To elucidate this phenomenon from an anatomical standpoint, we performed an ISP block either alone or with a GTO block using water-based acrylic dye in three thiel-embalmed cadavers. Both dyes were clearly separated by the tendinous septum running obliquely inside the semispinalis capitis muscle (SCA). The tendinous septum of the SCA may have a relatively strong connection with the dorsal edge of the semispinalis cervicis muscle, and this structure may stem the injectate spread. Therefore, the GON and TON, running through the medial head of the SCA, and the dorsal rami of the inferior level are spatially separated by the tendinous septum, and cannot be blocked with a single injection.
KeywordsSemispinalis capitis muscle Inter-semispinal plane block Greater occipital nerve Third occipital nerve
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Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Blumenfeld A, Ashkenazi A, Napchan U, Bender SD, Klein BC, Berliner R, Ailani J, Schim J, Friedman DI, Charleston LT, Young WB, Robertson CE, Dodick DW, Silberstein SD, Robbins MS. Expert consensus recommendations for the performance of peripheral nerve blocks for headaches―a narrative review. Headache. 2013;53:437–46.CrossRefGoogle Scholar
- 5.Eichenberger U, Greher M, Kapral S, Marhofer P, Wiest R, Remonda L, Bogduk N, Curatolo M. Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2–C3 zygapophysial joint pain. Anesthesiology. 2006;104:303–8.CrossRefGoogle Scholar
- 7.Tubbs RS, Mortazavi MM, Loukas M, D’Antoni AV, Shoja MM, Chern JJ, Cohen-Gadol AA. Anatomical study of the third occipital nerve and its potential role in occipital headache/neck pain following midline dissections of the craniocervical junction. J Neurosurg Spine. 2011;15:71–5.CrossRefGoogle Scholar
- 9.Robbins MS, Kuruvilla D, Blumenfeld A, Charleston LT, Sorrell M, Robertson CE, Grosberg BM, Bender SD, Napchan U, Ashkenazi A, Peripheral Nerve B, Other Interventional Procedures Special Interest Section of the American Headache S. Trigger point injections for headache disorders: expert consensus methodology and narrative review. Headache. 2014;54:1441–59.CrossRefGoogle Scholar