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

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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.

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Acknowledgements

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).

Funding

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

Author information

Author notes

  1. Tina Stegmann and Hanno Steinke have contributed equally to this manuscript.

Authors and Affiliations

  1. Institute of Anatomy, University of Leipzig, Liebigstrasse 13, 04103, Leipzig, Germany

    Tina Stegmann, Hanno Steinke & Thomas Wolfskämpf

  2. Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany

    Philipp Pieroh & Anna Völker

  3. Department of Anatomy and Cell Biology, Martin-Luther-University Halle-Wittenberg, Grosse Steinstrasse 52, 06097, Halle (Saale), Germany

    Philipp Pieroh & Faramarz Dehghani

  4. Department of Neurosurgery, University of Leipzig Medical Center, Liebigstrasse 20, 04103, Leipzig, Germany

    Mathias Jakob Groll

  5. Fraunhofer Institute for Machine Tools and Forming Technology IWU, Nöthnitzer Str. 44, 01187, Dresden, Germany

    Michael Werner

  6. Faculty of Natural Science, Pharmaceutical Technology and Biopharmaceutics, Martin-Luther-University Halle-Wittenberg, Wolfgang-Langenbeck-Str. 4, 06120, Halle (Saale), Germany

    Julia Kollan

  7. Department of Medical Psychology and Medical Sociology, University of Leipzig Medical Center, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany

    Andreas Hinz

  8. Department for Interdisciplinary Spine Surgery, AKG Klinik Hohwald GmbH, Hohwaldstrasse 40, 01844, Neustadt in Sachsen, Germany

    Mario Leimert

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  1. Tina Stegmann
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Contributions

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.

Corresponding author

Correspondence to Hanno Steinke.

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The authors declare that they have no conflict of interest.

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Electronic supplementary material

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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)

Online Table

 1: Mean age and ICD-code numbers off all body donors which were used for immunohistochemistry. (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)

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)

Supplementary material 5 (PPTX 40 kb)

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Stegmann, T., Steinke, H., Pieroh, P. et al. On the importance of the innervation of the human cervical longitudinal ligaments at vertebral level. Surg Radiol Anat 42, 127–136 (2020). https://doi.org/10.1007/s00276-019-02316-6

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  • DOI: https://doi.org/10.1007/s00276-019-02316-6

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