Top

Acta Neurochirurgica

Published in:

01-06-2015 | Clinical Article - Neurosurgical Anatomy

Intradural communication between dorsal rootlets of spinal nerves: their clinical significance

Authors: Bilgehan Solmaz, Necati Tatarlı, Davut Ceylan, Evren Keleş, Safiye Çavdar

Published in: Acta Neurochirurgica | Issue 6/2015

Abstract

Background

Anatomical and surgical textbooks give almost no attention to the intradural communications between dorsal rootlets of adjacent spinal nerves. These communications can be of significance in various neurosurgical procedures and clinical conditions of the region.

Methods

The spinal cord of six formaldehyde-fixed cadavers was dissected from C1–S5. The dorsal rootlets of the spinal nerves were exposed via a posterior approach and communications between adjacent spinal nerves were documented.

Results

The frequency of communication between adjacent dorsal rootlets of the spinal nerves showed variations among spinal levels. Thirty-eight dorsal rootlet communications were observed in six cadavers (12 sides) and 20 (52.6 %) were at cervical levels, 14 (36.8 %) at thoracic levels, and four (10.5 %) at lumbar levels. The majority of communications were observed on the left side (65.8 %). Communications were most frequently observed at cervical (C4–C5, C5–C6) and upper thoracic (T1–T2) levels and seen least frequently at lower thoracic and lumbar levels. No communications were observed at sacral levels. Five types of communication were observed: I. oblique ascending, II. oblique descending III. short Y, IV. long Y and V shaped. None of the communication extended beyond one segment at any spinal level. The occurrence of such dorsal rootlet communications ranged from 3 to 7 for each cadaver and the mean was 4.8 ± 1.3. Histological sections from various levels of the dorsal rootlet communications showed that all consisted of myelinated fibers of varying diameters.

Conclusions

Such communications may lead to misinterpretation of the pathology on the basis of clinical signs and symptoms and also should be considered in rhizotomy.

Boyer P, Buchheit F, Thiebaut JB, Arrouf L, Rihaoui SA (1981) Anatomy of intradural anastomoses between cervical nerve roots. Neurochirurgie 27(3):191–196PubMed

Friedman AH, Nashold BS Jr, Bronec PR (1988) Dorsal root entry zone lesions for the treatment of brachial plexus avulsion injuries: a follow-up study. Neurosurgery 22(2):369–373CrossRefPubMed

Hagenah R, Kosak M, Freckmann N (1983) Anatomic topographical relationship of the intraspinal accessory root to the upper cervical roots and to the vessels of the cranial cervical region. Acta Anat (Basel) 115(2):158–167CrossRef

Haldeman S, Shouka M, Robboy S (1988) Computed tomography, electrodiagnostic and clinical findings in chronic workers’ compensation patients with back and leg pain. Spine 13:345–350CrossRefPubMed

Hamilton WJ, Mossman HW (1972) Human embryology, 4th edn. Williams & Wilkins, Baltimore, p 445

Hollinshead WH (1982) Anatomy for surgeons. Vol 3. The back and limb, 3rd edn. Harper & Row, Philadelphia

Jasper HH, Ballem G (1949) Unipolar electromyograms of normal and denervated human muscle. J Neurophysiol 12:231PubMed

Khatri BO, Baruah J, McQuillen MP (1984) Correlation of electro-myography with computed tomography in evaluation of lower back pain. Arch Neurol 41:594–597CrossRefPubMed

Koch D, Wakhloo AK (1992) CT-guided chemical rhizotomy of the C1 root for occipital neuralgia. Neuroradiology 34(5):451–452CrossRefPubMed

10.

Lang J (1992) Suboccipital approach (and other approaches) to aneurysms at the craniocervical junction. F.K. Schattauer Verlagsgesellschaft, Stuttgart

11.

Lang J (1993) Clinical anatomy of the cervical spine. Thieme, New York, pp 106–109

12.

Marzo JM, Simmons EH, Kallen F (1987) Intradural connections between adjacent cervical spinal roots. Spine 12(10):964–968CrossRefPubMed

13.

Nardin RA, Patel MR, Gudas TF, Rutkove SB, Raynor EM (1999) Electromyography and magnetic resonance imaging in the evaluation of radiculopathy. Muscle Nerve 22(2):151–155CrossRefPubMed

14.

Oh CS, Chung IH, Koh KS, Kim HJ, Kim SS (2001) Intradural anastomoses between the accessory nerve and the posterior roots of cervical nerves: their clinical significance. Clin Anat 14(6):424–427CrossRefPubMed

15.

Oh CS, Chung IH, Koh KS, Kim HJ, Nam KI (2002) Morphologic study of the connections between the accessory nerve and the posterior root of the first cervical nerve. Clin Anat 15(4):267–270CrossRefPubMed

16.

Orhan M, Yurttaş Saylam C, Aktan Ikiz ZA, Uçerler H, Zileli M (2009) Connections between the accessory nerve and the posterior root of the first cervical nerve. Surg Radiol Anat 31(2):107–111CrossRefPubMed

17.

Ouaknine G, Nathan H (1973) Anastomotic connections between the eleventh nerve and the posterior root of the first cervical nerve in humans. J Neurosurg 38(2):189–197CrossRefPubMed

18.

Pallie W (1959) The intersegmental anastomoses of posterior spinal rootlets and their significance. J Neurosurg 16:188–196CrossRefPubMed

19.

Pallie W, Manuel JK (1968) Intersegmental anastomoses between dorsal spinal rootlets in some vertebrates. Acta Anat 70:341–351CrossRefPubMed

20.

Perneczky A, Sunder-Plassmann M (1980) Intradural variant of cervical nerve root fibres potential cause of misinterpreting the segmental location of cervical disc prolapses from clinical evidence. Acta Neurochir (Wien) 52:79–83CrossRef

21.

Sadler TW (2012) Langman’s medical embryology, 12th edn. Williams & Wilkins, Baltimore, pp 359–362

22.

Saylam CY, Orhan M, Aktan Ikiz ZA, Uçerler H, Zileli M (2009) Connection types between the spinal root of the accessory nerve and the posterior roots of the C2–C6 spinal nerves. Surg Radiol Anat 31(6):419–423CrossRefPubMed

23.

Schwartz HG (1956) Anastomoses between cervical nerve roots. J Neurosurg 13:190–194CrossRefPubMed

24.

Seker A, Ceylan D, Tatarlı N, Abdullaev T, Gülbar S, Konya D, Bayri Y, Keleş E, Kılıç T, Cavdar S (2013) A unique case of intradural communicating branches between the accessory nerve and the dorsal roots of the cervical spinal nerves. J Neurol Surg A Cent Eur Neurosurg 74(6):415–418CrossRefPubMed

25.

Shea PA, Woods WW, Werden DH (1950) Electromyography in diagnosis of nerve root compression syndrome. Arch Neurol Psychiatr 64(1):93–104CrossRef

26.

Tanaka N, Fujimoto Y, An HS, Ikuta Y, Yasuda M (2000) The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine (Phila Pa 1976). 25(3):286–291

27.

Trojaborg W (1994) Clinical, electrophysiological, and myelographic studies of 9 patients with cervical spinal root avulsions: discrepancies between EMG and X-ray findings. Muscle Nerve 17(8):913–922CrossRefPubMed

28.

Tubbs RS, Loukas M, Slappey JB, Shoja MM, Oakes WJ, Salter EG (2007) Clinical anatomy of the C1 dorsal root, ganglion, and ramus: a review and anatomical study. Clin Anat 20(6):624–627CrossRefPubMed

29.

Tubbs RS, Loukas M, Shoja MM, Ardalan MR, Apaydin N, Myers C, Shokouhi G, Oakes WJ (2008) Contributions of the fourth spinal nerve to the brachial plexus without prefixation. J Neurosurg Spine 8(6):548–551CrossRefPubMed

30.

Tubbs RS, El-Zammar D, Loukas M, Cömert A, Cohen-Gadol AA (2009) Intradural cervical root adjacent interconnections in the normal, prefixed, and postfixed brachial plexus. J Neurosurg Spine 11(4):413–416CrossRefPubMed

31.

Williams PL, Warwick R, Dyson M, Bannister LH (1989) Gray’s anatomy, 37th edn. Churchill Livingstone, London, p 1123

32.

Wu Z, Tsai C, Yang D, Chu F, Chang T (1987) Electrophysiologic study and computed tomography in diagnosis of lumbosacral radiculopathy. Chin Med J 39:119–125

Title: Intradural communication between dorsal rootlets of spinal nerves: their clinical significance
Authors: Bilgehan Solmaz
Necati Tatarlı
Davut Ceylan
Evren Keleş
Safiye Çavdar
Publication date: 01-06-2015
Publisher: Springer Vienna
Published in: Acta Neurochirurgica / Issue 6/2015
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI: https://doi.org/10.1007/s00701-015-2425-5

At a glance: The STEP trials

Springer Medicine

Intradural communication between dorsal rootlets of spinal nerves: their clinical significance

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2015

Dumb-bell mass straddling the ridge of petrous: an atypical presentation of mucormycosis

Response to: Is it worth performing suture of the cauda equina roots after traumatic penetrating lumbar injury in a combat support hospital?

Characteristics of intracranial pressure (ICP) waves and ICP in children with treatment-responsive hydrocephalus

A new classification and clinical results of Gamma Knife radiosurgery for cavernous sinus hemangiomas: a report of 53 cases

Tractography of Meyer’s loop for temporal lobe resection—validation by prediction of postoperative visual field outcome‬‬‬‬

Preconditioning with pitavastatin, an HMG-CoA reductase inhibitor, attenuates C-Jun N-terminal kinase activation in experimental subarachnoid hemorrhage-induced apoptosis