Classification and clinical anatomy of the first spinal nerve: Surgical implications - Laboratory investigation

R. Shane Tubbs, Marios Loukas, Bulent Yalçin, Mohammadali Mohajel Shoja, Aaron A. Cohen-Gadol

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Object. Data regarding the first cervical nerve are scanty and conflicting, however this nerve may need to be identified for neurosurgical procedures such as rhizotomy for torticollis and suboccipital pain syndromes. The authors performed the present study to elucidate further the detailed anatomy of the first cervical nerve and review its clinical relevance. Methods. Forty adult cadavers (80 sides) were used in this study. Dissection was performed at the craniocervical junction with special attention to the formation and presence of the components of the C-1 spinal nerve. Additionally, connections between the C-1 nerve and the spinal accessory nerves were recorded. Results. The authors classified the C-1 nerves into Types Ia, Ib, and II, in 34, 9, and 37 sides, respectively. Type Ia was composed of ventral and dorsal roots with a dorsal root ganglion, Type Ib was composed of ventral and dorsal roots and no dorsal root ganglion, and Type II was composed of only ventral roots. All types contained both dorsal and ventral rami. Mackenzie's nerve was identified on 2 left sides (2.5%). On 48 sides (60%), the C-1 nerve received a mean of 2.5 dorsal rootlets. In the remaining specimens, C-1 did not receive any dorsal rootlets. On the sides found to receive C-1 dorsal rootlets, 14 (30%) were found to have a distinct dorsal root ganglion present, and in 21 (44%) the spinal accessory nerve joined with the dorsal rootlets. The first cervical vertebra in these cases did not possess a dorsal root ganglion. A dorsal ramus of the C-1 spinal nerve was identified on all sides. Communication between the dorsal rami of C-1 and C-2 near their posterior elements was found on 12 sides (15%). Conclusions. A detailed knowledge of C-1 nerve anatomy may be of use to the surgeon operating in the vicinity. Specifically, this knowledge may be helpful in procedures involving C-1 rhizotomy, including peripheral denervation procedures for cervical dystonia and occipital neuralgia.

Original languageEnglish (US)
Pages (from-to)390-394
Number of pages5
JournalJournal of Neurosurgery: Spine
Volume10
Issue number4
DOIs
StatePublished - Apr 1 2009
Externally publishedYes

Fingerprint

Spinal Nerves
Spinal Nerve Roots
Spinal Ganglia
Anatomy
Accessory Nerve
Rhizotomy
Torticollis
Neurosurgical Procedures
Cervical Vertebrae
Neuralgia
Denervation
Cadaver
Dissection
Communication
Pain

Keywords

  • Anatomy
  • C-1 spinal nerve
  • Cervical spine
  • Craniocervical junction
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Neurology
  • Clinical Neurology

Cite this

Classification and clinical anatomy of the first spinal nerve : Surgical implications - Laboratory investigation. / Tubbs, R. Shane; Loukas, Marios; Yalçin, Bulent; Mohajel Shoja, Mohammadali; Cohen-Gadol, Aaron A.

In: Journal of Neurosurgery: Spine, Vol. 10, No. 4, 01.04.2009, p. 390-394.

Research output: Contribution to journalArticle

Tubbs, R. Shane ; Loukas, Marios ; Yalçin, Bulent ; Mohajel Shoja, Mohammadali ; Cohen-Gadol, Aaron A. / Classification and clinical anatomy of the first spinal nerve : Surgical implications - Laboratory investigation. In: Journal of Neurosurgery: Spine. 2009 ; Vol. 10, No. 4. pp. 390-394.
@article{f68775fdb3bf466f9252d5a16d7a079b,
title = "Classification and clinical anatomy of the first spinal nerve: Surgical implications - Laboratory investigation",
abstract = "Object. Data regarding the first cervical nerve are scanty and conflicting, however this nerve may need to be identified for neurosurgical procedures such as rhizotomy for torticollis and suboccipital pain syndromes. The authors performed the present study to elucidate further the detailed anatomy of the first cervical nerve and review its clinical relevance. Methods. Forty adult cadavers (80 sides) were used in this study. Dissection was performed at the craniocervical junction with special attention to the formation and presence of the components of the C-1 spinal nerve. Additionally, connections between the C-1 nerve and the spinal accessory nerves were recorded. Results. The authors classified the C-1 nerves into Types Ia, Ib, and II, in 34, 9, and 37 sides, respectively. Type Ia was composed of ventral and dorsal roots with a dorsal root ganglion, Type Ib was composed of ventral and dorsal roots and no dorsal root ganglion, and Type II was composed of only ventral roots. All types contained both dorsal and ventral rami. Mackenzie's nerve was identified on 2 left sides (2.5{\%}). On 48 sides (60{\%}), the C-1 nerve received a mean of 2.5 dorsal rootlets. In the remaining specimens, C-1 did not receive any dorsal rootlets. On the sides found to receive C-1 dorsal rootlets, 14 (30{\%}) were found to have a distinct dorsal root ganglion present, and in 21 (44{\%}) the spinal accessory nerve joined with the dorsal rootlets. The first cervical vertebra in these cases did not possess a dorsal root ganglion. A dorsal ramus of the C-1 spinal nerve was identified on all sides. Communication between the dorsal rami of C-1 and C-2 near their posterior elements was found on 12 sides (15{\%}). Conclusions. A detailed knowledge of C-1 nerve anatomy may be of use to the surgeon operating in the vicinity. Specifically, this knowledge may be helpful in procedures involving C-1 rhizotomy, including peripheral denervation procedures for cervical dystonia and occipital neuralgia.",
keywords = "Anatomy, C-1 spinal nerve, Cervical spine, Craniocervical junction, Surgery",
author = "Tubbs, {R. Shane} and Marios Loukas and Bulent Yal{\cc}in and {Mohajel Shoja}, Mohammadali and Cohen-Gadol, {Aaron A.}",
year = "2009",
month = "4",
day = "1",
doi = "10.3171/2008.12.SPINE08661",
language = "English (US)",
volume = "10",
pages = "390--394",
journal = "Journal of Neurosurgery: Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
number = "4",

}

TY - JOUR

T1 - Classification and clinical anatomy of the first spinal nerve

T2 - Surgical implications - Laboratory investigation

AU - Tubbs, R. Shane

AU - Loukas, Marios

AU - Yalçin, Bulent

AU - Mohajel Shoja, Mohammadali

AU - Cohen-Gadol, Aaron A.

PY - 2009/4/1

Y1 - 2009/4/1

N2 - Object. Data regarding the first cervical nerve are scanty and conflicting, however this nerve may need to be identified for neurosurgical procedures such as rhizotomy for torticollis and suboccipital pain syndromes. The authors performed the present study to elucidate further the detailed anatomy of the first cervical nerve and review its clinical relevance. Methods. Forty adult cadavers (80 sides) were used in this study. Dissection was performed at the craniocervical junction with special attention to the formation and presence of the components of the C-1 spinal nerve. Additionally, connections between the C-1 nerve and the spinal accessory nerves were recorded. Results. The authors classified the C-1 nerves into Types Ia, Ib, and II, in 34, 9, and 37 sides, respectively. Type Ia was composed of ventral and dorsal roots with a dorsal root ganglion, Type Ib was composed of ventral and dorsal roots and no dorsal root ganglion, and Type II was composed of only ventral roots. All types contained both dorsal and ventral rami. Mackenzie's nerve was identified on 2 left sides (2.5%). On 48 sides (60%), the C-1 nerve received a mean of 2.5 dorsal rootlets. In the remaining specimens, C-1 did not receive any dorsal rootlets. On the sides found to receive C-1 dorsal rootlets, 14 (30%) were found to have a distinct dorsal root ganglion present, and in 21 (44%) the spinal accessory nerve joined with the dorsal rootlets. The first cervical vertebra in these cases did not possess a dorsal root ganglion. A dorsal ramus of the C-1 spinal nerve was identified on all sides. Communication between the dorsal rami of C-1 and C-2 near their posterior elements was found on 12 sides (15%). Conclusions. A detailed knowledge of C-1 nerve anatomy may be of use to the surgeon operating in the vicinity. Specifically, this knowledge may be helpful in procedures involving C-1 rhizotomy, including peripheral denervation procedures for cervical dystonia and occipital neuralgia.

AB - Object. Data regarding the first cervical nerve are scanty and conflicting, however this nerve may need to be identified for neurosurgical procedures such as rhizotomy for torticollis and suboccipital pain syndromes. The authors performed the present study to elucidate further the detailed anatomy of the first cervical nerve and review its clinical relevance. Methods. Forty adult cadavers (80 sides) were used in this study. Dissection was performed at the craniocervical junction with special attention to the formation and presence of the components of the C-1 spinal nerve. Additionally, connections between the C-1 nerve and the spinal accessory nerves were recorded. Results. The authors classified the C-1 nerves into Types Ia, Ib, and II, in 34, 9, and 37 sides, respectively. Type Ia was composed of ventral and dorsal roots with a dorsal root ganglion, Type Ib was composed of ventral and dorsal roots and no dorsal root ganglion, and Type II was composed of only ventral roots. All types contained both dorsal and ventral rami. Mackenzie's nerve was identified on 2 left sides (2.5%). On 48 sides (60%), the C-1 nerve received a mean of 2.5 dorsal rootlets. In the remaining specimens, C-1 did not receive any dorsal rootlets. On the sides found to receive C-1 dorsal rootlets, 14 (30%) were found to have a distinct dorsal root ganglion present, and in 21 (44%) the spinal accessory nerve joined with the dorsal rootlets. The first cervical vertebra in these cases did not possess a dorsal root ganglion. A dorsal ramus of the C-1 spinal nerve was identified on all sides. Communication between the dorsal rami of C-1 and C-2 near their posterior elements was found on 12 sides (15%). Conclusions. A detailed knowledge of C-1 nerve anatomy may be of use to the surgeon operating in the vicinity. Specifically, this knowledge may be helpful in procedures involving C-1 rhizotomy, including peripheral denervation procedures for cervical dystonia and occipital neuralgia.

KW - Anatomy

KW - C-1 spinal nerve

KW - Cervical spine

KW - Craniocervical junction

KW - Surgery

UR - http://www.scopus.com/inward/record.url?scp=66349113445&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=66349113445&partnerID=8YFLogxK

U2 - 10.3171/2008.12.SPINE08661

DO - 10.3171/2008.12.SPINE08661

M3 - Article

C2 - 19441999

AN - SCOPUS:66349113445

VL - 10

SP - 390

EP - 394

JO - Journal of Neurosurgery: Spine

JF - Journal of Neurosurgery: Spine

SN - 1547-5654

IS - 4

ER -