Comparison of sensory and sympathetic innervation of the dura mater and posterior longitudinal ligament in the cervical spine after removal of the stellate ganglion
H. Yamada et al., Comparison of sensory and sympathetic innervation of the dura mater and posterior longitudinal ligament in the cervical spine after removal of the stellate ganglion, J COMP NEUR, 434(1), 2001, pp. 86-100
Although cervical spinal tissues are rich in sensory and sympathetic fibers
, which play a significant role in clinical phenomena, there is little info
rmation available regarding their anatomical characteristics. In this study
, we compared the innervation of the cervical dura mater and the posterior
longitudinal ligament (PLL) to that after removal of the stellate ganglion
to determine whether the anatomical background plays a significant role in
clinical manifestations. Immunoreactivities for calcitonin gene-related pep
tide (CGRP) and substance P (SP) were used as sensory markers, and immunore
activity for neuropeptide Y (NPY) was used as a sympathetic marker. Sensory
fibers in the cervical dura mater were distributed within each cervical se
gment, but those in the PLL extended beyond the segmental borders. A dense
sensory fiber network forming a single layer was seen at the intervertebral
disc region in the cervical PLL, whereas sympathetic fibers in this region
were sparsely distributed. Sympathetic fibers were distributed not only ar
ound the vascular wall but also in the region independent from vessels, and
some occasionally ran together with sensory fibers in both the dura mater
and the PLL. Removal of the stellate ganglion had little effect on the dist
ribution of sensory fibers but denervated the sympathetic fiber networks in
the region independent from vessels of the upper ipsilateral cervical PLL.
In conclusion, the cervical dura mater and the PLL have different sensory
and sympathetic innervations. Sympathetic fibers pass through the stellate
ganglion to project to the region independent from vessels in the upper cer
vical PLL. Clinical symptoms may be attributed to this characteristic inner
vation of the cervical spine. (C) 2001 Wiley-Liss, Inc.