Cervical Extraforaminal Ligaments: an Anatomical Study

Overview

Journal Surg Radiol Anat

Specialties Anatomy & Histology
General Surgery
Radiology

Date 2017 Jul 21

PMID 28725916

Citations 5

Authors

Mehmet Arslan

Halil Ibrahim Acar

Ayhan Comert

Affiliations

Soon will be listed here.

Abstract

Purpose: The purpose of this study was to elucidate the anatomy and clinical importance of extraforaminal ligaments in the cervical region.

Methods: This study was performed on eight embalmed cadavers. The existence and types of extraforaminal ligaments were identified. The morphology, quantity, origin, insertion, and orientation of the extraforaminal ligaments in the cervical region were observed.

Results: Extraforaminal ligaments could be divided into two types: transforaminal ligaments and radiating ligaments. It was observed that during their course, transforaminal ligaments cross the intervertebral foramen ventrally. They usually originate from the anteroinferior margin of the anterior tubercle of the cranial transverse process and insert into the superior margin of the anterior tubercle of the caudal transverse process. The dorsal aspect of the transforaminal ligaments adhere loosely to the spinal nerve sheath. The length, width and thickness of these ligaments increased from the cranial to the caudal direction. A single intervertebral foramen contained at least one transforaminal ligament. A total of 98 ligaments in 96 intervertebral foramina were found. The spinal nerves were extraforaminally attached to neighboring anterior and posterior tubercle of the cervical transverse process by the radiating ligaments. The radiating ligaments consisted of the ventral superior, ventral, ventral inferior, dorsal superior and dorsal inferior radiating ligaments. Radiating ligaments originated from the adjacent transverse processes and inserted into the nerve root sheath. The spinal nerve was held like the hub of a wheel by a series of radiating ligaments. The dorsal ligaments were the thickest. From C2-3 to C6-7 at the cervical spine, radiating ligaments were observed. They developed particularly at the level of the C5-C6 intervertebral foramen.

Conclusions: This anatomic study may provide a better understanding of the relationship of the extraforaminal ligaments to the cervical nerve root.

Citing Articles

A comparative study of the anatomy and MRI images of the lumbar foraminal ligaments at the L1-L5 levels.

Zhong E, Fan C, Li Q, Zhao Q Surg Radiol Anat. 2023; 45(12):1535-1543.

PMID: 37872310 DOI: 10.1007/s00276-023-03251-3.

Foraminal Ligaments Tether Upper Cervical Nerve Roots: A Potential Cause of Postoperative C5 Palsy.

Jack A, Osburn B, Tymchak Z, Ramey W, Oskouian R, Hart R J Brachial Plex Peripher Nerve Inj. 2020; 15(1):e9-e15.

PMID: 32728377 PMC: 7383057. DOI: 10.1055/s-0040-1712982.

Factors Associated With C5 Palsy Following Cervical Spine Surgery: A Systematic Review.

Jack A, Ramey W, Dettori J, Tymchak Z, Oskouian R, Hart R Global Spine J. 2019; 9(8):881-894.

PMID: 31819855 PMC: 6882094. DOI: 10.1177/2192568219874771.

The relationship between density variations of transverse ligament tubercles on multidetector computed tomography (MDCT) and age, gender, or laterality in a large cohort.

Luan Q, Ban Y, Liu K, Sun B, Wang X, Lin X Surg Radiol Anat. 2019; 42(2):137-141.

PMID: 31486863 DOI: 10.1007/s00276-019-02324-6.

A morphological comparison of the extraforaminal ligament between the cervical and thoracic regions.

Nonthasaen P, Nasu H, Kagawa E, Akita K Surg Radiol Anat. 2017; 40(5):571-580.

PMID: 29282503 DOI: 10.1007/s00276-017-1963-3.

References

GOLUB B, Silverman B . Transforaminal ligaments of the lumbar spine. J Bone Joint Surg Am. 1969; 51(5):947-56. View

Grimes P, Massie J, Garfin S . Anatomic and biomechanical analysis of the lower lumbar foraminal ligaments. Spine (Phila Pa 1976). 2000; 25(16):2009-14. DOI: 10.1097/00007632-200008150-00002. View

Sunderland S . Brachial plexus injuries. Clin Neurol Neurosurg. 1993; 95 Suppl:S1-2. DOI: 10.1016/0303-8467(93)90026-d. View

Cramer G, Skogsbergh D, Bakkum B, Winterstein J, Yu S, Tuck Jr N . Evaluation of transforaminal ligaments by magnetic resonance imaging. J Manipulative Physiol Ther. 2002; 25(4):199-208. DOI: 10.1067/mmt.2002.123174. View

Kraan G, Delwel E, Hoogland P, van der Veen M, Wuisman P, Stoeckart R . Extraforaminal ligament attachments of human lumbar nerves. Spine (Phila Pa 1976). 2005; 30(6):601-5. DOI: 10.1097/01.brs.0000155403.85582.39. View

Rydevik B, Brown M, Lundborg G . Pathoanatomy and pathophysiology of nerve root compression. Spine (Phila Pa 1976). 1984; 9(1):7-15. DOI: 10.1097/00007632-198401000-00004. View

Transfeldt E, Robertson D, Bradford D . Ligaments of the lumbosacral spine and their role in possible extraforaminal spinal nerve entrapment and tethering. J Spinal Disord. 1993; 6(6):507-12. DOI: 10.1097/00002517-199306060-00006. View

Lohman C, Gilbert K, Sobczak S, Brismee J, James C, Day M . 2015 Young Investigator Award Winner: Cervical Nerve Root Displacement and Strain During Upper Limb Neural Tension Testing: Part 1: A Minimally Invasive Assessment in Unembalmed Cadavers. Spine (Phila Pa 1976). 2015; 40(11):793-800. DOI: 10.1097/BRS.0000000000000686. View

Kraan G, Hoogland P, Wuisman P . Extraforaminal ligament attachments of the thoracic spinal nerves in humans. Eur Spine J. 2009; 18(4):490-8. PMC: 2899458. DOI: 10.1007/s00586-009-0881-4. View

10.

Gilbert K, Brismee J, Collins D, James C, Shah R, Sawyer S . 2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 1. A novel measurement technique during straight leg raise in unembalmed cadavers. Spine (Phila Pa 1976). 2007; 32(14):1513-20. DOI: 10.1097/BRS.0b013e318067dd55. View

11.

de Peretti F, Micalef J, Bourgeon A, Argenson C, Rabischong P . Biomechanics of the lumbar spinal nerve roots and the first sacral root within the intervertebral foramina. Surg Radiol Anat. 1989; 11(3):221-5. DOI: 10.1007/BF02337826. View

12.

Akdemir G . Thoracic and lumbar intraforaminal ligaments. J Neurosurg Spine. 2010; 13(3):351-5. DOI: 10.3171/2010.3.SPINE09799. View

13.

Olsewski J, SIMMONS E, KALLEN F, Mendel F . Evidence from cadavers suggestive of entrapment of fifth lumbar spinal nerves by lumbosacral ligaments. Spine (Phila Pa 1976). 1991; 16(3):336-47. DOI: 10.1097/00007632-199103000-00014. View

14.

Maric D, Krstonosic B, Eric M, Maric D, Stankovic M, Milosevic N . An anatomical study of the lumbar external foraminal ligaments: appearance at MR imaging. Surg Radiol Anat. 2014; 37(1):87-91. DOI: 10.1007/s00276-014-1320-8. View

15.

Gilbert K, Brismee J, Collins D, James C, Shah R, Sawyer S . 2006 Young Investigator Award Winner: lumbosacral nerve root displacement and strain: part 2. A comparison of 2 straight leg raise conditions in unembalmed cadavers. Spine (Phila Pa 1976). 2007; 32(14):1521-5. DOI: 10.1097/BRS.0b013e318067dd72. View

16.

Kraan G, Smit T, Hoogland P, Snijders C . Lumbar extraforaminal ligaments act as a traction relief and prevent spinal nerve compression. Clin Biomech (Bristol). 2009; 25(1):10-5. DOI: 10.1016/j.clinbiomech.2009.09.001. View

17.

Fatani J . Ligaments associated with lumbar intervertebral foramina. 1. L1 to L4. J Anat. 1988; 156:177-83. PMC: 1261921. View

18.

Fatani J, Butt M . Ligaments associated with lumbar intervertebral foramina. 2. The fifth lumbar level. J Anat. 1988; 159:1-10. PMC: 1262003. View

19.

Shi B, Zheng X, Zhang H, Sun C, Cao Y, Jin A . The morphology and clinical significance of the extraforaminal ligaments at the cervical level. Spine (Phila Pa 1976). 2014; 40(1):E9-17. DOI: 10.1097/BRS.0000000000000668. View

20.

Herzberg G, NARAKAS A, Comtet J, Bouchet A, Carret J . Microsurgical relations of the roots of the brachial plexus. Practical applications. Ann Chir Main. 1985; 4(2):120-33. DOI: 10.1016/s0753-9053(85)80122-8. View