Cervical nerve roots and the dural sheath: a histological study using human fetuses near term

Abstract

We have previously reported that the thoracolumbar posterior nerve root shows a tortuous epidural course, based on studies of human fetuses near term. For comparison with the cervical nerve, examinations were conducted using frontal, sagittal and horizontal sections of cervical vertebrae from 22 fetuses at 30-38 weeks of gestation. The cervical nerve root showed a short, straight and lateral course near the zygapophysial joint. Multiple rather than single bundles of the cervical posterior root seemed to account for the majority of sensory nerve fibers innervating the upper extremity. Fasciculation of rootlets was evident near the thoracolumbar spinal cord, whereas it was seen in the dural pocket at the nerve exit from the dural sac although both sites were subdural. As in the thoracolumbar region, the nerve sheath was continuous with the dura mater and independently surrounded each of the anterior and posterior roots. Radicular arteries were few in the cervical region. In 2 of the 22 fetuses (31 weeks and 33 weeks), there was a segmental, unilateral abnormality of nerve rootlet fasciculation where the dorsal root ganglion was located lateral or peripheral to the intervertebral region. Long nerve roots running inferiorly are a necessary adaptation to the delayed and marked growth of the thoracolumbar vertebral column. In children, the cervical nerve roots are likely to be affected by movement or dislocation of the vertebrae. The segmental abnormality of the cervical nerve root may be linked to rare variations in the brachial plexus.

Biportal Endoscopic Posterior Cervical Foraminotomy for Adjacent 2-Level Foraminal Lesions Using a Single Approach (Sliding Technique)

“…Cervical nerve roots frequently consist of dual nerve roots including motor and sensory nerve roots. 9 The possibility of dual cervical nerve roots should always be kept in mind to prevent motor nerve root injury. When finding or removing ruptured disc particles around the nerve root, it is strongly recommended to minimize nerve root retraction and manipulation as much as possible.…”

A separate-dural-incision method of extradural dumbbell spinal schwannoma resection: cumulative experience at a single center

“…The invagination of the dural ring (Fig. 1 ), composed of band-like tissue with a thin sheath around the nerve root, [ 9 ] is the anatomical feature that may cause confusion between the intradural/extradural tumor type (Eden classification type II) and the extradural dumbbell tumor (Eden classification type III) during surgery [ 8 ]. Many dumbbell tumors could be totally removed without durotomy, although these tumors seem to have an intradural/extradural mass [ 8 ].…”