title: Localization of the medial branches of the cervical dorsal rami during cervical laminoplasty.
abstract: METHODS
  Observational anatomic study.
  
  
  OBJECTIVE
  To give precise information on the surgical anatomy of the medial branches of the cervical dorsal rami.
  
  
  BACKGROUND
  The anatomy of the medial branches has not been sufficiently described.
  
  
  METHODS
  We recorded the location of the medial branches in 94 consecutive patients who underwent laminoplasty for cervical compression myelopathy. A posterior cervical approach was made along the edge of the nuchal ligament, and, after carefully detaching the trapezius muscle from the nuchal ligament; we identified the right-side branches around the semispinalis capitis muscle. We recorded the location of the branches with reference to the spinous processes and the semispinalis capitis and trapezius muscles. In 52 patients, we electrically stimulated the branches and observed the contraction of these muscles.
  
  
  RESULTS
  Branches were identified between C3 and C6 spinous process levels in 92 patients. A single branch was identified in 56 patients, 2 branches were identified in 35 patients, and 3 branches were identified in the remaining 1 patient. Branches were located between C3 and C4 (n = 12), between C4 and C5 (n = 80), between C5 and C6 (n = 2), and at C6 (n = 35). There were 4 patterns of final course: 52 branches passed through the medial side of the semispinalis capitis and trapezius muscles and terminated in a subcutaneous area; 50 branches penetrated the semispinalis capitis and trapezius muscles and terminated in a subcutaneous area; 12 branches terminated in the semispinalis capitis muscle; and 15 branches penetrated the semispinalis capitis and terminated at the nuchal ligament. In 19 of 52 patients tested, the semispinalis capitis muscle contracted after electrical stimulation.
  
  
  CONCLUSIONS
  Medial branches of the cervical dorsal rami were discernible in cervical posterior approach laminoplasty and were frequently found adjacent to C4 and C5 spinous processes. The medial branches sometimes supplied motor fibers to the semispinalis capitis muscle. Knowledge of the course of these branches might be helpful for avoiding injury during laminoplasty.
authors.affiliation: Department of Orthopedics, Faculty of Medicine, Jichi Medical University, Tochigi, Japan. seichi-spine@jichi.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Seichi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higashi
authors.forename: Teruaki
authors.initials: T
authors.lastname: Endo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kojima
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Inoue
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hoshino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000033:anatomy & histology* / Q000601:surgery; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000033:anatomy & histology* / Q000601:surgery; D011446:Prospective Studies; D013127:Spinal Nerves / Q000033:anatomy & histology* / Q000601:surgery