Gray ramus communicans

Abstract: Objective : There are limited treatment options for patients with painful osteoporotic vertebral compression fracture(OVCF) in whom surgery is not strongly indicated or when pain persists even after vertebroplasty. Conservative treatments generally do not provide adequate or prolonged pain relief since the pain in these patients is thought to originate from within and surrounding vertebra. The purpose of this study is to verify the usefulness of percutaneous nerve block on gray ramus communicans in these patients. Methods : We retrospectively analyzed 36 patients in whom nerve blocks on gray ramus communicans were performed for painful OVCF after failure of conservative therapy and/or after percutaneous vertebroplasty. Bilateral nerve blocks were done on the gray ramus tracts of the somatic nerve roots corresponding with OVCF under C-arm fluoroscopic guidance. Patient-reported pain scores and amount of analgesic medication were measured. Results : All patients tolerated procedures well. Significant initial pain relief was noted in 34 (94.4%) patients and the pain relief was durable in 30(88.2%) of these 34 patients at last visit (at least 4 months after procedure). None of these patients required surgeries during the follow-up period. Decreased analgesic requirement was documented in 30(83.3%) of patients. There was no procedure related complication. Conclusion : Prompt and relatively prolonged improvement of pain without complication after this procedure in majority of patients with persistently painful OVCF supports its effectiveness and safety. Thus, it may be considered a useful adjuvant therapeutic option in these clinical settings.

Abstract: The study of the neuronal organization of ganglia L3–L6 of the sympathetic chain in cats by intracellular recording showed that neurons of the ganglion can be divided into three main groups on the principle of sympathetic preganglionic fibers of different types converging on them. The most numerous group (66%) consists of neurons on which sympathetic preganglionic fibers of the B1, B2, and C groups (with conduction velocities of 12.0±0.7, 4.4±0.3, and 1.0±0.1 m/sec respectively) simultaneously converge, while the least numerous group (10%) is formed by neurons with only sympathetic preganglionic fibers of the C-group converging on them; an intermediate group (24%) consists of neurons activated by sympathetic preganglionic fibers of the B1 and B2 groups. The preganglionic fibers to the ganglionic neurons can mainly be traced from the rostral segments of the spinal cord through the white rami communicantes. Sympathetic preganglionic fibers activating the neurons also enter the ganglion through their own and caudally situated white rami communicantes. Neurons of the ganglion were found to receive a preganglionic (C input) run in the composition of the gray ramus communicans and caudal commissure; the remaining neurons send their axons evidently into visceral branches.

Abstract: There is significant paucity in the literature regarding the vertebral nerve Moreover, descriptions of this structure are conflicting To evaluate further the anatomy and potential clinical significance of this structure, 10 fresh adult cadavers (20 sides) underwent dissection and macroscopic observation of this structure All specimens were found to have a vertebral nerve that originated from the stellate ganglion with the exception of two left sides (10%) in which this nerve arose from the inferior cervical ganglion This nerve ascended posteromedial to the vertebral artery The vertebral nerve was found to be, in essence, a long and deep gray ramus communicans that connected most commonly the stellate ganglia to C6 or C7 spinal nerves by passing through the C6 and C7 transverse foramina Fifteen percent of sides were found to have a vertebral nerve that was plexiform in its configuration Fifty percent were found to have very small branches that entered the fibrous capsule of adjacent zygapophyseal and intervertebral joints Some specimens were noted to have meningeal branches of the vertebral nerve Based on our observations, the vertebral nerve is simply a deep ramus communicans, which often provides articular and meningeal branches to the adjacent spine As neck pain is a significant reason for physician office visits, additional knowledge of the nerves innervating the joints and adjacent meninges of the neck could be important for both surgical and medical blockade of nerve fibers