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3
rd
International Conference on
Health Care and
Health Management
Joint Event
&
November 04-05, 2019 | Prague, Czech Republic
6
th
International Conference on
Neuroscience and
Neurological Disorders
Journal of Neurology and Clinical Neuroscience | Volume 3
Anatomy of spinal dorsal rami and its implications in back pain
Linqiu Zhou
Thomas Jefferson University, USA
T
he diagnosis and treatment of back pain are challenging.
Knowledge of neuroanatomy and biomechanics of the
spinal dorsal rami are crucial. The spinal dorsal rami are the
posterior branches of the spinal nerve. They innervate back
from the occiput to the sacrum. The dorsal rami of C2 and C3
become greater, lesser and third occipital nerves. Dysfunction
of these nerves can cause cervicogenic headache. In the low
cervical and lumbar spine, each spinal dorsal ramus divides
into medial and lateral branches. The medial (small) branch
supplies the tissues from the midline to the zygapophysial
joint line and innervates two to three adjacent zygapophysial
joints and soft tissues. The lateral (large) branch innervates
the tissues lateral to the zygapophysial joint line. The
dermatome of the dorsal ramus is completely different from
the dermatome described in the text book. Clinically, the pain
presentations follow these anatomic distributions, which can
be used for localization of the disordered dorsal ramus. The
diagnosis can be confirmed by single dorsal ramus block by
resulting in relief of pain andmuscle spasm. Anatomically, the
common dorsal ramus and its medial and lateral branches
surround the zygapophysial joint, which serves as a pivot
of the spinal functional unit. Any abnormal movement or
pathology of the zygapophysial joint can cause stress or
tension to the dorsal rami and induce back pain. Clinically, in
the low back, L1 and L2 are the most common sites of dorsal
rami disorder, because of their anatomical and biomechanical
factors. Treatments of back pain include spinal dorsal
ramus injection, percutaneous neurotomy and core muscle
strengthening exercise. Summarily, disorder of the spinal
dorsal ramus is an important source of back pain. Based on
the anatomy and clinical presentation, the disordered spinal
dorsal ramus can be localized and treated.
e
:
linzhoumd@yahoo.com