Abstract
This study aimed to provide topographic information of the greater occipital (GON) and third occipital (3ON) nerves, with the three-dimensional locations of their emerging points on the back muscles (60 sides, 30 cadavers) and their spatial relationship with muscle layers, using a 3D digitizer (Microscribe G2X, Immersion Corp, San Jose CA, USA). With reference to the external occipital protuberance (EOP), GON pierced the trapezius at a point 22.6 ± 7.4 mm lateral and 16.3 ± 5.9 mm inferior and the semispinalis capitis (SSC) at a point 13.1 ± 6.0 mm lateral and 27.7 ± 9.9 mm inferior. With the same reference, 3ON pierced, the trapezius at a point 12.9 ± 9.3 mm lateral and 44.2 ± 21.4 mm inferior, the splenius capitis at a point 10.0 ± 5.3 mm lateral and 59.2 ± 19.8 mm inferior, and SSC at a point 11.5 ± 9.9 mm lateral and 61.4 ± 15.3 mm inferior. Additionally, GON arose, winding up the obliquus capitis inferior, with the winding point located 52.3 ± 11.7 mm inferior to EOP and 30.2 ± 8.9 mm lateral to the midsagittal line. Knowing the course of GON and 3ON, from their emergence between vertebrae to the subcutaneous layer, is necessary for reliable nerve detection and precise analgesic injections. Moreover, stereotactic measurement using the 3D digitizer seems useful and accurate for neurovascular structure study.
Highlights
On the posterior neck and occipital region, the posterior rami of the upper cervical spinal nerves issue occipital cutaneous nerves
greater occipital nerve (GON) is a distinct nerve including the second cervical spinal nerve, which communicates with the first cervical spinal nerve, third, or lesser occipital nerve during its entire course
The piercing position of GON is clinically important for the diagnosis and treatment of pain syndrome in the posterior neck region
Summary
On the posterior neck and occipital region, the posterior rami of the upper cervical spinal nerves issue occipital cutaneous nerves. It innervates the skin on the lower part of the posterior neck. Clarifying the exact anatomical information regarding the occipital cutaneous nerves should help establish a diagnosis strategy aided by these tools, and improve the efficiency of block anaesthesia treatment, anatomical reports about the emergence and route of GON and 3ON are few, whereas, several studies have reported clinical phenomena after analgesic treatment for occipital neuralgia in living patients. The relative position of the occipital cutaneous nerves with layers formed by these back muscles can provide useful information for the interpretation of the sonographic image during ultrasonic-guided injection[1]. We provided 3D supplementary images showing metric information of the two occipital cutaneous nerves to facilitate the understanding of their stereoscopic topography
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