The vertebral nerve: A comprehensive review of its form and function

The literature is littered with variable and scant reports of the vertebral nerve. The present paper reviews the literature regarding this nervous structure of the neck and attempts to clarify a number of issues surrounding its form, function, and implications of surgical manipulation. The nerve may arise from the stellate ganglion or the ansa subclavia, amongst a number of other structures. Additionally, the terminal insertion of the vertebral nerve varies in the reported literature, with authors observing various terminations. Animal models of the vertebral nerve have limited value, as variations between species and with species have been observed. This review also indicates that contradictory evidence exists regarding the clinical implications of vertebral nerve damage. Although irritation may result in ocular disturbance, hearing loss, headaches, and dizziness, a high degree of incongruity exists around whether or not any clinical findings will actually be observed. Based on our review of the available literature and recent cadaveric research, it appears it may be more logical to classify the vertebral nerve as a variable ramus communicans that connects the stellate or inferior cervical ganglia to the lower cervical spinal nerves and not a structure that ascends entirely with the vertebral artery to enter the cranium.