The nerve supply of the lumbar intervertebral disc

Abstract

The anatomical studies, basic to our understanding of lumbar spine innervation through the sinu-vertebral nerves, are reviewed. Research in the 1980s suggested that pain sensation was conducted in part via the sympathetic system. These sensory pathways have now been clarified using sophisticated experimental and histochemical techniques confirming a dual pattern. One route enters the adjacent dorsal root segmentally, whereas the other supply is non-segmental ascending through the paravertebral sympathetic chain with re-entry through the thoracolumbar white rami communicantes. Sensory nerve endings in the degenerative lumbar disc penetrate deep into the disrupted nucleus pulposus, insensitive in the normal lumbar spine. Complex as well as free nerve endings would appear to contribute to pain transmission. The nature and mechanism of discogenic pain is still speculative but there is growing evidence to support a 'visceral pain' hypothesis, unique in the muscloskeletal system. This mechanism is open to 'peripheral sensitisation' and possibly 'central sensitisation' as a potential cause of chronic back pain.

Intervertebral Disc Degeneration and Low Back Pain: Molecular Mechanisms and Stem Cell Therapy

“…There is growing evidence that these pain receptors in painful disc are peripherally sensitized by the activity of sympathetic efferent which may initiate a pain impulse in response to ischemia, pressure changes or in amatory irritation. (142,243) Knowing why nerves and blood vessels grow into AF may lead to effective strategies to hinder the process, or render it less painful. AF may reflects a microenvironment of low mechanical stress within a tissue which normally exhibits a fluid pressure many times greater than systolic blood pressure.…”

Application of Radiofrequency in Low Back Pain Treatment

“…Because the IVD was supply by the sympathetic trunk, somatosensory nerves and their communicating network through multiple segments, discogenic back pain is always hard to localize and seemed to be a visceral pain (Bogduk et al, 1981) and RF applying to the target nerves of IVD is much more complicated than other parts of the spinal column (Bogduk et al, 1981;Brown et al, 1997;Edgar 2007). During IVD degeneration, increase neuronal activity is found in inner NP which is the possible mechanism of painful disc (Freemont et al, 1997;Coppes et al, 1997;Hurri & Karppinen 2004;Peng et al, 2006;Peng et al, 2009;Freemont et al, 2002;Freemont 2009).…”

New Challenges for Intervertebral Disc Treatment Using Regenerative Medicine

“…9,38,39 Together, these can result in increased risk of nociceptor irritation due to hypoxia, pressure changes, and inflammation. 40,41 Consequently, therapies are typically designed to target one or more axes of the triad of innervation, inflammation, and mechanical stability. For example, disc denervation as a basis for therapy has been implemented thermally (i.e., intradiscal electrothermal therapy 42,43 ) or chemically (e.g., methylene blue 44 ).…”