Sensory nerve fibres from lumbar intervertebral discs pass through rami communicantes. A possible pathway for discogenic low back pain.

Abstract	It has been thought that lumbar intervertebral discs were innervated segmentally. We have previously shown that the L5-L6 intervertebral disc in the rat is innervated bilaterally from the L1 and L2 dorsal root ganglia through the paravertebral sympathetic trunks, but the pathways between the disc and the paravertebral sympathetic trunks were unknown. We have now studied the spines of 17 rats to elucidate the exact pathways. We examined serial sections of the lumbar spine using immunohistochemistry for calcitonin gene-related peptide, a sensory nerve marker. We showed that these nerve fibres from the intervertebral disc ran through the sinuvertebral nerve into the rami communicantes, not into the corresponding segmental spinal nerve. In the rat, sensory information from the lumbar intervertebral discs is conducted through rami communicantes. If this innervation pattern applies to man, simple decompression of the corresponding nerve root will not relieve discogenic pain. Anterior interbody fusion, with the denervation of rami communicantes, may be effective for such low back pain.
Authors	K Suseki, Y Takahashi, K Takahashi, T Chiba, M Yamagata, H Moriya
Journal	The Journal of bone and joint surgery. British volume (J Bone Joint Surg Br) Vol. 80 Issue 4 Pg. 737-42 (Jul 1998) ISSN: 0301-620X [Print] England
PMID	9699846 (Publication Type: Journal Article)
Chemical References	Biomarkers Vasoactive Intestinal Peptide Dopamine beta-Hydroxylase Calcitonin Gene-Related Peptide
Topics	Animals Biomarkers (analysis) Calcitonin Gene-Related Peptide (analysis) Dopamine beta-Hydroxylase (analysis) Ganglia, Spinal (surgery, ultrastructure) Humans Immunohistochemistry Intervertebral Disc (innervation) Low Back Pain (etiology, surgery) Lumbar Vertebrae (innervation) Nerve Fibers (ultrastructure) Neural Pathways (ultrastructure) Neurons, Afferent (ultrastructure) Rats Rats, Sprague-Dawley Spinal Fusion Spinal Nerve Roots (surgery) Spinal Nerves (ultrastructure) Sympathetic Nervous System (surgery, ultrastructure) Vasoactive Intestinal Peptide (analysis)

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