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Kanematsu R, Hanakita J, Takahashi T, Minami M, Miyasaka K, Shimauchi-Ohtaki H, Tomita Y. Severe low back pain with mild leg symptoms due to lumbar spine stenosis. Br J Neurosurg 2024; 38:35-38. [PMID: 33463390 DOI: 10.1080/02688697.2020.1868402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Some patients with lumbar spine stenosis (LSS) have severe low back pain (LBP) with only mild leg symptoms. The effects of decompression surgery for such patients remain unknown. METHODS Of 818 patients with LSS who underwent surgical treatment in our institution from 2011 to 2019, eight patients had a numeric rating scale (NRS) score of ≥7 for LBP and 3≤ for leg pain. The patients' age, sex, clinical characteristics, preoperative leg symptoms, and level of LSS were investigated. The detailed characteristics of LBP, such as the disease duration, location of LBP, and exacerbating factors, were obtained from each patient. The NRS and Japanese Orthopaedic Association (JOA) scores for LBP were evaluated on admission, at 1 and 3 months postoperatively, and at the final follow-up (>1 year postoperatively). RESULTS All patients were male with a mean age of 71.5 years (range, 57-82 years). LBP was exacerbated during walking in six patients and during an extension posture in three patients. The median duration of LBP was 2.9 years (range, 0.3-7 years). The stenosis was located at L2/3 in three patients, L3/4 in five patients, and L4/5 in seven patients. The stenosis involved one level in three patients and more than two levels in five patients. Other pathologies, such as sacroiliac joint lesions, facet pain, superior/middle cluneal nerve pain, and discogenic pain, were excluded by diagnostic anesthetic block and detailed physical examination. All patients underwent posterior decompression surgery without fusion. In all eight patients, the NRS score for LBP significantly improved from 7.6 (range, 7-10) to 1.7 (range, 0-3) and the JOA score improved from 13.1 (range, 4-19) to 21.8 (range, 18-27). CONCLUSION A low proportion of patients showed walking-evoked severe LBP with mild leg symptoms due to lumbar spine stenosis. The patients' pain was improved by decompression surgery with satisfactory results.
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Affiliation(s)
- Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Junya Hanakita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Toshiyuki Takahashi
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Manabu Minami
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | - Kazuhiro Miyasaka
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
| | | | - Yosuke Tomita
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Fujieda, Japan
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Clinical anatomy of the lumbar sinuvertebral nerve with regard to discogenic low back pain and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2999-3008. [PMID: 34052894 DOI: 10.1007/s00586-021-06886-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/15/2021] [Accepted: 05/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Kim HS, Wu PH, Jang IT. Lumbar Degenerative Disease Part 1: Anatomy and Pathophysiology of Intervertebral Discogenic Pain and Radiofrequency Ablation of Basivertebral and Sinuvertebral Nerve Treatment for Chronic Discogenic Back Pain: A Prospective Case Series and Review of Literature. Int J Mol Sci 2020; 21:ijms21041483. [PMID: 32098249 PMCID: PMC7073116 DOI: 10.3390/ijms21041483] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 01/17/2023] Open
Abstract
Degenerative disc disease is a leading cause of chronic back pain in the aging population in the world. Sinuvertebral nerve and basivertebral nerve are postulated to be associated with the pain pathway as a result of neurotization. Our goal is to perform a prospective study using radiofrequency ablation on sinuvertebral nerve and basivertebral nerve; evaluating its short and long term effect on pain score, disability score and patients’ outcome. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain. 30 patients with 38 levels of intervertebral disc presented with discogenic back pain with bulging degenerative intervertebral disc or spinal stenosis underwent Uniportal Full Endoscopic Radiofrequency Ablation application through either Transforaminal or Interlaminar Endoscopic Approaches. Their preoperative characteristics are recorded and prospective data was collected for Visualized Analogue Scale, Oswestry Disability Index and MacNab Criteria for pain were evaluated. There was statistically significant Visual Analogue Scale improvement from preoperative state at post-operative 1wk, 6 months and final follow up were 4.4 ± 1.0, 5.5 ± 1.2 and 5.7 ± 1.3, respectively, p < 0.0001. Oswestery Disability Index improvement from preoperative state at 1week, 6 months and final follow up were 45.8 ± 8.7, 50.4 ± 8.2 and 52.7 ± 10.3, p < 0.0001. MacNab criteria showed excellent outcomes in 17 cases, good outcomes in 11 cases and fair outcomes in 2 cases Sinuvertebral Nerve and Basivertebral Nerve Radiofrequency Ablation is effective in improving the patients’ pain, disability status and patient outcome in our study.
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Affiliation(s)
- Hyeun Sung Kim
- Nanoori Gangnam Hospital, Seoul, Spine Surgery, Seoul 06048, Korea; (P.H.W.); (I.-T.J.)
- Correspondence: ; Tel.: +82-2-6003-9767; Fax.: +82-2-3445-9755
| | - Pang Hung Wu
- Nanoori Gangnam Hospital, Seoul, Spine Surgery, Seoul 06048, Korea; (P.H.W.); (I.-T.J.)
- National University Health Systems, Juronghealth Campus, Orthopaedic Surgery, Singapore 609606, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Seoul, Spine Surgery, Seoul 06048, Korea; (P.H.W.); (I.-T.J.)
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Shayota B, Wong TL, Fru D, David G, Iwanaga J, Loukas M, Tubbs RS. A comprehensive review of the sinuvertebral nerve with clinical applications. Anat Cell Biol 2019; 52:128-133. [PMID: 31338228 PMCID: PMC6624329 DOI: 10.5115/acb.2019.52.2.128] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/12/2019] [Indexed: 11/27/2022] Open
Abstract
The anatomy and clinical significance of the sinuvertebral nerve is a topic of considerable interest among anatomists and clinicians, particularly its role in discogenic pain. It has required decades of research to appreciate its role, but not until recently could these studies be compiled to establish a more complete description of its clinical significance. The sinuvertebral nerve is a recurrent nerve that originates from the ventral ramus, re-entering the spinal canal via the intervertebral foramina to innervate multiple meningeal and non-meningeal structures. Its complex anatomy and relationship to discogenic pain have warranted great interest among clinical anatomists owing to its sympathetic contribution to the lumbar spine. Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.
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Affiliation(s)
- Brian Shayota
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - T. L. Wong
- Seattle Science Foundation, Seattle, WA, USA
| | - Donald Fru
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - Glen David
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, WA, USA
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
| | - R. Shane Tubbs
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies
- Seattle Science Foundation, Seattle, WA, USA
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Sensory innervation of the dorsal longitudinal ligament and the meninges in the lumbar spine of the dog. Histochem Cell Biol 2014; 142:433-47. [PMID: 24748503 DOI: 10.1007/s00418-014-1218-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
Although intervertebral disc herniation is a well-known disease in dogs, pain management for this condition has remained a challenge. The goal of the present study is to address the lack of information regarding the innervation of anatomical structures within the canine vertebral canal. Immunolabeling was performed with antibodies against protein gene product 9.5, Tuj-1 (neuron-specific class III β-tubulin), calcitonin gene-related peptide, and neuropeptide Y in combination with the lectin from Lycopersicon esculentum as a marker for blood vessels. Staining was indicative of both sensory and sympathetic fibers. Innervation density was the highest in lateral areas, intermediate in dorsal areas, and the lowest in ventral areas. In the dorsal longitudinal ligament (DLL), the highest innervation density was observed in the lateral regions. Innervation was lower at mid-vertebral levels than at intervertebral levels. The presence of sensory and sympathetic fibers in the canine dura and DLL suggests that pain may originate from both these structures. Due to these regional differences in sensory innervation patterns, trauma to intervertebral DLL and lateral dura is expected to be particularly painful. The results ought to provide a better basis for the assessment of medicinal and surgical procedures.
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He W, Sheng ZM, Wang L, Gaischek I, Litscher G. Modulation of Autonomic Nervous System During and After Acupuncture Treatment of Lumbosacral Pain in Women: A Preliminary Clinical Observational Study. Med Acupunct 2013. [DOI: 10.1089/acu.2012.0884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Wei He
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Department of Meridians, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ze-Min Sheng
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Privatclinic Lassnitzhoehe, Lassnitzhoehe, Austria
| | - Lu Wang
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
| | - Ingrid Gaischek
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
| | - Gerhard Litscher
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, and TCM Research Center Graz, Medical University of Graz, Graz, Austria
- Department of Meridians, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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Takahashi Y, Ohtori S, Takahashi K. Peripheral nerve pathways of afferent fibers innervating the lumbar spine in rats. THE JOURNAL OF PAIN 2009; 10:416-25. [PMID: 19327644 DOI: 10.1016/j.jpain.2008.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2008] [Revised: 10/13/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED We investigated the pathways of afferent fibers innervating the lumbar spine. The neurotracer DiI was applied to reference sites at the L5 level in rats. One of 4 surgeries was performed before DiI application: (1) transaction of the dorsal ramus of the L2 spinal nerve, (2) transaction of the ventral ramus of the L2 spinal nerve, (3) transaction of the psoas major muscle at L3-L4, or (4) removal of the paravertebral sympathetic trunks from L3-L5. The number of DiI-labeled neurons in the dorsal root ganglia after surgery was compared with neuron numbers in surgery-naïve rats. The number of DiI-labeled neurons decreased drastically with transection of the L2 ventral ramus or psoas major muscle for the ventral and lateral portions of the disc and vertebral body and after transection of the L2 dorsal ramus for the facet joint and spinous process. Removal of the sympathetic trunks did not reduce the number of DiI-labeled neurons significantly in the extra-spinal canal sites. In contrast, significant reductions occurred after the removal of the paravertebral sympathetic trunks in the intra-spinal canal sites. Extra-spinal canal sites received afferent fibers primarily through somatic routes, but intra-spinal canal sites received afferent fibers via the sympathetic trunks. PERSPECTIVE Extra-spinal canal sites of the lumbar spine received afferent fibers from muscles originating in the site. Intra-spinal canal sites received a considerable number of afferent fibers via the paravertebral sympathetic trunks. These results may provide new insights for nerve block treatment of low back pain.
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Affiliation(s)
- Yuzuru Takahashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan.
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Saxler G, Brankamp J, von Knoch M, Löer F, Hilken G, Hanesch U. The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy, even after application of autologous fat grafts. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2008; 17:1362-72. [PMID: 18704516 DOI: 10.1007/s00586-008-0741-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 06/19/2008] [Accepted: 07/29/2008] [Indexed: 11/30/2022]
Abstract
A considerable number of patients complain about pain after lumbar surgery. The spinal dura mater has been debated as a possible source of this pain. However, there is no information if laminectomy influences the nociceptive sensory innervation of the dura. Therefore, we quantitatively evaluated the density of SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis in an animal model of laminectomy. Twelve adult Lewis rats underwent laminectomy, in six of them the exposed dura was covered by an autologous fat graft. Further six animals without surgical treatment served as controls. Six weeks after surgery, the animals were perfused and the lumbar dura was processed immunohistochemically for the detection of CGRP- and SP-containing nerve fibers. In controls, the peptidergic nerve fibers were found predominantly in the ventral but rarely in the dorsal dura mater lumbalis. After laminectomy, the density of SP- and CGRP-immunopositive neurons significantly increased in ventral as well as in dorsal parts of the dura. Axonal spines could be observed in some cases at the site of laminectomy. The application of autologous fat grafts failed to inhibit the significant increase in the density of peptidergic afferents. Thus, we have provided the first evidence that laminectomies induce an increase in the density of putative nociceptive SP- and CGRP-immunopositive neurons in the lumbar dura mater ascribable to an axonal sprouting of fine nerve fibers. This effect was not prevented by using autologous fat grafts. It is conceivable that the neuronal outgrowth of nociceptive afferents is a cause of low back pain observed after lumbar surgery.
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Affiliation(s)
- Guido Saxler
- Department of Orthopaedic Surgery, University of Duisburg, Hufelandstrasse 55, 45122, Essen, Germany.
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Michaloudi H, Batzios C, Chiotelli M, Grivas I, Papadopoulos GC. Mast cells populations fluctuate along the spinal dura mater of the developing rat. Brain Res 2008; 1226:8-17. [PMID: 18621360 DOI: 10.1016/j.brainres.2008.05.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 05/15/2008] [Accepted: 05/15/2008] [Indexed: 11/19/2022]
Abstract
The present study reveals developmental changes in the number, the phenotype and the distribution pattern of mast cells (MCs) along the cervical, the thoracic and the lumbar parts of the spinal dura mater. Postnatal infiltration of spinal dura by MCs does not appear to follow a sequential developmental pattern and meningeal MCs are unevenly distributed along the various parts of the examined dura. At each spinal level, areas most densely populated by MCs are the dorsal dura and the dural sleeves of the dorsal (sensory) spinal roots The developmental time course of the total MCs number is characterized by significant fluctuations in all three parts examined, with notable increases at P1, P4, P21 and P60 (peak value) for the cervical part, at P1 (peak value), P7 and P21 for the thoracic part and at P1, P7 (peak value) and P30 for the lumbar part. At P180, MCs number declines to 56%, 33% and 13% of the peak values for the cervical, the thoracic and the lumbar part, respectively. However, a different developmental pattern is followed by each subpopulation of MCs identified on the basis of their staining characteristics, namely connective tissue type mast cells (CTMCs), mucosal type or cells with characteristics of immature mast cells (MTMCs) and mixed type MCs, in each part examined. The findings may be of importance in elucidating physiological and pathological processes in the dura mater and the vertebral column.
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Affiliation(s)
- Helen Michaloudi
- Laboratory of Anatomy and Histology, Veterinary School, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece.
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Sympathectomy reduces mechanical allodynia, tumor necrosis factor-alpha expression, and dorsal root ganglion apoptosis following nerve root crush injury. Spine (Phila Pa 1976) 2008; 33:1163-9. [PMID: 18469688 DOI: 10.1097/brs.0b013e31817144fc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An analysis of pain behavior and neuronal apoptosis in the dorsal root ganglion (DRG) following crush injury to the L5 nerve root, with or without surgical sympathectomy. OBJECTIVES To determine whether sympathectomy prevents pain behavior and to compare pain behavior with expression of tumor necrosis factor (TNF)-alpha and apoptosis in the DRG. SUMMARY OF BACKGROUND DATA Sympathetic block is used to relieve symptoms in radiculopathy patients. One effect of the block is improvement of blood flow to the nerve. However, this beneficial effect continues longer than the expected duration of local anesthesia, suggesting an unknown neuroprotective effect involving interference with sympathetic activity. METHODS Sprague-Dawley rats (n = 102) were used and divided into 4 experimental groups. In the crush group, animals received a crush injury to the L5 nerve root. In the sympathectomy group, animals received sympathectomy (Syx) on the left side. In the Syx + crush group, both sympathectomy and crush injury were performed. In the sham group, the surgical procedure was the same, but neither sympathectomy nor crush injury took place. Mechanical allodynia was determined in 4 groups. Expression of TNF-alpha was compared in rats with crush injury, with and without sympathectomy. Using immunostaining for caspase 3, NeuN, and GFAP, localization of apoptotic cells was observed. In addition, we compared the percentage of neurons undergoing apoptosis in the DRG. RESULTS Sympathectomy prevented mechanical allodynia throughout the 14-day experimental period. TNF-alpha expression was increased in the DRG following crush-only injury, whereas it was decreased in animals undergoing sympathectomy after the crush injury. DRG apoptosis in the crush group was significantly higher than in the sympathectomy group at day 7 (P < 0.05). CONCLUSION Surgical sympathectomy reduced mechanical allodynia for 14 days after nerve root crush injury, and that DRG apoptosis was decreased in injured animals that underwent sympathectomy. Sympathetic block may not only cause an increase in nerve blood flow, but may also prevent the development of significant TNF-alpha elevation, DRG apoptosis, and neuropathic pain.
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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.
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Affiliation(s)
- M A Edgar
- Surgery UCL, UCLH, Emmanuel Kaye House, 37a Devonshire Street, London W1G 6QA, UK.
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Mizuno S, Takebayashi T, Kirita T, Tanimoto K, Tohse N, Yamashita T. The effects of the sympathetic nerves on lumbar radicular pain. ACTA ACUST UNITED AC 2007; 89:1666-72. [DOI: 10.1302/0301-620x.89b12.19258] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A rat model of lumbar root constriction with an additional sympathectomy in some animals was used to assess whether the sympathetic nerves influenced radicular pain. Behavioural tests were undertaken before and after the operation. On the 28th post-operative day, both dorsal root ganglia and the spinal roots of L4 and L5 were removed, frozen and sectioned on a cryostat (8 μm to 10 μm). Immunostaining was then performed with antibodies to tyrosine hydroxylase (TH) according to the Avidin Biotin Complex method. In order to quantify the presence of sympathetic nerve fibres, we counted TH-immunoreactive fibres in the dorsal root ganglia using a light microscope equipped with a micrometer graticule (10 x 10 squares, 500 mm x 500 mm). We counted the squares of the graticule which contained TH-immunoreactive fibres for each of five randomly-selected sections of the dorsal root ganglia. The root constriction group showed mechanical allodynia and thermal hyperalgesia. In this group, TH-immunoreactive fibres were abundant in the ipsilateral dorsal root ganglia at L5 and L4 compared with the opposite side. In the sympathectomy group, mechanical hypersensitivity was attenuated significantly. We consider that the sympathetic nervous system plays an important role in the generation of radicular pain.
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Affiliation(s)
| | | | | | | | - N. Tohse
- Department of Cellular Physiology and Signal Transduction School of Medicine Sapporo Medical University, South 1, West 16 & 17, Chuo-ku, Sapporo 060–8543, Japan
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Tonosaki Y, Nishiyama K, Roubos EW, Sugiura Y. alpha-Melanophore-stimulating hormone (alpha-MSH) antagonizes interleukin-1beta-induced hyperalgesia and Fos expression in the paraventricular and arcuate nucleus of the rat. Neuroendocrinology 2005; 81:167-73. [PMID: 16015027 DOI: 10.1159/000086888] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Accepted: 03/07/2005] [Indexed: 11/19/2022]
Abstract
It is known that intracerebroventricular (ICV) administration of a low dose of interleukin-1beta (IL-1beta) induces hyperalgesia and that this effect can be inhibited by alpha-melanophore-stimulating hormone (alpha-MSH). To identify the part of the brain that is affected by hyperalgesia-induced IL-1beta and the possible site of alpha-MSH inhibition, we have examined Fos expression in the rat brain in response to ICV microinjection of alpha-MSH and/or IL-1beta. Following injection of 10 pg IL-1beta, hyperalgesia was induced and Fos became expressed in the paraventricular nucleus (PVN) of the hypothalamus and in the arcuate nucleus (ARC), which contains alpha-MSH-producing neurons. IL-1beta injection did not induce Fos expression in the pars intermedia of the pituitary gland, which contains endocrine melanotrope cells that release alpha-MSH into the systemic circulation. ICV co-injection of IL-1beta with 30 ng alpha-MSH fully inhibited both hyperalgesia and Fos expression in the PVN and the ARC. We conclude that PVN neurons are activated by hyperalgesic IL-1beta and propose that this effect is abolished by alpha-MSH possibly released from the ARC but not from the pituitary gland.
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Affiliation(s)
- Yoshikazu Tonosaki
- Department of Anatomy, Hirosaki University School of Medicine, Hirosaki, Japan.
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Aoki Y, Takahashi Y, Takahashi K, Chiba T, Kurokawa M, Ozawa T, Moriya H. Sensory innervation of the lateral portion of the lumbar intervertebral disc in rats. Spine J 2004; 4:275-80. [PMID: 15125848 DOI: 10.1016/j.spinee.2003.10.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2003] [Accepted: 10/02/2003] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT An annular tear extending to the outer one-third of the annulus is thought to be one of the causes of low back pain. However, some patients have bilateral low back symptoms, even if the annular tear is localized in the lateral disc. Because nociceptive information from the lateral disc is transmitted by the dorsal root ganglion (DRG) neurons innervating the lateral disc, we investigated the distribution of the DRG neurons innervating the lateral portion of the disc. PURPOSE To clarify the distribution and pathway of the DRG neurons innervating the lateral portion of the L5-L6 disc in rats. STUDY DESIGN/SETTING Using the retrograde tracing method, we studied the innervation pattern of the lateral portion of the L5-L6 intervertebral disc in rats. METHODS The retrograde transport of Fluoro-Gold (F-G; Fluorochrome, Denver, CO) was used in 22 rats. Subjects included a nontreated group (n=16) and a sympathectomized group (n=6). Seven days after the application of F-G crystals to the left lateral portion of the L5-L6 disc, bilateral T12-L6 DRGs were observed by fluorescent microscopy. RESULTS In the nontreated group, of all the F-G-labeled neurons, 93.1% were present in the left DRGs and 6.9% were in the right DRGs. The number of labeled neurons was largest in the left L2 DRGs. In the sympathectomized group, the numbers of labeled neurons in the T13, L1 and L2 DRGs were significantly lower than the numbers in the nontreated group. CONCLUSION Results of this study indicate that DRG neurons innervating the lateral portion of the disc are distributed mainly in the ipsilateral side but also in the contralateral side. The DRG neurons in T13, L1 and L2 innervate the lateral portion of the L5-L6 disc through the paravertebral sympathetic trunks.
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Affiliation(s)
- Yasuchika Aoki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba City 260-8670, Japan.
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Raoul S, Faure A, Robert R, Rogez JM, Hamel O, Cuillère P, Le Borgne J. Role of the sinu-vertebral nerve in low back pain and anatomical basis of therapeutic implications. Surg Radiol Anat 2003; 24:366-71. [PMID: 12647025 DOI: 10.1007/s00276-002-0084-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2001] [Accepted: 07/06/2002] [Indexed: 11/29/2022]
Abstract
Low back pain is frequent and results in major disability for patients. This anatomical study was done to understand mechanisms involved in that pain. Two kinds of innervation are present in the lumbar spine: one depends on the somatic nervous system and the other on the sympathetic nervous system. The sympathetic nerves are the sinu-vertebral nerves and the rami communicantes which innervate the intervertebral disc, the ventral surface of the dura mater, the longitudinal dorsal ligament and the longitudinal ventral ligament. The sinu-vertebral nerve was described first by Luschka in 1850. This nerve is implicated in diffuse low back pain because of its pathway and its sympathetic component. This nerve cannot directly reach a somatic element at each level of the lumbar spine, so must first reach the L2 spinal ganglion. Thus, there is a "hole" in the somatic innervation between L3 and L5 because the dorsal nerves do not reach the skin at these levels. The pain therefore takes another route through the sympathetic system. Discogenic pain is mediated by the sinu-vertebral nerves, and through the rami communicantes reaches the L2 spinal ganglion. Anatomical and clinical features reinforce this hypothesis.
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Affiliation(s)
- S Raoul
- Department of Anatomy, Nantes University, 1 rue Gaston Veil, 44035, Nantes Cedex, France.
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Yamada H, Honda T, Yaginuma H, Kikuchi S, Sugiura Y. Comparison of sensory and sympathetic innervation of the dura mater and posterior longitudinal ligament in the cervical spine after removal of the stellate ganglion. J Comp Neurol 2001; 434:86-100. [PMID: 11329131 DOI: 10.1002/cne.1166] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although cervical spinal tissues are rich in sensory and sympathetic fibers, which play a significant role in clinical phenomena, there is little information available regarding their anatomical characteristics. In this study, we compared the innervation of the cervical dura mater and the posterior longitudinal ligament (PLL) to that after removal of the stellate ganglion to determine whether the anatomical background plays a significant role in clinical manifestations. Immunoreactivities for calcitonin gene-related peptide (CGRP) and substance P (SP) were used as sensory markers, and immunoreactivity for neuropeptide Y (NPY) was used as a sympathetic marker. Sensory fibers in the cervical dura mater were distributed within each cervical segment, but those in the PLL extended beyond the segmental borders. A dense sensory fiber network forming a single layer was seen at the intervertebral disc region in the cervical PLL, whereas sympathetic fibers in this region were sparsely distributed. Sympathetic fibers were distributed not only around the vascular wall but also in the region independent from vessels, and some occasionally ran together with sensory fibers in both the dura mater and the PLL. Removal of the stellate ganglion had little effect on the distribution of sensory fibers but denervated the sympathetic fiber networks in the region independent from vessels of the upper ipsilateral cervical PLL. In conclusion, the cervical dura mater and the PLL have different sensory and sympathetic innervations. Sympathetic fibers pass through the stellate ganglion to project to the region independent from vessels in the upper cervical PLL. Clinical symptoms may be attributed to this characteristic innervation of the cervical spine.
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Affiliation(s)
- H Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
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Ohtori S, Takahashi K, Chiba T, Yamagata M, Sameda H, Moriya H. Sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats. Spine (Phila Pa 1976) 2001; 26:946-50. [PMID: 11317119 DOI: 10.1097/00007632-200104150-00020] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The levels of dorsal root ganglions (DRGs) innervating the dorsal portion of the lumbar intervertebral discs from L1-L2 to L4-L5 were investigated in rats by the retrograde transport method. The pathways and functions of nerve fibers supplying the dorsal portion of the discs were investigated by denervation and immuno-histochemistry. OBJECTIVES To investigate the sensory innervation of the dorsal portion of the lumbar intervertebral discs in rats. SUMMARY OF BACKGROUND DATA The dorsal portion of the L5-L6 disc has been reported to be innervated multisegmentally, and anesthetic blockade of the paravertebral sympathetic trunks and the L2 spinal nerve can relieve discogenic low back pain. However, sensory innervation of the dorsal portion of the lumbar discs at other levels has not been clarified. METHODS A retrograde transport of Fluoro-Gold was used. We studied a nonsympathectomy group (n = 44) and a sympathectomy group (n = 50) in which paravertebral sympathetic trunks were resected from L1 to L5 levels. Using a ventral approach, Fluoro-Gold crystals were inserted into the dorsal portion of the L1-L2, L2-L3, L3-L4, and L4-L5 discs. Seven days after surgery, Fluoro-Gold-labeled neurons were counted in the bilateral dorsal root ganglions from T10 to L6. RESULTS Fluoro-Gold-labeled neurons were distributed in dorsal root ganglions from T11 to L5 levels in the nonsympathectomy group. However, in the sympathectomy group the number of labeled neurons was less than that of the nonsympathectomy group in T11, T12, and T13 dorsal root ganglions of the L1-L2 disc group, in T12, T13, and L1 dorsal root ganglions of the L2-L3 disc group, in T12, T13, L1, and L2 dorsal root ganglions of the L3-L4 disc group, and in T12, T13, L1, and L2 dorsal root ganglions of the L4-L5 disc group. CONCLUSION The dorsal portion of the lumbar discs from L1-L2 to L4-L5 is multisegmentally innervated by the T11 through L5 dorsal root ganglions. Sensory fibers from the upper dorsal root ganglions innervate the dorsal portion of the discs via the paravertebral sympathetic trunks, although those from the lower dorsal root ganglions innervate via the sinuvertebral nerves. Furthermore, sensory nerve fibers enter the paravertebral sympathetic trunks through the corresponding ramus communicans and reach the dorsal root ganglions via each ramus communicans at the L2 and/or more cranial levels.
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Affiliation(s)
- S Ohtori
- Third Department of Anatomy, School of Medicine, Chiba University, Chiba, Japan.
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Konnai Y, Honda T, Sekiguchi Y, Kikuchi S, Sugiura Y. Sensory innervation of the lumbar dura mater passing through the sympathetic trunk in rats. Spine (Phila Pa 1976) 2000; 25:776-82. [PMID: 10751287 DOI: 10.1097/00007632-200004010-00004] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Sensory innervation of the lumbar dura mater passing through the sympathetic trunk was investigated by neuronal tracing and immunohistochemical methods. OBJECTIVE To assess an anatomic basis indicating that sympathetic block in the higher lumbar region is effective for patients with low back pain. SUMMARY OF BACKGROUND DATA Low back pain is elicited by disorder or mechanical stimulation of the lumbar dura mater. Clinically, the authors often have observed patients in whom root block at the responsible level or sympathetic block at the higher level could relieve low back pain. Therefore, there may be two different sensory routes, the segmental innervation at the same level and nonsegmental fibers from higher dorsal root ganglia. METHODS The tracers were injected into the sympathetic trunk between L3 and L4 of rats. The lumbar dorsal root ganglia and dura mater were examined, and labeled cells were measured in size and the distribution. To establish the sensory property, the materials were processed in immunohistochemistry for calcitonin gene-related peptide. RESULTS Many small- to medium-sized neurons were retrogradely labeled L1 and L2 dorsal root ganglia after injection into the sympathetic trunk. The anterogradely labeled fibers were found in the dura mater at L4 and L5. Some of the labeled neurons and fibers were immunoreactive for calcitonin gene-related peptide. CONCLUSION Sensory fibers from the upper lumbar ganglia innervated the lower lumbar dura mater directly. These sensory nerves may mediate low back pain and possibly interact with sympathetic nerves.
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Affiliation(s)
- Y Konnai
- Departments of Orthopaedic Surgery and Anatomy, Fukushima Medical College, Fukushima, and the Department of Anatomy, Nagoya University School of Medicine, Nagoya, Japan
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Ohtori S, Takahashi Y, Takahashi K, Yamagata M, Chiba T, Tanaka K, Hirayama J, Moriya H. Sensory innervation of the dorsal portion of the lumbar intervertebral disc in rats. Spine (Phila Pa 1976) 1999; 24:2295-9. [PMID: 10586451 DOI: 10.1097/00007632-199911150-00002] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN The vertebral levels of dorsal root ganglia innervating the dorsal portion of the L5-L6 intervertebral disc were investigated in rats using a retrograde transport method. The pathways and functions of nerve fibers supplying the dorsal portion of the disc were determined by denervation and immunohistochemistry. OBJECTIVES The dorsal portion of the lumbar intervertebral disc has been reported to be innervated segmentally, but anesthetic block of the paravertebral sympathetic trunks and the L2 spinal nerve can relieve discogenic low back pain. In the current study, the sensory innervation of the dorsal portion of the L5-L6 intervertebral disc was investigated, because the disc anatomically corresponds to the L4-L5 disc in humans, and the dorsal portion of the human L4-L5 disc is frequently subject to injury that causes low back pain. METHODS A retrograde transport of Fluoro-Gold (F-G; Fluorochrome, Denver, CO) was used. Subjects included nontreated control (n = 32) and sympathectomized rats in which paravertebral sympathetic trunks were removed from L2 to L3 (n = 9). In a ventral approach, Fluoro-Gold crystals were placed on the dorsal portion of the L5-L6 disc, and labeled neurons in the bilateral dorsal root ganglia from T10 to L6 were counted. RESULTS Fluoro-Gold crystals did not leak from the dorsal portion of the L5-L6 disc in 14 of the 32 nontreated rats and in 5 of the 9 sympathectomized rats. These rats were used for analysis. Fluro-Gold-labeled neurons were found in dorsal root ganglia from T13 to L6 in the 14 control rats but only from L2 to L6 in the 5 sympathectomized rats. CONCLUSION The dorsal portion of the L5-L6 disc of rats was shown to be multisegmentally innervated by the T13 to L6 dorsal root ganglia. The sensory fibers from T13, L1, and L2 dorsal root ganglia were shown to innervate the dorsal portion of the L5-L6 disc through the paravertebral sympathetic trunks. In contrast, those from the L3-L6 dorsal root ganglia may innervate the dorsal portion of the L5-L6 disc through the sinuvertebral nerves.
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Affiliation(s)
- S Ohtori
- Department of Orthopaedic Surgery, School of Medicine, Chiba University, Japan
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Yamada H, Honda T, Kikuchi S, Sugiura Y. Direct innervation of sensory fibers from the dorsal root ganglion of the cervical dura mater of rats. Spine (Phila Pa 1976) 1998; 23:1524-9; discussion 1529-30. [PMID: 9682308 DOI: 10.1097/00007632-199807150-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Sensory innervation in the cervical dura mater of rats was investigated immunohistochemically in whole tissues and transverse sections of the decalcified vertebral column. OBJECTIVE To investigate the origin and distribution of sensory innervation in the cervical dura mater. SUMMARY OF BACKGROUND DATA It has been generally accepted that irritation of the cervical structures is one of the major causes of pain in the neck and the upper extremities. Sensory fibers in the cervical dura mater are possible mediators of pain. However, there is little information about sensory innervation in the cervical dura mater, including the epiradicular sheath. METHODS Ten Wistar rats were used for wholemount immunohistochemical observations of the cervical dura mater. The vertebral columns of five rats were processed for immunohistochemistry after decalcification. In all specimens, sensory fibers were demonstrated by the peptide immunohistochemistry, and sensory innervation was examined. RESULTS The cervical dura mater was arbitrarily divided into three areas: ventral, dorsal, dorsal root ganglion. A large number of fibers were in the dorsal root ganglion area and were distributed in the corresponding segments. Some calcitonin gene-related peptide immunoreactive fibers in the dorsal root ganglion were directly innervated from dorsal root ganglion area neurons and did not form nerve bundles, similar to the sinuvertebral nerve. Several immunoreactive fibers were seen in the ventral area; fibers were rarely observed in the dorsal area. CONCLUSIONS A large number of sensory fibers are segmentally distributed in the cervical dura mater, and some of them are directly traced from dorsal root ganglion neurons.
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Affiliation(s)
- H Yamada
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Japan
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Kallakuri S, Cavanaugh JM, Blagoev DC. An immunohistochemical study of innervation of lumbar spinal dura and longitudinal ligaments. Spine (Phila Pa 1976) 1998; 23:403-11. [PMID: 9516694 DOI: 10.1097/00007632-199802150-00001] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
STUDY DESIGN An immunocytochemical study of nerve fibers in lumbar spinal dura and longitudinal ligaments was conducted in New Zealand white rabbits. OBJECTIVES To demonstrate the presence of nerve fibers and to establish the presence of nociceptive and sympathetic nerve fibers in lumbar dura and longitudinal ligaments. SUMMARY OF BACKGROUND DATA The role of dura as a source of low back pain is still unclear, and the data present a somewhat conflicting picture of the nature of nociceptive innervation in this tissue. METHODS An immunocytochemical method was used to study dura and longitudinal ligaments from New Zealand White rabbits. RESULTS Numerous fine nerve fibers and some small bundles were demonstrated in both the dura and the longitudinal ligaments. In dorsal dura, the fibers were seen at lateral margins running toward midline. In ventral dura and longitudinal ligaments, the fibers were seen throughout the substance of these tissues. A population of substance P, calcitonin gene-related peptide, and tyrosine hydroxylase-reactive nerve fibers were observed in all the tissues. In addition, fibers exhibiting nicotinamide adenine dinucleotide phosphate diaphorase activity were also observed, indicating the presence of nitric oxide in dura. CONCLUSIONS The results clearly demonstrate an extensive distribution of nerve fibers in dura and longitudinal ligaments. The presence of a significant number of putative nociceptive fibers supports a possible role for these structures as a source of low back pain and radicular pain.
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Affiliation(s)
- S Kallakuri
- Wayne State University, Bioengineering Center, Detroit, Michigan, USA
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Suseki K, Takahashi Y, Takahashi K, Chiba T, Tanaka K, Moriya H. CGRP-immunoreactive nerve fibers projecting to lumbar facet joints through the paravertebral sympathetic trunk in rats. Neurosci Lett 1996; 221:41-4. [PMID: 9014176 DOI: 10.1016/s0304-3940(96)13282-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We previously reported that the L5-6 facet joint is innervated from DRGs from L1 to L5 and the paravertebral sympathetic ganglia from T12 to L6 in rats. In the present study, to determine the sensory pathway from L5-6 facet joint, we placed the fluorescent carbocyanine dye, DiI, in the L5-6 facet joint, and examined the paravertebral sympathetic trunks and ganglia bilaterally. We found some DiI-labeled nerve fibers exhibiting calcitonin gene-related peptide (CGRP)-immunoreactivity, and some DiI-labeled neurons surrounded by CGRP-immunoreactive varicose fibers in the ganglia. The results suggest that a sensory pathway from the L5-6 facet joint to L1 and/or L2 DRGs is present in the paravertebral sympathetic trunk, and that sensory nerve fibers may connect with sympathetic postganglionic neurons projecting to lumbar facet joints.
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Affiliation(s)
- K Suseki
- Department of Orthopaedic Surgery, School of Medicine, Chiba University, Japan
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