European Spine Journal

, Volume 17, Supplement 4, pp 428–431 | Cite as

Resolving discogenic pain

Review

Abstract

Recent basic science studies on discogenic low back pain have provided new knowledge about this condition. This paper reviews some of these results and presents an overview of the following findings. The rat lumbar intervertebral disk may be innervated non-segmentally through the paravertebral sympathetic nerve and segmentally through the sinuvertebral nerves, and also by dichotomizing sensory fibers. The exposure of the nucleus pulposus (NP) to the outer annulus fibrosus (AF) may induce nerve injury and ingrowth into the disk. Nerve growth factor (NGF)-sensitive neurons are predominant in the rat intervertebral disk, which indicates that hyperalgesic responses can be induced by inflammation. NGF in the NP may promote axonal growth. Lumbar fusion may inhibit nerve ingrowth into the degenerated disk and reduce the percentage of calcitonin gene related peptide (CGRP)-positive neurons.

Keywords

Low back pain Lumbar spine Intervertebral disk Pathophysiology 

Notes

Conflict of interest statement

None of the authors has any potential conflict of interest.

References

  1. 1.
    Aoki Y, Ohtori S, Takahashi K, Ino H, Takahashi Y, Chiba T, Moriya H (2004) Innervation of the lumbar intervertebral disc by nerve growth factor-dependent neurons related to inflammatory pain. Spine 29:1077–1081PubMedCrossRefGoogle Scholar
  2. 2.
    Aoki Y, Akeda K, An H, Muehleman C, Takahashi K, Moriya H, Masuda K (2006) Nerve fiber ingrowth into scar tissue formed following nucleus pulposus extrusion in the rabbit anular-puncture disc degeneration model: effects of depth of puncture. Spine 31:E774–E780PubMedCrossRefGoogle Scholar
  3. 3.
    Coppes MH, Marani E, Thomeer RT, Oudega M, Groen GJ (1990) Innervation of annulus fibrosus in low back pain. Lancet 336:189–190PubMedCrossRefGoogle Scholar
  4. 4.
    Coppes MH, Marani E, Raph TWM, Thomeer RT, Groen GJ (1997) Innervation of “painful” lumbar discs. Spine 22(20):2342–2349PubMedCrossRefGoogle Scholar
  5. 5.
    Edgar MA (2007) Nerve supply of the lumbar intervertebral disc. J Bone Joint Surg (Br) 89-B:1135–1139Google Scholar
  6. 6.
    Freemont AJ, Peacock TE, Goupille P, Hoyland JA, O’Brien J, Jayson MIV (1997) Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181PubMedCrossRefGoogle Scholar
  7. 7.
    Freemont AJ, Watkins A, Maitre CL, Baird P, Jeziorska M, Knight MTN, Ross ERS, O’Brien JP, Hoyland JA (2002) Nerve growth factor expression and innervation of the painful intervertebral disc. J Pathol 197:286–292PubMedCrossRefGoogle Scholar
  8. 8.
    Inoue G, Ohtori S, Aoki Y, Ozawa T, Doya H, Saito T, Ito T, Akazawa T, Moriya H, Takahashi K (2006) Exposure of the nucleus pulposus to the outside of the annulus fibrosus induces nerve injury and regeneration of the afferent fibers innervating the lumbar intervertebral discs in rats. Spine 31:1433–1438PubMedCrossRefGoogle Scholar
  9. 9.
    Koshi T, Ohtori S, Yamashita M, Yamauchi K, Suzuki M, Takahashi K (2007) Lumbar posterior lateral fusion inhibits sensory nerve ingrowth into degenerated lumbar intervertebral discs and discogenic low back pain in rats. J Jpn Orthop Assoc 81:S1000 (in Japanese)Google Scholar
  10. 10.
    Kurokawa M, Takahashi Y, Takahashi Ka, Chiba T, Yamagata M, Sameda H, Aoki Y, Ozawa T, Moriya H (2003) DRG neurons innervating three levels of lumbar intervertebral discs in rats. Abstracts of 30th annual meeting of International Society for the Study of the Lumbar Spine 2003, p. 3Google Scholar
  11. 11.
    Morinaga T, Takahashi K, Yamagata M, Chiba T, Tanaka K, Takahashi Y, Nakamura S, Suseki K, Moriya H (1996) Sensory innervation to the anterior portion of lumbar intervertebral disc. Spine 21:1848–1851PubMedCrossRefGoogle Scholar
  12. 12.
    Nachemson A (2004) Epidemiology and the economics of low back pain. In: Herkowits HN, Dvorak J, Bell G, Nordin M, Grob D (eds) The lumbar spine, 3rd edn. Lippincott, Philadelphia, pp 3–10Google Scholar
  13. 13.
    Nakamura S, Takahashi K, Takahashi Y, Morinaga T, Shimada Y, Moriya H (1996) Origin of nerves supplying the posterior portion of lumbar intervertebral discs in rats. Spine 21:917–924PubMedCrossRefGoogle Scholar
  14. 14.
    Ohtori S, Takahashi Y, Takahashi K, Chiba T, Tanaka K, Hirayama J, Moriya H (1999) Sensory innervation of the dorsal portion of the lumbar intervertebral disc in rats. Spine 24:2295–2299PubMedCrossRefGoogle Scholar
  15. 15.
    Shinohara H (1970) A study on lumbar disc lesion significance of histology of free nerve endings in lumbar disc. J Jpn Orthop Assoc 44:553–570 (in Japanese)Google Scholar
  16. 16.
    Takahashi Y, Nakajima Y, Sakamoto T, Moriya H, Takahashi K (1993) Capsaicin applied to rat lumbar intervertebral disc causes extravasation in the groin skin: a possible mechanism of referred pain of the intervertebral disc. Neurosci Lett 161:1–3PubMedCrossRefGoogle Scholar
  17. 17.
    Woolf CJ, Allchorne A, Safieh-Garabedian B, Poole S (1997) Cytokines, nerve growth factor and inflammatory hyperalgesia: the contribution of tumor necrosis factor alpha. Br J Pharmacol 121(3):417–424PubMedCrossRefGoogle Scholar
  18. 18.
    Yamauchi K, Ohtori S, Endo M, Nakagawa K, Takahashi K, Yamashita T (2007) Axonal outgrowth of Substance P immunoreactive DRG fibers in cultured human degenerative intervertebral discs related with pain transmission pathways in vitro. J Jpn Orthop Assoc 81:S999 (in Japanese)Google Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Kazuhisa Takahashi
    • 1
  • Yasuchika Aoki
    • 1
  • Seiji Ohtori
    • 1
  1. 1.Department of Orthopedic Surgery, Graduate School of MedicineChiba UniversityChibaJapan

Personalised recommendations