Neural innervation patterns in the sacral vertebral body
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To characterize the distribution of nerves within a single S1 vertebral body, with particular emphasis on the superior endplate that interfaces with the L5/S1 disc.
Musculature and connective tissue surrounding the sacrum was carefully dissected away for close visual inspection of penetrating nerve fibers. The S1 vertebral body was then isolated for histology and serial coronal sections were cut and stained with a ubiquitous neural antibody marker (PGP 9.5). Slides were analyzed and nerves were manually marked on high resolution, composite captured images, rendering 3D depictions of internal nerve distribution.
The vast majority of nerves were closely associated with blood vessels within the marrow space with a uniform distribution in both the superior and inferior endplates of the S1 vertebral body. The highest nerve density was seen at the centrum (anatomic center) of the S1 vertebral body with smaller peaks seen at the lateral borders. Nerve fibers were observed branching from anterior sacral nerves and penetrating the lateral border of the S1 (during dissection), corresponding with peaks on nerve density maps.
Our results demonstrate that the S1 body and endplate are densely innervated and the peak in nerve density at the vertebral center coincides with vasculature patterns previously described in lumbar vertebral bodies. In the sacrum, however, there is no posterior nutrient foramen that facilitates nerve penetration through the vertebral cortex. Rather, our data indicate that nerves penetrate the S1 via the lateral aspects, consistent with being branches of the anterior sacral nerve. Since PGP 9.5 is a ubiquitous neural marker these identified nerves are likely composed of a mixed population of nociceptive and autonomic fibers.
KeywordsPain Nerve Vertebrae Sacroplasty Vertebroplasty Spine
Funding provided by Relievant Medsystems, Inc. and the National Institutes of Health (R01AR063705).
Conflict of interest
Jeffrey Lotz is a consultant for Relievant Medsystems, Inc. who partially funded this work.
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