Role of the sinu-vertebral nerve in low back pain and anatomical basis of therapeutic implications

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. The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server at http://dx.doi.org/10.1007/s00276-002-0084-8.

Résumé

Les lombalgies sont fréquentes et invalidantes. Afin de mieux comprendre les mécanismes qui sous-tendent ces douleurs lombaires, des travaux anatomiques ont été réalisés. Il existe deux grands types d'innervation pour la colonne lombaire: une innervation somatique et une innervation sympathique. Les nerfs dépendant du système sympathique sont les nerfs sinu-vertébraux et les rameaux communicants qui prennent en charge le disque intervertébral, le ligament longitudinal dorsal, le ligament longitudinal ventral et la face ventrale de la dure-mère. Le nerf sinu-vertébral lombaire a été décrit par Luschka pour la première fois en 1850. Du fait de sa composante sympathique et de son territoire d'innervation il pourrait être impliqué dans les douleurs lombaires diffuses, mal systématisées, en barre, correspondant à des douleurs sympathiques. Ce nerf ne peut rejoindre un élément somatique, impliqué dans la transmission de l'influx douloureux (le ganglion spinal), qu'au niveau de L2. En effet, il existe un "trou" d'innervation somatique entre L3 et L5 car les branches dorsales du nerf spinal n'atteignent pas l'élément cutané à ce niveau. L'influx douloureux est donc transmis par une autre voie, en l'occurrence par le système sympathique. La douleur d'origine discale ou ligamentaire emprunte les nerfs sinu-vertébraux correspondants, transite par les rameaux communicants, rejoint le tronc sympathique latéro-vertébral et remonte jusqu'au ganglion spinal de L2. Des arguments anatomiques et cliniques viennent renforcer cette hypothèse.

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Correspondence to S. Raoul.

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The French version of this article is available in the form of electronic supplementary material and can be obtained by using the Springer Link server at https://doi.org/10.1007/s00276-002-0084-8

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Raoul, S., Faure, A., Robert, R. et al. Role of the sinu-vertebral nerve in low back pain and anatomical basis of therapeutic implications. Surg Radiol Anat 24, 366–370 (2002). https://doi.org/10.1007/s00276-002-0084-8

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Keywords

  • Sinu-vertebral nerve
  • Lumbar spine
  • Sympathetic innervation
  • Anatomical study