Skip to main content
SpringerLink
Log in

Resolving discogenic pain

  • Review
  • Published:
European Spine Journal Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  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 29:1077–1081

    Article  PubMed  Google Scholar 

  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–E780

    Article  PubMed  Google Scholar 

  3. Coppes MH, Marani E, Thomeer RT, Oudega M, Groen GJ (1990) Innervation of annulus fibrosus in low back pain. Lancet 336:189–190

    Article  PubMed  CAS  Google Scholar 

  4. Coppes MH, Marani E, Raph TWM, Thomeer RT, Groen GJ (1997) Innervation of “painful” lumbar discs. Spine 22(20):2342–2349

    Article  PubMed  CAS  Google Scholar 

  5. Edgar MA (2007) Nerve supply of the lumbar intervertebral disc. J Bone Joint Surg (Br) 89-B:1135–1139

    Google Scholar 

  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 350:178–181

    Article  PubMed  CAS  Google Scholar 

  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 197:286–292

    Article  PubMed  CAS  Google Scholar 

  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 31:1433–1438

    Article  PubMed  Google Scholar 

  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. 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. 3

  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 21:1848–1851

    Article  PubMed  CAS  Google Scholar 

  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 3–10

    Google Scholar 

  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 21:917–924

    Article  PubMed  CAS  Google Scholar 

  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 24:2295–2299

    Article  PubMed  CAS  Google Scholar 

  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)

    CAS  Google Scholar 

  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 161:1–3

    Article  PubMed  CAS  Google Scholar 

  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):417–424

    Article  PubMed  CAS  Google Scholar 

  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 

Download references

Conflict of interest statement

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuoku, Chiba, Chiba, 260-8677, Japan

    Kazuhisa Takahashi, Yasuchika Aoki & Seiji Ohtori

Authors
  1. Kazuhisa Takahashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasuchika Aoki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seiji Ohtori
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kazuhisa Takahashi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Takahashi, K., Aoki, Y. & Ohtori, S. Resolving discogenic pain. Eur Spine J 17 (Suppl 4), 428–431 (2008). https://doi.org/10.1007/s00586-008-0752-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-008-0752-4

Keywords

Search

Navigation