Abstract
BACKGROUND CONTEXT
Discogenic low-back pain (DLBP) is one of the primary causes of low back pain (LBP)
and is associated with internal disk disruptions and is mainly transmitted by the
sinuvertebral nerve (SVN). The lack of a universal understanding of the anatomical
characteristics of the SVN has compromised surgical treatment for DLPB.
PURPOSE
This study aims to elaborate on the anatomical characteristics of the SVN and to discuss
their possible clinical significance.
STUDY DESIGN
The SVNs were dissected and immunostained in ten human lumbar specimens.
METHODS
The SVNs at the segments from L1–L2 to L5–S1 in ten human cadavers were studied, and
the number, origin, course, diameter, anastomotic branches, and branching points of
the SVNs were documented. Three longitudinal and five transverse zones were defined
in the dorsal coronal plane of the vertebral body and disc. The vertebrae were divided
longitudinally as follows: the region between the medial edges of the bilateral pedicles
is divided into three equal parts, the middle third is zone I and the lateral third
on both sides are zones II; the areas lateral to the medial margin of the pedicle
were zones III. The transverse zones were designated as follows: (a)superior margin
of the vertebral body to superior margin of the pedicle; (b) between superior and
inferior margins of the pedicle; (c) inferior margin of the pedicle to inferior margin
of the vertebral body; (d) superior margin of the disc to the midline of the disc;
and (e) midline of the disc to the inferior margin of the disc. The distribution characteristics
of SVNs in various zones were recorded, and tissue sections were immunostained with
anti-NF 200 and anti-PGP 9.5.
RESULTS
The SVNs are divided into main trunks and deputy branches, with 109 main trunks and
451 deputy branches identified in the 100 lumbar intervertebral foramens (IVFs). The
main trunks of the SVN originate from the spinal nerve and/or the communicating branch,
but the deputy branch originating from both roots was not observed. All the main trunks
and deputy branches of the SVNs originate from the posterolateral disc (III d and
III e). The deputy branches of the SVN primarily innervate the posterolateral aspect
of the intervertebral disc (III d 46.78%, III e 36.36%) and the subpedicular vertebral
body (III c 16.85%). The main trunk of the SVNs passes primarily through the subpedicular
vertebral body (III c 96.33%) and divides into ascending, transverse, and descending
branches in the IVF: III c (23/101, 22.77%) or spinal canal: II c (73/101, 72.28%),
II d (3/101, 2.97%), II b (2/101, 1.98%). The main trunk possesses extensive innervation,
and except for the most medial discs (I d and I e), it almost dominates all other
zones of the spinal canal. At the segments from L1–L2 to L5–S1, 39 ipsilateral anastomoses
connecting the ascending branch to the main trunk or spinal nerve at the upper level
were observed, with one contralateral anastomosis observed at L5.
CONCLUSION
The zone distribution characteristics of SVNs are similar across all levels. Comparatively,
the proportion of double-root origin and the number of insertion points of the SVNs
increased at the lower level. The three types of anastomosis offer connections between
SVNs at the same level and at different levels. The posteromedial disc is innervated
by corresponding and subjacent main trunks, with the posterolateral disc mainly innervated
by the deputy branch.
CLINICAL SIGNIFICANCE
Detailed information and zone distribution characteristics of the lumbar SVNs can
help improve clinicians' understanding of DLBP and improve the effectiveness of treatments
targeting the SVNs.
Keywords
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Article info
Publication history
Published online: April 07, 2023
Accepted:
March 31,
2023
Received in revised form:
March 19,
2023
Received:
October 25,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
FDA device/drug status: Not applicable.
Author disclosures: JC: Nothing to disclose. ZL: Nothing to disclose. YX: Nothing to disclose. ZZ: Nothing to disclose. ZZ: Nothing to disclose. CF: Nothing to disclose. QL: Nothing to disclose. QZ: Nothing to disclose.
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