Y Konnai1, T Honda, Y Sekiguchi, S Kikuchi, Y Sugiura. 1. Departments of Orthopaedic Surgery and Anatomy, Fukushima Medical College, Fukushima, and the Department of Anatomy, Nagoya University School of Medicine, Nagoya, Japan.
Abstract
STUDY DESIGN: Sensory innervation of the lumbar dura mater passing through the sympathetic trunk was investigated by neuronal tracing and immunohistochemical methods. OBJECTIVE: To assess an anatomic basis indicating that sympathetic block in the higher lumbar region is effective for patients with low back pain. SUMMARY OF BACKGROUND DATA: Low back pain is elicited by disorder or mechanical stimulation of the lumbar dura mater. Clinically, the authors often have observed patients in whom root block at the responsible level or sympathetic block at the higher level could relieve low back pain. Therefore, there may be two different sensory routes, the segmental innervation at the same level and nonsegmental fibers from higher dorsal root ganglia. METHODS: The tracers were injected into the sympathetic trunk between L3 and L4 of rats. The lumbar dorsal root ganglia and dura mater were examined, and labeled cells were measured in size and the distribution. To establish the sensory property, the materials were processed in immunohistochemistry for calcitonin gene-related peptide. RESULTS: Many small- to medium-sized neurons were retrogradely labeled L1 and L2 dorsal root ganglia after injection into the sympathetic trunk. The anterogradely labeled fibers were found in the dura mater at L4 and L5. Some of the labeled neurons and fibers were immunoreactive for calcitonin gene-related peptide. CONCLUSION: Sensory fibers from the upper lumbar ganglia innervated the lower lumbar dura mater directly. These sensory nerves may mediate low back pain and possibly interact with sympathetic nerves.
STUDY DESIGN: Sensory innervation of the lumbar dura mater passing through the sympathetic trunk was investigated by neuronal tracing and immunohistochemical methods. OBJECTIVE: To assess an anatomic basis indicating that sympathetic block in the higher lumbar region is effective for patients with low back pain. SUMMARY OF BACKGROUND DATA: Low back pain is elicited by disorder or mechanical stimulation of the lumbar dura mater. Clinically, the authors often have observed patients in whom root block at the responsible level or sympathetic block at the higher level could relieve low back pain. Therefore, there may be two different sensory routes, the segmental innervation at the same level and nonsegmental fibers from higher dorsal root ganglia. METHODS: The tracers were injected into the sympathetic trunk between L3 and L4 of rats. The lumbar dorsal root ganglia and dura mater were examined, and labeled cells were measured in size and the distribution. To establish the sensory property, the materials were processed in immunohistochemistry for calcitonin gene-related peptide. RESULTS: Many small- to medium-sized neurons were retrogradely labeled L1 and L2 dorsal root ganglia after injection into the sympathetic trunk. The anterogradely labeled fibers were found in the dura mater at L4 and L5. Some of the labeled neurons and fibers were immunoreactive for calcitonin gene-related peptide. CONCLUSION: Sensory fibers from the upper lumbar ganglia innervated the lower lumbar dura mater directly. These sensory nerves may mediate low back pain and possibly interact with sympathetic nerves.