S Quinones1, M Konschake2, L L Aguilar3, C Simon4,5, P Aragones1,6, L M Hernández7, A Abramovic8,9, R S Tubbs10,11,12,13,14,15,16, J Bouzada1, F J Valderrama-Canales1, T Vazquez1, J Sanudo1. 1. Department of Anatomy and Embryology, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain. 2. Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria. marko.konschake@i-med.ac.at. 3. Unidad de Columna. Servicio de COT., Hospital Plató., Barcelona, Spain. 4. Computer Science and Statistics, URJC., Madrid, Spain. 5. Instituto Universitario de Evaluación Sanitaria, UCM, Madrid, Spain. 6. Department of Orthopedics. Hospital, Universitario Santa Cristina, Madrid, Spain. 7. Human Anatomy and Embryology Unit, Department of Surgery, Medical and Social Sciences, Scholl of Medicine and Health Sciences, University of Alcalá, UAH, Alcalá de Henares, Madrid, Spain. 8. Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria. 9. Department of Neurosurgery, Medical University of Innsbruck (MUI), Innsbruck, Austria. 10. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, USA. 11. Department of Neurology, Tulane University School of Medicine, New Orleans, LA, USA. 12. Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA. 13. Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA. 14. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA. 15. Department of Anatomical Sciences, School of Medicine, St. George's University, West Indies, Grenada. 16. University of Queensland, Brisbane, Australia.
Abstract
PURPOSE: Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS: Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS: 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION: A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: Lumbar discogenic diffuse pain is still not understood. Authors describe the sinuvertebral nerve (SVN) as one possible cause. Body-donor studies are rare and controversial. Therefore, the aim was to revisit the origin, course and distribution in a body-donor study. METHODS: Six lumbar blocks (3 female, 3 male) aged between 59 and 94 years were dissected. After removal of the back muscles, lamina, dura mater and cauda equina, the anterior vertebral venous plexus, spinal artery and SVN were exposed and evaluated. RESULTS: 43 nerves out of 48 levels could be evaluated. The origin of the SVN was constituted by two roots: a somatic and a sympathetic branch arising from the rami communicantes. In 4/48 intervertebral canals studied (8.3%), we found two SVN at the same level. In 35/48 cases, one SVN was found. In 9/48 cases, no SVN was found. The SVN had a recurrent course below the inferior vertebral notch; in the vertebral canal it showed different patterns: ascending branch (31/43, 72.1%), common branch diverging into two branches (10/43, 23.3%), double ascending branch (1/43, 2.3%) finalizing two levels above and a descending branch (1/43, 2.3%). In 12/43 cases (27.9%) the SVN had ipsilateral connections with another SVN. The distribution ended in the middle of the vertebral body supplying adjacent structures. CONCLUSION: A thorough understanding of the anatomy of the SVN might lead to significant benefits in therapy of discogenic low back pain. We suggest blocking the SVN at the level of the inferior vertebral notch of two adjacent segments. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.