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Child's Nervous System
Published in: Child's Nervous System 2/2016

01-02-2016 | Review Paper

Comprehensive anatomical and immunohistochemical review of the innervation of the human spine and joints with application to an improved understanding of back pain

Authors: Pamela Youssef, Marios Loukas, Jens R. Chapman, Rod J. Oskouian, R. Shane Tubbs

Published in: Child's Nervous System | Issue 2/2016

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Abstract

Background

Pain of spinal origin contributes significantly to cervical, thoracic, and lower back pain presentations. Such pain originates in the nerve fibers supplying the joints or the surrounding ligaments and intervertebral discs. Although there has been little detailed discussion of spinal bony innervation patterns in the literature, the clinical implications of these patterns are anatomically and medically significant.

Methods

The present review provides a detailed analysis of the innervation of the spine, identifying the unique features of each part via online search engines.

Conclusions

The clinical implications of these various studies lie in the importance of the innervation patterns for the mechanism of spinal pain. Immunohistochemical studies have provided further evidence regarding the nature of the innervation of the spine.
Literature
1.
Adams MA, Lama P, Zehra U, Dolan P (2015) Why do some intervertebral discs degenerate when others (in the same spine) do not? Clin Anat 28:195–204CrossRefPubMed
2.
Ahmed M, Bjurholm A, Kreichergs A, Schultzberg M (1993) Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide- immunoreactive nerve fibers in the vertebral bodies, discs, dura mater and spinal ligaments of the rat lumbar spine. Spine 18:268–273CrossRefPubMed
3.
Ashton IK, Ashton BA, Gibson SJ, Polak JM, Jaffray DC, Eisenstein SM (1992) Morphological basis for back pain: the demonstration of nerve fibers and neuropeptides in the lumbar facet joint capsule but not in ligamentum flavum. J Orthop Res 10:72–78CrossRefPubMed
4.
Bogduk N, Lambert G, Duckworth J (1981) The anatomy and physiology of the vertebral nerve in relation to the cervical migraine. Cephalagia 1:11–24CrossRef
5.
6.
Bogduk N, Marsland A (1988) The cervical zygoapophysial joints as a source of neck pain. Spine 13:610–617CrossRefPubMed
7.
Bogduk N (1997) Clinical anatomy of the lumbar spine and sacrum, 3rd edn. Churchill Linvingstone, New York
8.
Borenstein D (1996) Epidemiology, etiology, diagnostic evaluation, and treatment of low back pain. Curr Opin Rheumatol 8:124–129CrossRefPubMed
9.
10.
Canbay S, Gurer B, Bozkurt M, Comert A, Izci Y, Baskaya MK (2014) Anatomical relationships and positions of the lumbar and sacral segments of the spinal cord according to the vertebral bodies and the spinal roots. Clin Anat 27:227–233CrossRefPubMed
11.
Cardoso AC, Fontes RB, Tan LA, Rhoton AL, Roh SW, Fessler RG (2015) Biomechanical effects of the transcndylar approach on the craniocervical junction. Clin Anat 28:683–689CrossRefPubMed
12.
Chua WH, Bogduk N (1995) The surgical anatomy of thoracic facet denervation. Acta Neurochir (Wien) 136:140–144CrossRef
13.
Conti A, Maestroni GJ, Cosentino M, Frigo G, Lecchini S, Marino F, Bombelli R, Ferrari M, Brivio F, Roselli MG, Lissoni P (2000) Evidence for a neuroimmunomodulatory and a hematopoietic role of the Luschka’s coccygeal body. Neuro Endocrinol Lett 21:391–403PubMed
14.
Degmetich S, Bailey JF, Liebenberg E, Lotz JC (2015) Neural innervation patterns in the sacral vertebral body. Eur Spine J Jun 16
15.
Dreyfuss P, Michaelsen M, Fletcher D (1994) Atlanto-occipital and lateral atlanto-axial joint patterns. Spine 19:1125–1131CrossRefPubMed
16.
Groen GJ, Bajlet B, Drukker J (1990) Nerve and nerve plexuses of the human vertebral column. Am J Anat 188:282–296CrossRefPubMed
17.
Hartman J (2014) Anatomy and clinical significance of the uncinate process and uncovertebral joint: a comprehensive review. Clin Anat 27:431–440CrossRefPubMed
18.
Ikeda R (1991) Innervation of the sacroiliac joint. Macroscopical and histological studies. Nippon Ika Daigaku Zasshi 58:587–596CrossRefPubMed
19.
Imai S, Konttinen YT, Tokunga Y (1997) An ultrastructural study of CGRP- immunoreactive nerve fibers innervating the rat posterior longitudinal ligament. Spine 22:1941–1947CrossRefPubMed
20.
Inami S, Shiga T, Tsujino A, Yabuki T, Okado N, Ochiai N (2001) Immunohistochemical demonstration of nerve fibers in the synovial fold of the human cervical facet joint. J Ortho Res 19:593–596CrossRef
21.
Johnson GM (2004) The sensory and sympathetic nerve supply within the cervical spine: review of recent observations. Man Ther 9:71–76CrossRefPubMed
22.
Katsura H, Tatsuo S (2002) Anatomical study of lumbar spine innervation. Folia Morphol 61(2):71–79
23.
Korkala O, Gronblad M, Liesi P, Karaharju E (1985) Imuunohistochemical demonstration of nociceptors in the ligamentous structures of the lumbar spine. Spine 10:156–157CrossRefPubMed
24.
Manchikanti L, Boswell M, Singh V, Pampati V, Damron K, Beyer C (2004) Prevalence of facet joint pain in chronic spinal pain of cervical, thoracic, and lumbar regions. BMC Musculoskeletal Disorder 5:15CrossRef
25.
McCarthy PW, Petts P, Hamilton A (1992) RT97- and calcitonin gene related peptide-like immunoreactivity in lumbar intervertebral discs and adjacent tissue from the rat. J Anat 180:15–24PubMedCentralPubMed
26.
27.
McLain RF, Pickar JG (1998) Mechanoreceptor endings in human thoracic and lumbar facet joints. Spine 23(2):168–173CrossRefPubMed
28.
Moore KL, Dalley AF, Agur AMR (2010) Clinically Oriented Anatomy, 6th edn. London: Lippincott Williams & Wilkins, Philadelphia, PA, pp 358–359
29.
30.
Ohtori S, Takahashi K, Moriya H (2003) Calcitonin gene-related peptide immunoreactive DRG neurons innervating the cervical facet joints show phenotypic switch in cervical facet injury in rats. Eur Spine J 12:211–215PubMedCentralCrossRefPubMed
31.
Orita S, Ohtori S, Taniguchi A, Yamashita M, Yamauchi K, Inoue G, Suzuki M, Eguchi Y, Ochiai N, Kishida S, Takaso M, Aoki Y, Takahashi K, Kawakami M (2010) Direct evidence for sensory innervation of the dorsal portion of the Co5/6 coccygeal intervertebral disc in rats. Spine 35(14):1346–1352PubMed
32.
Patel N, Gross A, Brown L et al (2012) A randomized, placebo- controlled study to assess the efficacy of lateral branch neurotomy for chronic sacroiliac joint pain. Pain Med 13:383–398CrossRefPubMed
33.
Romanes GJ (1986) Cunningham’s manual of practical anatomy, 15th edn. Oxford University Press, Oxford, pp 192–193
34.
Siwe SA (1931) The cervical part of the gangliated cord, with special reference to its connections with the spinal nerves and certain cerebral nerves. Am J Anat 48:479–497CrossRef
35.
Stilwell D (1956) The nerve supply of the vertebral column and its associated structures in the monkey. Anat Rec 125:139–169CrossRefPubMed
36.
Stolker RJ, Vervest AC, Groen GJ (1993) Percutaneous facet denervation in chronic thoracic spinal pain. Acta Neurochir (Wien) 122(1–2):82–90CrossRef
37.
Sunderland S (1978) The spinal nerves. Nerve and nerve injuries, 2nd edn. Churchill Livingstone, Edinburgh, pp 1021–1031
38.
Suseki K, Takahashi Y, Takahashi K, Chiba T, Yamagata M, Moriya H (1998) Sensory nerve fibers from lumbar intervertebral discs pass through rami communicantes. J Bone Joint Surg (Br) 80B:737–742CrossRef
39.
Tubbs RS, Loukas M, Remy AC, Shoja M, Salter GE, Oakes JW (2007) The vertebral nerve revisited. Clin Anat 20:644–647CrossRefPubMed
40.
Van Kleef M, Jan Stolker R, Lataster A, Geurts J, Benzon HT, Mekhail N (2010) Evidence based interventional pain medicine according to clinical diagnoses, 10. Thoracic pain. Pain Pract 10:327–338CrossRefPubMed
41.
Vleeming A, Schuenke MD, Masi AT, Carreiro JE, Danneels L, Willard FH (2012) The sacroiliac joint: an overview of its anatomy, function and potential clinical implications. J Anat 221:537–567PubMedCentralCrossRefPubMed
42.
Willard FH, Carreiro JE, Manko W (1998) Third interdisciplinary world congress on low back and pelvic pain. Austria, Vienna, pp 207–209
43.
Woon JT, Stringer MD (2012) Clinical anatomy of the coccyx: a systematic review. Clin Anat 25(2):158–167CrossRefPubMed
44.
45.
Wozniak W, Grzymistawska M (2009) Innervation of the human cervical and thoracic vertebrae at eight postovulatory weeks. Folia Morphol 68(2):84–87
46.
Yan J, Ogino K, Hitomi J (2009) The terminal insertional segments and communications of the vertebral nerve in the human cervical region. Surg Radiol Anat 31:165–171CrossRefPubMed
47.
Yin W, Willard F, Dixon T, Bogduk N (2008) Ventral innervation of the lateral C1-C2 joint: an anatomical study. Pain Med 9:1022–1029CrossRefPubMed
Metadata
Title
Comprehensive anatomical and immunohistochemical review of the innervation of the human spine and joints with application to an improved understanding of back pain
Authors
Pamela Youssef
Marios Loukas
Jens R. Chapman
Rod J. Oskouian
R. Shane Tubbs
Publication date
01-02-2016
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 2/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-015-2880-6

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