Nerves and nerve plexuses of the human vertebral column.

Groen GJ, Baljet B, Drukker J.

Am J Anat. 1990 Jul;188(3):282-96.

Department of Functional Anatomy, University of Utrecht, The Netherlands.

The origin, distribution, and termination pattern of nerves supplying the vertebral column and its associated structures have been studied in the human fetus by means of an acetylcholinesterase whole-mount method. The vertebral column is surrounded by ventral and dorsal nerve plexuses which are interconnected. The ventral nerve plexus consists of the nerve plexus associated with the anterior longitudinal ligament. This longitudinally oriented nerve plexus has a bilateral supply from many small branches of the sympathetic trunk, rami communicantes, and perivascular nerve plexuses of segmental arteries. In the thoracic region, the ventral nerve plexus also is connected to the nerve plexuses of costovertebral joints. The dorsal nerve plexus is made up of the nerve plexus associated with the posterior longitudinal ligament. This nerve plexus is more irregular and receives contributions only from the sinu-vertebral nerves. The sinu-vertebral nerves originate from the rami communicantes and, in the cervical region, also from the nerve plexus of the vertebral artery. Thick and thin sinu-vertebral nerves are found. Most frequently three types of thick sinu-vertebral nerves are observed, i.e., ascending, descending, or dichotomizing ones. Finally, the distribution of the branches of the ventral and dorsal nerve plexuses and of the sinu-vertebral nerves is described.

PMID: 2371968 [PubMed - indexed for MEDLINE]


The innervation of the spinal dura mater: anatomy and clinical implications.

Groen GJ, Baljet B, Drukker J.

Acta Neurochir (Wien). 1988;92(1-4):39-46.

Department of Anatomy, University of Utrecht, The Netherlands.

The nerves supplying the spinal dura mater were studied in four human foetuses (16-22 weeks) with the acetylcholinesterase in toto staining method. The ventral spinal dura contains a dense, longitudinally oriented, nerve plexus, which receives its contributions from: (I) the sinuvertebral nerves, (II) the nerve plexus of the posterior longitudinal ligament, (III) the nerve plexus of radicular branches of segmental arteries. Dorsal dural nerves are much smaller in number, do not form an evident plexus and do not reach the medial region of the dorsal dura. The dorsal nerves are derived from the ventral dural plexus at the level of the "intersleeval" parts of the dura mater. The ventral dural nerves may extend up to eight segments, with a great amount of overlap between adjacent nerves. This may provide an anatomical substrate for the understanding of extrasegmentally referred dural pain. The curled bundles of nerve fibres of pathways (I) and (II) provide an adequate adaptation to displacements of the spinal dura mater during flexion and extension. Pathway (III) has not been described before. The described nerve plexuses may be of importance in elucidating the mechanisms of epidural therapies in back pain and peripheral vascular disease.

PMID: 3407473 [PubMed - indexed for MEDLINE]


An immunohistochemical study of innervation of lumbar spinal dura and longitudinal ligaments.

Kallakuri S, Cavanaugh JM, Blagoev DC.

Spine (Phila Pa 1976). 1998 Feb 15;23(4):403-11.

Wayne State University, Bioengineering Center, Detroit, Michigan, USA.

STUDY DESIGN: An immunocytochemical study of nerve fibers in lumbar spinal dura and longitudinal ligaments was conducted in New Zealand white rabbits. OBJECTIVES: To demonstrate the presence of nerve fibers and to establish the presence of nociceptive and sympathetic nerve fibers in lumbar dura and longitudinal ligaments. SUMMARY OF BACKGROUND DATA: The role of dura as a source of low back pain is still unclear, and the data present a somewhat conflicting picture of the nature of nociceptive innervation in this tissue. METHODS: An immunocytochemical method was used to study dura and longitudinal ligaments from New Zealand White rabbits. RESULTS: Numerous fine nerve fibers and some small bundles were demonstrated in both the dura and the longitudinal ligaments. In dorsal dura, the fibers were seen at lateral margins running toward midline. In ventral dura and longitudinal ligaments, the fibers were seen throughout the substance of these tissues. A population of substance P, calcitonin gene-related peptide, and tyrosine hydroxylase-reactive nerve fibers were observed in all the tissues. In addition, fibers exhibiting nicotinamide adenine dinucleotide phosphate diaphorase activity were also observed, indicating the presence of nitric oxide in dura. CONCLUSIONS: The results clearly demonstrate an extensive distribution of nerve fibers in dura and longitudinal ligaments. The presence of a significant number of putative nociceptive fibers supports a possible role for these structures as a source of low back pain and radicular pain.

PMID: 9516694 [PubMed - indexed for MEDLINE]


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.

Ahmed M, Bjurholm A, Kreicbergs A, Schultzberg M.

Spine (Phila Pa 1976). 1993 Feb;18(2):268-73.

Department of Orthopaedics, Karolinska Institute, Stockholm, Sweden.

The occurrence of autonomic nerves in the lumbar spine of rats was investigated by immunohistochemical technique. Both peptidergic nerves, represented by immunoreactivity to neuropeptide Y (NPY), vasoactive intestinal polypeptide (VIP), and noradrenergic nerves as reflected by tyrosine hydroxylase (TH) immunoreactivity, were identified. NPY- and TH-positive nerves were predominantly found in the blood vessels walls. They occurred in the bone and periosteum of the vertebral body, disc, dura mater, and in the spinal ligaments. They were particularly numerous along the growth plate and in the outer layers of the intervertebral discs. VIP-positive fibers were predominantly nonvascular. They occurred in all tissues analyzed, but were most abundant in the vertebral bone marrow and periosteum. The VIP-immunoreactive fibers in the outer fibrous layers of the disc and the spinal ligaments were occasionally observed in blood vessel walls. No immunoreactivity could be detected in the nucleus pulposus. In the dura mater, NPY-, TH- and VIP-positive fibers were found both in the ventral and dorsal portion. In view of the vasoconstrictive properties of both NPY and noradrenaline, it may be assumed that the abundance of NPY- and TH-immunoreactive nerves fibers in blood vessel walls reflects a vasoregulatory activity. The predominance of nonvascular VIP-positive fibers in the vertebral bone marrow and periosteum may represent an involvement in local bone physiology.

PMID: 8095104 [PubMed - indexed for MEDLINE]


Innervation of the lumbar spine.

Edgar MA, Ghadially JA.

Clin Orthop Relat Res. 1976 Mar-Apr;(115):35-41.

Back pain, in spinal stenosis, can arise from many sources. Apart from nerve root involvement any of the structures considered above can be implicated. In degenerative conditions, where discogenic and posterior facet pain are present, excess activity tends to increase these symptoms. In addition there is evidence that impulses reaching the spinal nerve root through the sinu-vertebral nerve and possibly the posterior ramus may potentiate the irritability of that root. Whether such a mechanism contributes to the claudication of degenerative spinal stenosis is not known.

PMID: 1253494 [PubMed - indexed for MEDLINE]


The innervation of the spinal dura mater: anatomy and clinical implications.

Groen GJ, Baljet B, Drukker J.

Acta Neurochir (Wien). 1988;92(1-4):39-46.

Department of Anatomy, University of Utrecht, The Netherlands.

The nerves supplying the spinal dura mater were studied in four human foetuses (16-22 weeks) with the acetylcholinesterase in toto staining method. The ventral spinal dura contains a dense, longitudinally oriented, nerve plexus, which receives its contributions from: (I) the sinuvertebral nerves, (II) the nerve plexus of the posterior longitudinal ligament, (III) the nerve plexus of radicular branches of segmental arteries. Dorsal dural nerves are much smaller in number, do not form an evident plexus and do not reach the medial region of the dorsal dura. The dorsal nerves are derived from the ventral dural plexus at the level of the "intersleeval" parts of the dura mater. The ventral dural nerves may extend up to eight segments, with a great amount of overlap between adjacent nerves. This may provide an anatomical substrate for the understanding of extrasegmentally referred dural pain. The curled bundles of nerve fibres of pathways (I) and (II) provide an adequate adaptation to displacements of the spinal dura mater during flexion and extension. Pathway (III) has not been described before. The described nerve plexuses may be of importance in elucidating the mechanisms of epidural therapies in back pain and peripheral vascular disease.

PMID: 3407473 [PubMed - indexed for MEDLINE]


Nerve endings in the human lumbar spinal column and related structures.

Jackson HC 2nd, Winkelmann RK, Bickel WH.

J Bone Joint Surg Am. 1966 Oct;48(7):1272-81.

The nerve terminals of the human lumbar vertebral column and its relatedstructures were studied with cholinesterase and silver-impregnation techniques inspecimens from twenty-one autopsies (including two fetuses and two newborninfants) and fifteen surgical procedures. Nerve endings of three morphological types were found: (1) free fiber endings, (2) complex unencapsulated endings which sometimes had expanded tips, and (3) encapsulated endings. In the fetuses and newborn infants, encapsulated (Vater-Pacini) endings were primarily concentrated around the facet-joint capsules and on the ventrolateral surface of the annulus fibrosus. Many free nerve fibers and nerve networks were found in the anterior and posterior longitudinal ligaments and in the peripheral layersof the annulus fibrosus. No nerve elements were found in the deeper zones of theannulus or in the nucleus pulposus. The cartilaginous end plates of the vertebrae had a nerve supply closely associated with the vascular sinusoids in the developingtissues of the fetuses and infants. In the adult specimens, fine free nerve fibers were observed in practically all anatomical locations studied. Complex, unencapsulated endings were concentrated primarily in theperiosteum of the lumbar vertebrae and within the synovial intervertebral facet-joint capsules. Encapsulated nerve terminations were found only in the region of the fibrous facet capsules in the adult tissues. No significant increase in nerve elements was observed inseveral degenerated lumbar dises studied with the cholinesterase technique. Nerve fibers usually considered to be pain sensitive were found in the loose areolar tissue and periphery of the annulus fibrosus but none was seen within the body of the disc or in the nucleus pulposus.

PMID: 5921784 [PubMed - indexed for MEDLINE]


The nerve supply of the vertebral column and its associated structures in the monkey.

STILWELL DL Jr.

Anat Rec. 1956 Jun;125(2):139-69.

PMID: 13354975 [PubMed - indexed for MEDLINE]


The anatomy of lumbosacral posterior rami and meningeal branches of spinal nerve (sinu-vertebral nerves); with an experimental study of their functions.

PEDERSEN HE, BLUNCK CF, GARDNER E.

J Bone Joint Surg Am. 1956 Apr;38-A(2):377-91.

The distribution of the lumbosacral posterior rami and the sinu-vertebralbranches (ramus meningeus) of spinal nerves was determined by dissection ofnewborn and adult cadavera and by a detailed study of serial sections of humanfoetuses. In addition, blood pressure and respiration were recorded andelectromyograms were made in decerebrate cats during electrical and mechanicalstimulation of low-back structures. The posterior rami, in addition to their cutaneous and muscular distribution, give sensory fibers to fascia, ligaments, periosteum, and intervertebral joints. Adjacent divisions overlap in their area of supply. Interspinous ligaments are supplied mainly bybranches from the next cranial level. Sinu-vertebral nerves supply posteriorlongitudinal ligament, dura mater, periosteum, and blood vessels, show intersegmentalanastomoses, and contain sensory fibers. Painful stimulation of joints and ligaments of the lumbosacral region in cats produces reflex spasm of dorsal and hamstring muscles, as well as non-specific changes in respiration and blood pressure. It is suggested that clinically a painful stimulus to any deep structure in this region is poorly localized and can give rise to a common symptom complex which includes both low-back and leg pain.

PMID: 13319400 [PubMed - indexed for MEDLINE]


Extraosseous spinal lesions mimicking disc disease.

Guyer RD, Collier RR, Ohnmeiss DD, Stith WJ, Hochschuler SH, Rashbaum RF, Vanharanta H, Loguidice V.

Spine (Phila Pa 1976). 1988 Mar;13(3):328-31.

To identify characteristics of patient presentation that would help distinguish extraosseous spinal tumors from the more common herniated disc, nine cases of intraspinal tumors were reviewed. These nine patients were identified in a group of 744 patients who presented with symptoms similar to disc herniation but failed to respond to conservative care and underwent spinal surgery. This study indicates that intraspinal tumor should be suspected in patients with the following characteristics: 1) painless neurological deficit; 2) night pain or pain which increases in the supine position; 3) pain disproportionate to that normally expected with lumbar disc disease; 4) no change in symptoms after successful surgery for herniated disc; 5) elevated spinal fluid protein; or 6) a teenager with symptoms of disc herniation. Myelography is an effective radiologic procedure for the diagnosis of spinal tumor but MRI should be equally effective if the procedure includes a scan of the conus as well as cauda equina.

PMID: 3388119 [PubMed - indexed for MEDLINE]