Back Pain and Aberrant Intervertebral Disc Innervation
Source: Freemont AJ, et al. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997;350: 178-181.
Pathologic study of intervertebral disc mate-rial, removed at surgery from 38 patients with chronic low back pain (LBP), was compared to 34 control samples, obtained within eight hours post mortem from previously healthy persons. Standard histologic and immunohistochemical techniques identified nerve fibers and nerve markers, including substance P, a nociceptive neurotransmitter, and GAP43, a growth-associated protein expressed during axonogenesis.
None of the control samples evidenced nerve fibers extending into the inner third of the annulus fibrosis, whereas LBP disc material showed nerve fibers extending into the inner third of the annulus fibrosis and nucleus pulposus in 46% and 22%, respectively. Nerves usually accompanied blood vessels, except in 14 LBP samples, but whereas both types expressed substance P, only the non blood-vessel-associated nerves expressed GAP43. More than twice as many (57% vs 25%) disc samples from discographically proven pain levels in LBP patients showed deep nerve ingrowth as compared to disc samples taken from non-pain levels in the same patients. The strong association of deep nerve fiber ingrowth into disc material in chronic LBP suggests that it may play a significant role in pain pathogenesis. mr
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