Faustmann P M
Abteilung für Neuroanatomie und Molekulare Hirnforschung, Ruhr-Universität Bochum.
Z Orthop Ihre Grenzgeb. 2004 Nov-Dec;142(6):706-8. doi: 10.1055/s-2004-832490.
The aim of this study is to give a short overview about the innervation of the intervertebral disc and the nerve connections between the somatosensible and autonomous nervous systems in the paravertebral region.
A short review of the clinical and experimental literature including gross-anatomical, histochemical and immunohistochemical studies as well as functional studies after application of tracer substances has been made. We also present our own experimental immunohistochemical and molecular biological investigations on paravertebral muscle biopsies of a patient with post-discotomy syndrome.
The annulus fibrosus of the intervertebral disc is innervated by myelinated nerve fibres. Neuronal markers for pain-leading fibres were found to be positive in the dorsal region of the annulus, and especially in the posterior longitudinal ligament. Nerve ingrowth into the diseased intervertebral disc was found in chronic back pain. The main innervation of the intervertebral disc is formed by the sinuvertebral nerves. The sinuvertebral nerves are recurrent branches of the ventral rami that re-enter the intervertebral foramina to be distributed within the vertebral canal. They are mixed polysegmental nerves and nerve plexuses, each being formed by a somatic root from a ventral ramus and an autonomic root from a grey ramus communicans. The number of nerve bundles was reduced by resection of sympathetic trunks. The expression of neuronal markers in the sarcolemma of the paravertebral muscles is reduced after discotomy.
The neuroanatomical basis of discogenic pain can be summarised as follows: 1. The intervertebral disc receives an extensive innervation, especially the annulus fibrosus. 2. Nerve extension was found into the nucleus pulposus of the degenerated disc. 3. The sinuvertebral nerve plexuses facilitate a polysegmental signal and pain spreading. 4. The innervation of the intervertebral disc is very high connected with the paravertebral muscles. 5. A local denervation of the paravertebral muscles was found in post-discotomy syndrome.
本研究旨在简要概述椎间盘的神经支配以及椎旁区域躯体感觉神经系统与自主神经系统之间的神经连接。
对临床和实验文献进行了简短综述，包括大体解剖学、组织化学和免疫组织化学研究以及应用示踪物质后的功能研究。我们还展示了对一名椎间盘切除术后综合征患者椎旁肌肉活检进行的自身实验性免疫组织化学和分子生物学研究。
椎间盘的纤维环由有髓神经纤维支配。在纤维环的背侧区域，尤其是后纵韧带中，发现了疼痛传导纤维的神经元标记物呈阳性。在慢性背痛中发现神经长入患病的椎间盘。椎间盘的主要神经支配由窦椎神经形成。窦椎神经是腹侧支的返支，重新进入椎间孔并分布于椎管内。它们是混合性多节段神经和神经丛，每一个都由来自腹侧支的躯体根和来自灰交通支的自主根形成。切除交感干后神经束数量减少。椎间盘切除术后椎旁肌肌膜中神经元标记物的表达降低。
椎间盘源性疼痛的神经解剖学基础可总结如下：1. 椎间盘接受广泛的神经支配，尤其是纤维环。2. 在退变椎间盘的髓核中发现神经延伸。3. 窦椎神经丛促进多节段信号和疼痛扩散。4. 椎间盘的神经支配与椎旁肌高度相关。5. 在椎间盘切除术后综合征中发现椎旁肌局部去神经支配。
