Integrated Program in Neuroscience, The Montreal Neurological Institute-Hospital, Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada.
Health and Rehabilitation Sciences (Physical Therapy), Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
Pain Med. 2021 Jun 4;22(6):1281-1304. doi: 10.1093/pm/pnab070.
Back pain is an elusive symptom complicated by a variety of possible causes, precipitating and maintaining factors, and consequences. Notably, the underlying pathology remains unknown in a significant number of cases. Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans.
Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers.
Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states.
While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remains unclear.
腰痛是一种难以捉摸的症状，其病因复杂多样，包括多种诱发和维持因素，以及后果。值得注意的是，在相当多的病例中，潜在的病理仍然未知。椎间盘（IVD）的变化与腰痛有关，这使得许多人推测 IVD 可能是疼痛的直接来源，通常被称为椎间盘源性腰痛。然而，尽管对 IVD 的神经解剖学进行了数十年的研究，但文献中对于组织内神经成分的分布和功能仍然缺乏共识。目前的范围综述提供了对记录人类 IVD 内神经成分的形态、形态和免疫反应性的研究的全面系统概述。
通过三步系统搜索，从六个单独的数据库中检索文章，并由两名评审员独立评估。
在 IVD 内描述了三类神经成分：血管周围神经、独立于血管的感觉神经和机械感受器。神经始终定位于纤维环的外层。神经向内层纤维环和髓核的内生长仅发生在退行性和疾病状态。
尽管 IVD 内的神经支配模式很明确，但在腰痛背景下，神经成分的具体拓扑排列和功能仍不清楚。
