Nakamura S I, Takahashi K, Takahashi Y, Yamagata M, Moriya H
Department of Orthopaedic Surgery, School of Medicine, Chiba University, Japan.
J Bone Joint Surg Br. 1996 Jul;78(4):606-12.
The afferent pathways of discogenic low-back pain have not been fully investigated. We hypothesised that this pain was transmitted mainly by sympathetic afferent fibres in the L2 nerve root, and in 33 patients we used selective local anaesthesia of this nerve. Low-back pain disappeared or significantly decreased in all patients after the injection. Needle insertion provoked pain which radiated to the low back in 23 patients and the area of skin hypoalgesia produced included the area of pre-existing pain in all but one. None of the nine patients with related sciatica had relief of that component of their symptoms. Our findings show that the main afferent pathways of pain from the lower intervertebral discs are through the L2 spinal nerve root, presumably via sympathetic afferents from the sinuvertebral nerves. Discogenic low-back pain should be regarded as a visceral pain in respect of its neural pathways. Infiltration of the L2 nerve is a useful diagnostic test and also has some therapeutic value.
椎间盘源性下腰痛的传入通路尚未得到充分研究。我们推测这种疼痛主要由L2神经根中的交感传入纤维传导，在33例患者中，我们对该神经进行了选择性局部麻醉。注射后所有患者的下腰痛消失或明显减轻。针刺引发的疼痛放射至23例患者的下背部，除1例患者外，所产生的皮肤感觉减退区域包括先前存在疼痛的区域。9例伴有相关坐骨神经痛的患者中，其症状的该组成部分均未得到缓解。我们的研究结果表明，来自下位椎间盘的主要疼痛传入通路是通过L2脊神经根，可能是通过来自窦椎神经的交感传入纤维。就其神经通路而言，椎间盘源性下腰痛应被视为一种内脏痛。L2神经浸润是一种有用的诊断试验，也具有一定的治疗价值。
