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Discogenic Low Back Pain and Sinuvertebral Nerve

 李昆興(Kung-Shing Lee);林志隆(Chih-Lung Lin);劉安祥(Ann-Shung Lieu);羅永欽(Joon-Khim Loh);王致仁(Chih-Zen Wang);黃旭霖(Shiuh-Lin Hwang);關皚麗(Aij-Lie Kwan);洪純隆(Shen-Long Howng)
Chronic low back pain is very common in the pain clinic, and the exact cause is not well known until some interventional procedures are taken. These include facet blocks, sacroiliac joint injection, selective nerve root blocks and discogram. Discogenic pain (arising from the intervertebral discs) accounts for 40% of chronic low back pain and many studies have indicated that the sinuvertebral nerve has an important role in innervating the tissues around the vertebrae. Recently, we use immunohistochemistry to study where the low back pain origins. However, the afferent pathways of discogenic low back pain have not been fully investigated. Herein, we hypothesised that this pain was transmitted mainly by sympathetic afferent fibers in the L2 nerve root, and in 43 patients we used selective local anaesthetic and steroid of this nerve by CT-guidance. 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.
下背痛的成因很多,也很複雜,但往往很難明確地指出引起疼痛的真正構造。目前,臨床上可以利用關節注射與椎間盤攝影來找出「慢性下背痛」的部分原因。其中超過40%是腰椎間盤內部構造破壞所引起的椎問盤原因性的慢性下背痛。隨著腰脊椎手術的進步,與免疫組識生化技術的廣泛應用,人們對於腰痠背痛、下背痛的致病機轉有了更進一步的認識。在腰脊椎腔內,有許多富含疼痛感覺纖維的組織,這些組織受到刺激,也可能會導致腰痠背痛與下背痛。而以上大部分的組識,就是竇椎神經(sinuvertebral nerve, SVN)所支配的,所以,竇稚神經與腰痠背痛、下背痛之間的關係是相當密切的。腰椎間盤原因性的下背痛,可透過SVN媒介,經由交感神經的交通支,到達L2的背根神經節,而導致下背痛。解剖學的證據與臨床上的觀察也支持此項學說。本科利用電腦斷層定位的雙側第二腰椎神經根注射,可以診斷與治療腰椎間盤原因性的下背痛。因此,對於慢性下背痛的病理機轉,竇椎神經可以提供另一種思維與新的切入點。