CRITICAL UPDATE – Innervation of Degenerative Intervertebral Discs
Innervation of Degenerative Intervertebral Discs
Can a degenerative intervertebral disc be injured? YES
Can that injury cause significant, permanent and persistent functional losses? YES
Is it true that a degenerative disc has MORE nerve endings than a healthy intervertebral disc? YES
Is there any scientific evidence regarding innervation of the degenerative disc and how that happens? YES
In a very recent research paper published in the Journal of Orthopedic Research (2011), the authors continued the work on the innervation of degenerative intervertebral discs. They stated, “Normal lumbar IVD [intervertebral discs] is avascular and aneural except for the outer 1/3 of the annulus fibrosus (AF). However, previous studies have described the ingrowth of nerves into the AF and nucleus pulposus (NP) of degenerated IVD...” (Lee et al., 2011, p.265).
When an intervertebral disc is degenerative, there is a complex series of chemicals that increase the growth of tiny blood vessels and nerves that transmit pain. These nerve fibers are involved with creating discogenic pain. That is pain created in and by the intervertebral disc in the absence of any nerve root compression. These pain syndromes are very real and are often confusing because they present without a dermatomal pattern of neurologic symptoms and negative electrodiagnostic testing.
This paper published in 2011 not only once again confirms the innervation of a healthy intervertebral disc, but also reiterates the increase in pain innervation in degenerative discs. When clients with degenerative (pre-existing) disc disease are evaluated, working with a clinician that understands the intricacies of the anatomy of the intervertebral disc is critical to correlating causation, bodily injury and persistent functional losses.
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Reference:
Lee, J. M., Song, J. Y., Baek, M., Jung, H. Y., Kang, H., Han, I. B., Kwon, Y. D., & Shin, D. E. (2011). Interleukin-1β induces angiogenesis and innervation in human intervertebral disc degeneration. Journal of Orthopedic Research, 29(2), 265-269.