Sensory Nerves in Herniated Discs
Pathologic Mechanism of Disc Pain
Injury patients often times have pain syndromes directly related to the injury of the intervertebral disc. There has been debate in the legal community as to the type and extent of the nerve supply to the intervertebral disc. In other words, can it actually transmit pain when injured?
In a very recent article Ohtori et al. 2018 stated “Many authors have investigated the pathological mechanisms of discogenic low back pain using animal models and examining human patients. Central to most investigations is understanding the innervation and instabilities of diseased intervertebral discs and the role of inflammatory mediators. We discuss three pathological mechanisms of discogenic low back pain: innervation, inflammation, and mechanical hypermobility of the intervertebral disc.” [pg 11]
They state in their paper, “Pathomechanisms of discogenic [caused from the disc] low back pain.
Innervation: animal model and specimens from humans revealed sensory nerve innervation of lumbar intervertebral discs (IVDs) and sensory nerve ingrowth into the inner layer (deep nerve ingrowth) of the degenerated IVD. [This is why injured discs generate pain sensation and why degenerative discs are injured with less trauma then healthy discs, they have more nerves]
Inflammation: many researchers have identified various proinflammatory molecules. [Once the process starts, it is difficult to control post injury]
Hypermobility: hypermobility of motion segment is usually induced in degenerated IVD. These factors are thought to be the major factors that induce discogenic low back pain.” [pg 12] [Hypermobility can also be induced in traumatic ligament injury in the spine]
Working with a health care team that understands human anatomy and how pain is generated after a traumatic injury is critically important to the short and long term prognosis of the injured client. This information helps to clarify the source of pain in many client injuries.
Reference:
1. Ohtori, S., Miyagi, M., & Inoue, G. (2018). Sensory nerve ingrowth, cytokines, and instability of discogenic low back pain: A review. Spine Surgery and Related Research, 2(1), 11-17.
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