J Korean Neurosurg Soc.  2023 Jul;66(4):344-355. 10.3340/jkns.2022.0140.

Narrative Review of Pathophysiology and Endoscopic Management of Basivertebral and Sinuvertebral Neuropathy for Chronic Back Pain

• Kim HS
• Wu PH
• Jang IT

• KMID: 2543527
• DOI: http://doi.org/10.3340/jkns.2022.0140

Abstract

Chronic lower back pain is a leading cause of disability in musculoskeletal system. Degenerative disc disease is one of the main contributing factor of chronic back pain in the aging population in the world. It is postulated that sinuvertebral nerve and basivertebral nerve main mediator of the nociceptive response in degenerative disc disease as a result of neurotization of sinuvertebral and basivertebral nerve. A review in literature is done on the pathoanatomy, pathophysiology and pain generation pathway in degenerative disc disease and chronic back pain and management strategy is discussed in this review to aid understanding of sinuvertebral and basivertebral neuropathy treatment strategies.

Keyword

Spondylosis; Sinuvertebral nerve; Basivertebral nerve; Discogenic back pain; Pathophysiology of back pain; Endoscopic spine surgery

Figure

• 

  Fig. 1. A : Axial cut of nerve distribution in a normal patient. Sinuvertebral and basivertebral nerve supplies the disc and adjacent end plate while medial branch of posterior primary ramus supplies facet joint. B : Axial cut of nerve distribution in a patient with facet subluxation. Facet subluxation leads to capsular laxity and subsequent widening of the facet joint, medial branch perceived subluxation as pain stimulation leading to the facet joint paint(red stained facet joint). C : Axial cut of nerve distribution in a patient with facet subluxation as well as advanced degenerative disc. Facet subluxation leads to capsular laxity and subsequent widening of the facet joint, medial branch perceived subluxation as pain stimulation leading to the facet joint pain (red stained facet joint) and there is also concurrent neuronal sensitization of sinuvertebral and basiverterbral nerve (red stained end plate) as well as facet joint pain.

• 

  Fig. 2. A-C : Coronal and sagittal picture of medial branch of posterior primary ramus in normal patient which traverses through fibro-osseous canal bounded by accessory process, the mammillary process and mammilloaccessory ligament and subsequently exits through the intermammillary fascicle and mamillostyloid fascicle of multifidus muscle, in Fig. 2c sinuvertebral and basivertebral branches of medial branch nerve supplies the disc. D-F : Coronal and sagittal picture of medial branch of posterior primary ramus in patient with degenerative disc disease and facet arthropathy. There is increased vascularity and granulation tissue at the region of posterior primary ramus supplying the facet and sinuvertebral and basivertebral nerve supplying the disc and end plates.

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  Fig. 3. Two radiofrequency ablation techniques for basivertebral neuropathy currently in practice. A : Transpedicular approach. B : Peripedicular approach.

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  Fig. 4. A : Mid coronal picture of normal patient which demonstrates lumbar spine with posterior spinous process, lamina, ligaments and half pedicle removed to demonstrate the distribution of sinuvertebral and basivertebral nerve. B : In corresponding mid coronal picture of patient who had sinuvertebral and basivertebral nerve neurotization. Red shaded area demonstrates the region of neurotization with peridiscal region being sinuvertebral nerve and intraosseous nerve branches being basivertebral nerve. C : In corresponding mid coronal picture of patient who had degenerative disc disease and lower back pain demonstrates corresponding neovascularization around region of sinuvertebral and basivertebral nerve. Modified from Kim et al. [48] with permission.

Reference

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