Institutional members access full text with Ovid®

Share this article on:

Dichotomizing Sensory Nerve Fibers Innervating Both the Lumbar Vertebral Body and the Area Surrounding the Iliac Crest: A Possible Mechanism of Referred Lateral Back Pain From Lumbar Vertebral Body

Fujii, Tatsuya MD; Sakuma, Yoshihiro MD; Orita, Sumihisa MD, PhD; Inoue, Gen MD, PhD; Ochiai, Nobuyasu MD, PhD; Kuniyoshi, Kazuki MD, PhD; Aoki, Yasuchika MD, PhD; Ishikawa, Tetsuhiro MD, PhD; Miyagi, Masayuki MD, PhD; Kamoda, Hiroto MD, PhD; Suzuki, Miyako MD, PhD; Kubota, Gou MD; Inage, Kazuhide MD; Sainoh, Takeshi MD; Sato, Jun MD; Yamauchi, Kazuyo MD, PhD; Toyone, Tomoaki MD, PhD; Nakamura, Junichi MD, PhD; Kishida, Shunji MD, PhD; Takahashi, Kazuhisa MD, PhD; Koshi, Takana MD, PhD; Ohtori, Seiji MD, PhD

doi: 10.1097/BRS.0b013e3182a879cd
Anatomy

Study Design. Animal study.

Objective. To determine the existence of dichotomizing sensory nerve fibers innervating both the lumbar vertebral body and the area surrounding the iliac crest (ASIC).

Summary of Background Data. Elderly patients with osteoporosis sometimes experience lumbar vertebral fracture and may feel diffuse nonlocalized pain in the back, the lateral portion of the trunk, and the ASIC. The pattern of sensory innervation of vertebral bodies remains unclear. DRG neurons with dichotomizing axons have been reported and are thought to be related to referred pain. The purpose of this study was to investigate the existence of dichotomizing axons to the lumbar vertebral bodies and the ASIC in rats.

Methods. Two kinds of neurotracers (1,1`-dioctadecyl-3,3,3`,3`-tetramethylindocarbocyanine perchlorate [DiI] and Fluoro-Gold [FG]) were used. DiI crystals were placed in the left ASIC, and FG was applied into the L2 vertebral body in 10 rats. Four weeks later, left DRGs from L1 to L6 were resected, sectioned, and observed under a fluorescence microscope.

Results. DiI-labeled DRG neurons innervating the ASIC and FG-labeled DRG neurons innervating the vertebral L2 body were distributed from L1 to L6. The ratio of total double-labeled per total DiI-labeled DRG neurons was 10.2%, and that of total double-labeled per total FG-labeled DRG neurons was 14.7%. These double-labeled DRG neurons innervating the L2 vertebral body had other axons that extended to the ASIC.

Conclusion. This finding provides a possible neuroanatomical explanation for referred pain in the ASIC from vertebral bodies.

We used 2 neurotracers to demonstrate dichotomizing sensory nerve fibers innervating both the lumbar vertebral body and the area surrounding the iliac crest (ASIC) in rats. We showed double-labeled dorsal root ganglion (DRG) neurons, thus providing a possible neuroanatomical explanation for referred pain in the ASIC from the vertebral body.

From the Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.

Address for correspondence and reprint requests to Seiji Ohtori, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan; E-mail: sohtori@faculty.chiba-u.jp

Acknowledgment date: May 6, 2013. Revision date: July 11, 2013. Acceptance date: August 2, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 by Lippincott Williams & Wilkins