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Nerves are more abundant than blood vessels in the degenerate human intervertebral disc

PainSci » bibliography » Binch et al 2015
Tags: etiology, spine, back pain, pro, pain problems

PainSci commentary on Binch 2015: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

There’s a controversial idea that damaged intervertebral discs are probably full of tiny nerve fibres and blood vessels. For this study, researchers decide to “count” them in 61 samples taken either from corpses or live surgical patients. All 61 samples were confirmed to be from degenerated discs based on tissue chemistry (pretty definitive, in other words: clear objective signs of degeneration). Their clever "immunohistochemistry" technique basically trigger an immune response to proteins that exist only in either nerves and blood vessels.

They certainly found nerve tissue, all the way through the disc, extending from the anulus fibrosus “deep” into the nucleus pulposus. There wasn’t an extremely strong correlation between degeneration and the presence of nerves and blood vessels, but there was definitely a link: “nerves are present within anulus fibrosus and nucleus pulposus of degenerate IVDs from patients.”

Also noteworthy: half the degenerate discs had nerves without blood supply, so apparently “nerves can migrate in the absence of blood vessels.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Chronic low back pain (LBP) is the most common cause of disability worldwide. New ideas surrounding LBP are emerging that are based on interactions between mechanical, biological and chemical influences on the human IVD. The degenerate IVD is proposed to be innervated by sensory nerve fibres and vascularised by blood vessels, and it is speculated to contribute to pain sensation. However, the incidence of nerve and blood vessel ingrowth, as well as whether these features are always associated, is unknown. We investigated the presence of nerves and blood vessels in the nucleus pulposus (NP) of the IVD in a large population of human discs.

METHODS: Immunohistochemistry was performed with 61 human IVD samples, to identify and localise nerves (neurofilament 200 [NF200]/protein gene product 9.5) and blood vessels (CD31) within different regions of the IVD.

RESULTS: Immunopositivity for NF200 was identified within all regions of the IVD within post-mortem tissues. Nerves were seen to protrude across lamellar ridges and through matrix towards NP cells. Nerves were identified deep within the NP and were in many cases, but not always, seen in close proximity to fissures or in areas where decreased matrix was seen. Fifteen percent of samples were degenerate and negative for nerves and blood vessels, whilst 16 % of all samples were degenerate with nerves and blood vessels. We identified 52% of samples that were degenerate with nerves but no blood vessels. Interestingly, only 4% of all samples were degenerate with no nerves but positive for blood vessels. Of the 85 samples investigated, only 6 % of samples were non-degenerate without nerves and blood vessels and 7% had nerves but no blood vessels.

CONCLUSIONS: This study addresses the controversial topic of nerve and blood vessel ingrowth into the IVD in a large number of human samples. Our findings demonstrate that nerves are present within a large proportion of NP samples from degenerate IVDs. This study shows a possible link between nerve ingrowth and degeneration of the IVD and suggests that nerves can migrate in the absence of blood vessels.

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