l.

Low back pain caused by the

sinuvertebral
nerve is often diffuse because of its
unique
anatomic pathway and sympathetic
components.258
The dorsal portion of the lower
lumbar disks
receives innervation from sensory
fibers arising
from the T13 to L2 DRG’s.259
• Branches of the ventral rami and the
gray rami
communicantes supply the lateral
aspects of the
disks in the lumbar spine.260,261 The
lateral portion of
the L5-L6 intervertebral disc (in rats)
arise from both
ipsilateral and contralateral dorsal root
ganglion
(DRG) neurons from the T13, L1, and
L2 levels.262
• The ventral (anterior) portion of the
Huatojiaji points,1 “facet joint
L5-L6
points”268
intervertebral disc (in rats) receives
innervation
from the L1 or L2 spinal nerves. This
may explain
why patients with lower lumbar disc
problems may
also experience pain in the inguinal
region, which
corresponds to the L1-L2
dermatome.263,264,265
• “Paradiscal rami” from the rami
communicantes
cross intervertebral disks and course
through the
connective tissue of the disc deep to
the origin of
the psoas muscle. These rami also
likely provide
discal innervation.266
• Severely degenerated lumbar
intervertebral disks
exhibit more extensive disc
innervation than do
normal disks.267
Facet joint capsule The joint capsule is richly innervated Huatojiaji points, “facet joint
by proprio points”272
ceptors and nociceptors. The synovial
membrane
of the lumbar facet joint (in rats) is
supplied by
sensory and sympathetic fibers.269 The
dorsal rami
supply the lateral portions of the facet
joints. The
sinuvertebral nerves supply the medial
portion of
the facet joints. Facet joints in the low

Costovertebral joints (thoracic
spine only)
Dorsal root ganglion (DRG)
Table 2-7
Potential Sources of Back Pain, Their Innervations, and Related
Acupuncture Points252,253,254
Chapter 2:: Function Follows Form 27
Spinal ligaments:
1) Longitudinal ligaments –
dorsal/posterior
and ventral/anterior
2) Supraspinal ligaments
3) Interspinous ligaments
Vertebral periosteum
Meninges
back receive
both segmental and nonsegmental
innervation,
due to the innervation from
sympathetic postgan
glionic neurons in the thoracolumbar
region and the
multisegmental nature of spinal
innervation.270 In
rats, the L5/L6 facet joint receives
multisegmental
innervation from the L1 to L5
DRGs.271
Dorsal rami and sympathetic fibers
supply the Huatojiaji points, “facet joint points”
costovertebral joints.
Mechanically sensitive nociceptors
(i.e., mechano
nociceptors) in the nervi nervorum of
the epineuria
Points along the inner Bladder channel
surrounding the DRG may contribute
to pain if
compression or tension affects the
DRG.
These ligaments contain free nerve
endings that
have been implicated as potential
contributors to
back pain.
• The sinuvertebral nerve supplies the
dorsal (or
posterior) longitudinal ligament.
• Recurrent branches of the rami
Points along the Governor Vessel
communicantes
channel
innervate the ventral (or anterior)
longitudinal
ligament.273
• The grey rami communicantes
supply the anterior
(ventral) longitudinal ligament.
• Medial branches of the lumbar
dorsal rami supply
the interspinous ligaments
The periosteum contains an extensive
plexus of Huatojiaji points or points along the
nerve fibers that exhibits the lowest Governor
pain threshold Vessel channel
of any of the deep tissues.
The dura is sensitive to mechanical
and noxious
stimulation; meningeal irritation may
contribute
to back pain. The sinuvertebral nerve
supplies the
dura mater.
The dura mater of the lower lumbar
spine receives
sensory fibers from the upper lumbar
ganglia; these
fibers may interact with sympathetic
nerv