The recurrent meningeal branches (sinuvertebral nerves) of the lumbar spine are mixed nerves formed by a somatic branch from the ventral ramus and a sympathetic branch from the grey rami communicantes, re-entering the intervertebral foramen to supply the posterior longitudinal ligament, posterior annulus fibrosus, dura mater, and epidural vessels.
The sinuvertebral nerve at each lumbar level is the primary nociceptive pathway for discogenic and posterior longitudinal ligament pain. Targeted sinuvertebral nerve blocks at the disc level provide diagnostic confirmation of discogenic pain. It is damaged during anterior lumbar discectomy, contributing to post-operative sensory changes in the epidural space. The sympathetic component explains why disc pain is poorly localised and associated with autonomic features.
Chemical sensitisation of the recurrent meningeal branches by inflammatory mediators from annular tears producing poorly localised lumbar pain with autonomic features, confirmed by provocative discography and managed with intradiscal therapies.
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