The sinuvertebral nerve (recurrent meningeal nerve, nerve of Luschka) is a small mixed nerve formed at each spinal level by a somatic branch from the spinal nerve and an autonomic branch from the grey ramus communicans. It re-enters the intervertebral foramen to supply the posterior longitudinal ligament, the posterior annulus fibrosus, the anterior dura, the epidural vessels, and the periosteum of the posterior vertebral body.
| Origin | Spinal nerve (somatic root) and adjacent grey ramus communicans (autonomic root), just outside the intervertebral foramen |
|---|---|
| Course | Re-enters the vertebral canal through the intervertebral foramen and runs on the posterior surface of the vertebral body and disc, sending ascending and descending branches |
| Sensory |
|
The sinuvertebral nerve is the main pain nerve of the intervertebral disc and posterior longitudinal ligament. Annular fissures that reach the outer annulus, where its terminals lie, produce discogenic back pain without nerve root compression. Its autonomic component and the overlap of branches between neighbouring levels help explain why disc pain is deep, poorly localised and often felt over several segments. Epidural steroid injections may work partly by reducing sensitisation of its terminals.
Annular fissures reaching the outer annulus stimulate sinuvertebral nerve terminals producing discogenic low back pain without radiculopathy, reproduced by provocative discography; epidural corticosteroid injection around the PLL and outer annulus reduces sinuvertebral nerve inflammation, providing temporary relief pending definitive management.
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