Clinical Anatomic Study And Application Of Sinuvertebral Nerve Lesioning Under Lumbar Endoscope For Discogenic Low Back Pain

Discogenic low back pain is the most common cause of chronic low back pain,accounting for about 40%,it has become a serious medical and social prob-lem.Sinuvertebral nerves are the main nerves that compose the lumbar disc pain signal pathway.Intraosseous basivertebral nerve ablation,endoscopic discectomy/radiofrequency thermoplasty,and other minimally invasive interventional pro-cedures are currently used to treat discogenic low back pain,but these methods only damage nerve endings in the vertebral body or disc.Generally,the early cu-rative effect is better but the long-term recurrence rate is higher.The intervertebral foraminal technique is widely used in spinal surgery,and has the advantages of minimally invasive,visualization,low cost,and mature technology.This provides a new idea for the treatment of discogenic low back pain:Once the initial segment of the sinuvertebral nerve lesioning under the endoscope,the conduction of pain stimulus is blocked,so it might bring a greater future effect.Due to the current distribution characteristics of the lumbar sinuvertebral nerves,especially the mi-croscopic features of the lumbar sinus vertebral nerves are not clear;and a clearer surgical field is needed to identify and lesion the lumbar sinuvertebral nerve under the endoscopy,existing research data have limited clinical significance.Therefore,the observation of the abutment relationship between the lumbar sinuvertebral nerves and the postcentral branch of the spinal artery and the anatomical features under the endoscopy have clinical guidance significance.Objective:The purpose of this study is to study the general and microscopic anatomy of the lumbar sinuvertebral nerves and its adjacent blood vessels,and to observe the effect of the lumbar sinuvertebral nerves lesioning under the endo-scope for the treatment of discogenic low back pain.Methods:Twenty healthy embalmed cadavers and 2 fresh cadavers were taken.The origin,number and spatial orientation of lumbar sinuvertebral nerves were examined in 10 embalmed cadavers,and the anatomical characteristics of the postcentral branches of lumbar intervertebral foramen were observed in other 10 embalmed cadavers.Morphological features of lumbar sinuvertebral nerve and postcentral branches of spinal artery were observed under the endoscope.Forty patients with single-stage discogenic low back pain as research sub-jects who were admitted to our hospital from July 2018-February 2019.The pre-operative low back pain VAS score was 4.45�0.876,and the ODI was 49.73�13.54.The sinuvertebral nerves were accurately ablated and lesioned under the percutaneous endoscopic.VAS and ODI scores were measured before surgery,1 month,3 months,6 months,and 12 months after surgery.Results:In our study,the sinuvertebral nerves were routinely divided into the following two types:one is the sinuvertebral nerve deputy branch originated from the anterior surface of the spinal ganglia or the starting point of the gray ramus communicans of the nerve root in the IVF and directly distributing the posterior lateral edge of the intervertebral disc and part of the vertebral body without enter-ing the inside of the spinal canal;another one is the sinuvertebral nerves main trunk,a similar origin to sinuvertebral nerves deputy branches.However,sinuver-tebral nerves main trunks inserts into the spinal canal medially along the posterior margin of the disc or vertebral body.The postcentral branch was routinely divided into the following 2 types:Main trunks,which branch from the spinal arteries or lumbar arteries and then divide into 2 branches(superior and inferior branches),and deputy branch,the superior and inferior branches straight from the spinal ar-teries.And sinuvertebral nerves and postcentral branch can be identified and pro-cessed under endoscope.Forty patients with sinuvertebral nerves lesioning.37 patients(92.5%)had a low back pain VAS score of ?2 at 12 months after operation,from an average of 4.45 points to average 1.30 points 12 months after operation;31(77.5%)patients had an ODI score of ?14 points after 12 months,from an average of 49.73 points before surgery to an average of 12.80 points after 12 months.Conclusion:Ablating initial segment of sinuvertebral nerve under lumbar endoscope for discogenic low back pain can significantly relieve the patients' pain and improve function in the long term.