J. Anat. (1981), 132, 1, pp.

39-56 39
With 8 figiures
Printed in Great Britain

The nerve supply to the human lumbar

intervertebral discs
N. BOGDUK, WENDY TYNAN AND A. S. WILSON
Department of Medicine, University of New South Wales, and Departnment
of Anatomy, University of Western Australia
(Accepted 2 June 1980)
INTRODUCTION
The presence of nerve fibres and nerve endings in the lumbar intervertebral
discs and in the adjacent longitudinal ligaments has been demonstrated by many
authors (Jung & Brunswig, 1932; Roofe, 1940; Ehrenhaft, 1943; Ikari, 1954;
Pedersen, Blunck & Gardner, 1956; Malinsky, 1959; Hirsch, fnglemark & Miller,
1963-1964; Jackson, Winkelmann & Bickel, 1966). Most of these have described
free nerve endings in the posterior and anterior longitudinal ligaments and in the
superficial layers of the anuli fibrosi, but more complex endings have also been
found in these tissues by Malinsky 1959, including encapsulated and non-
encapsulated receptors on the lateral surface of the anuli fibrosi.
The endings in the posterior longitudinal ligament and in the posterior parts of
the anuli fibrosi are derived from the lumbar sinuvertebral nerves (rami meningei),
the anatomy of which has been extensively described (Luschka, 1850; Hovelacque,
1925, 1927; Spurling & Bradford, 1939; Spurling & Grantham, 1940; Roofe, 1940;
Craig & Walsh, 1941; Buskirk, 1941; Bradford &Spurling, 1945; Lazorthes, Poulhes
& Espagne, 1947; Herlihy, 1949; Wiberg, 1949; Pedersen et al. 1956; Edgar &
Nundy, 1966; Edgar & Ghadially, 1976). The sinuvertebral nerves, however, are
distributed only to the tissues within the vertebral canals. The source of the nerve
endings in the lateral and anterior aspects of the lumbar intervertebral discs and in
the anterior longitudinal ligaments has not been stated in the literature describing
them. Fibres innervating these structures have usually been presumed to arise from
branches of the lumbar sympathetic trunks (Hovelacque, 1927; Mitchell, 1953;
Reilly, Yong-Hing, MacKay & Kirkaldy-Willis, 1978), but the pattern of inner-
vation has not previously been described. tn contrast to fibres from the sympathetic
system, in gross dissections of lumbar spines, Taylor & Twomey (1979) found what
appeared to be nerve fibres arising from the lumbar ventral primary rami and passing
to the adjacent intervertebral discs.
fn the absence of any comprehensive description of the innervation of the lumbar
intervertebral discs and their related longitudinal ligaments, the present study was
undertaken to establish in detail the source and pattern of innervation of these
structures, particularly those of the anterior longitudinal liagment and the lateral
aspects of the discs.

0021-8782/81/2828-8470 $02.00 1981 Anat. Soc. G.B. & 1.

40 N. BOGDUK, WENDY TYNAN AND A. S. WILSON

1A

... .....
..

Fig. 1. For legend see opposite.

METHODS
Macroscopic studies
Dissections were made of four adult human cadavers, of which one was embalmed
while the other three were autopsy specimens. The autopsy material was obtained
approximately 12 hours after death and was fixed by immersion in 10 % formalin.
Each specimen was dissected with the aid of a dissecting microscope at a magnifica-
tion of x 10 to x 50.
The lumbar sympathetic trunk was identified and dissected along its length,
including (as far as the magnification allowed) all branches arising from it. Visceral
and aortic branches were not studied further. All branches passing towards the
vertebral column were traced as far as possible along their length. Rami com-
municantes were traced to their junction with the ventral primary rami of the lumbar
spinal nerves. Branches of the rami communicantes were traced as far as possible.
In the intervertebral foramina the origin of the sinuvertebral nerves was carefully
 Innervation of lumbar intervertebral discs 41

Fig. 1. The sinuvertebral nerves. The arrow (C) indicates the cranial end of the specimen.
(A) Lateral view of a right LI intervertebral foramen, showing the original of the sinuvertebral
nerve. (B) Medial view of the same foramen as in (A), showing the recurrent course of the
nerve through the foramen. The nerve has been lifted by a 0-75 mm probe. (C) The course of a
left L2 sinuvertebral nerve within the vertebral canal. (D) A close-up view of the lesser des-
cending branch of the nerve in (C). P, pedicle, LF, ligamentum flavum; PLL, posterior longi-
tudinal ligament; IVD, intervertebral disc; drg, dorsal root ganglion; dr, dorsal ramus; vr,
ventral ramus; rc, ramus communicans; svn, sinuvertebral nerve; ar, autonomic root of svn;
sr, somatic root of svn; m, major ascending branch of svn; 1, lesser descending branch of svn;
b, branches to posterior longitidinal ligament.

displayed. To study the further course of these nerves the vertebral column was
divided along a sagittal plane; the laminae were removed and the dural sac retracted
dorsally and resected, leaving the spinal nerves in situ. The branches of the sinu-
vertebral nerves to the posterior longitudinal ligament and anuli fibrosi were then
dissected.
The ventral primary rami were traced distally from their origin as far as the
formation of the lumbar plexus. Branches of the plexus were not dissected in detail
unless they had previously been found to receive a ramus communicans.
To trace the rami communicantes and ventral primary rami, it was necessary to
resect the psoas major. This was done by tracing the nerve of interest into or deep
to the muscle for about one to two centimetres, cleaving the muscle fibres from
around it by blunt dissection. Once the short length of nerve was isolated, the muscle
fibres were resected 1-2 cm either side of the nerve. This procedure was repeated
until the whole length of the nerve was revealed when any remaining muscle fibres
were stripped from their origin.
42 N. BOGDUK, WENDY TYNAN AND A. S. WILSON
.. 1

Fig. 2. A line diagram illustrating examples of the various types of nerves described in this
study. Each type of nerve illustrated is shown in later figures in close-up photographs taken
from actual dissections. ALL, anterior longitudinal ligament; IVD, intervertebral disc; st,
sympathetic trunk; vr, ventral rami; 1, nerves to ALL (cf. Fig. 3); 2, 'typical' rami communi-
cantes, crossing the vertebral bodies deep to psoas; 3, a ramus communicans which pierced
between fibres of psoas; 4, a deep 'paradiscal' ramus communicans embedded in the connective
tissue of an IVD (cf. Fig. 6); 5, branches to the posterolateral aspect of an IVD from ventral
rami (cf. Fig. 4); 6, branches to the lateral aspect of an IVD from rami communicantes (cf.
Fig. 5); 7, branches to the posterolateral aspect of an IVD from rami communicantes (cf. Figs.
4C, 5C, 5D).

Microscopic studies
To confirm that the nerves so dissected were indeed neural tissue, segments of the
nerves were excised at suitable points and subjected to histological examination.
Tissue samples were rinsed in 0 1 M-cacodylate buffer (pH 7A4), fixed in I % osmium
tetroxide, rinsed in cacodylate buffer, dehydrated in alcohol and 1,2-epoxypropane,
and embedded in Araldite. Transverse sections were cut at 1-2 ,um and stained
in I % toluidine blue in 1 % borax solution.
Where nerve fibres were found to enter or pass adjacent to intervertebral discs,
wedges of the disc tissue 1-2 cm either side of the nerve were removed. Frozen
sections, cut at a thickness of 100-300 /tm were stained with silver according to the
method of Schofield (Carleton, 1967), and examined under the light microscope.
 Innervation of lumbar intervertebral discs 43

RESULTS
Sinuvertebral nerves
The sinuvertebral nerves were found to arise in the intervertebral foramina from
two roots: one from the ventral primary ramus and the other from a ramus com-
municans (Fig. 1 A). Each nerve entered the vertebral canal through the inter-
vertebral foramen by crossing the vertebral body just caudal to the pedicle (Fig. I B).
Within the canal the major branch of the nerve passed rostrally, parallel with the
lateral border of the posterior longitudinal ligament and giving off transverse
branches which passed deep to the ligament (Fig. I C). The major branch could
not be traced with confidence beyond the level of the intervertebral disc rostral
to its level of origin. Lesser branches of the sinuvertebral nerves passed medially
and caudally from the intervertebral foramen to ramify over the intervertebral
disc at the level of origin of the parent nerve (Fig. 1 D).
Rami communicantes
A variety of rami coruimnicantes was identified (Fig. 2). Each ventral primary
ramus received at least one, but more commonly two or more parallel rami which
ran from the sympathetic trunk around the concavity of the vertebral body deep
to the tendinous arcade of the psoas muscle. Other -ami communicantes penetrated
the psoas muscle and ran their entire course through it to reach a ventral primary
ramus. Such a ramus communicans was constantly identified passing between
the second lumbar sympathetic ganglion and the LI ventral primary ramus (Fig. 2,
label 3). In one specimen a ramus communicans was identified passing from the
sympathetic trunk through psoas to reach the genitofemoral nerve near its origin.
Branches to the anterior longitudinal ligament
Branches to the anterior longitudinal ligament were found to arise from rami
communicantes near their origin from the sympathetic trunk, with or -without a
separate connection to the sympathetic trunk (Figs. 2, 3). While the ramus com-
municans passed dorsally towards the ventral primary ramus, the branch to the
ligament passed ventrally around the concavity of the vertebral body in company
with vessels. The nerve and vessels passed deep to the ligament, between it and the
vertebral body, and supplied branches to the ligament (Figs. 2, 3).
Braiiches inniervating the lateral surfaces of the intervertebral discs
Three types of branches were found to innervate the lateral surface of the inter-
vertebral discs. While at no single level were all three types ever found, at least one
form was identified for each disc.
Branches were found arising from ventral primary rami and passing directly to
the posterolateral aspect of the adjacent intervertebral disc. These were either long
and individual, or short, multiple, and obscured by connective tissue (Figs. 2, 4).
These branches from the ventral primary rami were clearly separate from the
sinuvertebral nerves.
Two types of branches arose from rami communicantes which passed deep to the
tendinous arch of psoas. One type arose from the ramus as it crossed the vertebral
body; the branch passed rostrally or caudally and ramified in the connective tissue
on the lateral surface of the adjacent intervertebral disc (Figs. 2, 5). The second
44 N. BOGDUK, WENDY TYNAN AND A. S. WILSON

_~~~~~~~~~~~~~~~~NM
 Innervation of lumbar intervertebral discs 45

Fig. 4. Nerves to intervertebral discs from ventral rami. The arrow (C) indicates the cranial end
of the specimen. (A) An isolated single branch to an L2 disc (I VD) from a left L2 ventral ramus
(VR). (B) A bundle of nerves (n), enclosed in connective tissue, from a left L4 ventral ramus to
an L4 disc. Also seen is a branch (x) to the L4 disc from the L4 ramus communicans (re).

type arose from the ramus near its junction with the ventral primary ramus and
supplied the posterolateral aspect of the disc along with branches from the ventral
rami (Figs. 2, 4B, 5C, 5 D).
Whereas the above branches appeared on dissection to be 'end' branches to
discs, at three levels a ramus communicans was dissected which crossed an inter-
vertebral disc and bore an intimate relationship to it. At its origin, like typical rami,
it entered the tendinous arcade under psoas, but later, it left the arcade to pass
caudally across the subjacent disc. It was flattened and embedded in the superficial
connective tissue of the disc (Fig. 6) where it lay deep to the origin of psoas and not
between its fascicles. Ultimately the ramus connected distinctly to a ventral primary
ramus (Fig. 6). To demonstrate such rami adequately they had to be dissected free

Fig. 3. Nerves to the anterior longitudinal ligament. The arrow (C) indicates the cranial end of
the specimen. (A) A branch arising from a left LI ramus communicans and the sympathetic
trunk. The latter is retracted. (B) A close upof thenervein (A) showing it penetrating deep to the
ligament with a companion vein. (C) A branch arising from a right LI ramus communicans. The
ramus communicans is retracted. (D) A branch arising from a right L2 ramus communicans.
ALL, anterior longitudinal ligament; IVD, intervertebral disc; rc, ramus communicans (arrow
indicating direction to spinal nerve); st, sympathetic trunk; b, branch to anterior longitudinal
ligament; s, origin of branch from sympathetic trunk; r, origin of branch from ramus communi-
cans.
46 N. BOGDUK, WENDY TYNAN AND A. S. WILSON
. .._.

.4 ..
.. .:
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irc iA 1 X
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 Innervation of lumbar intervertebral discs 47
of the disc. Fine branches ending in disc tissue could not, therefore, be confirmed,
but the juxtaposition to disc tissue was so intimate that such branches could easily
have been present although too small to dissect.
Histological verification
In the Araldite sections (1-2,um) neural tissues were easily identifiable by the
presence of osmiophilic myelin sheaths, well defined endoneurial tissues and con-
spicuous perineurium (Fig. 7). Of the 15 samples studied, 14 were thus confinned
to be neural tissue (Fig. 7) while the remaining one proved to be a vascular structure.
In sections impregnated with silver the fairly densely innervated adherent frag-
ments of longitudinal ligaments contrasted sharply with the sparse innervation of
the intervertebral disc. Those few nerve fasciculi which did enter the disc approached
the perimeter obliquely in company with vascular structures. At the point of pene-
tration there was usually a somewhat less dense connective tissue barrier (Fig. 8 A).
The concentric rings of the anulus fibrosus were used to determine the depth of
neurovascular penetration. Nerve fibres were found up to a depth equivalent to one
third of the total thickness of the anulus fibrosus (Fig. 8B). Although the majority
of nerves demonstrated were paravascular in position and of small diameter, a few
were obviously remote from blood vessels and of larger diameter.

DISCUSSION
Since they have been extensively studied before, the lumbar sinuvertebral nerves
were dissected in the present study only to verify previous descriptions and to
complement the studies of the innervation of the lateral surface of the discs. There
has been debate as to the anatomy of the lumbar sinuvertebral nerves. Spurling &
Bradford (1939), Spurling & Grantham (1940), Roofe (1940) and Bradford &
Spurling (1945) described them as descending over two segments, whereas Lazorthes
et al. (1947) found them to have an exclusively ascending course. Pedersen et al.
(1956) found that they ramified upwards, downwards and transversely between
their level of origin and the disc above. The present findings are consistent with the
descriptions of both Lazorthes et al. (1947) and Pedersen et al. (1956) in that the
lumbar sinuvertebral nerves have a predominantly ascending distribution.
Some textbooks (Gray, 1973; Lockhart, Hamilton & Fyfe, 1965) imply the pre-
sence of only a single ramus communicans at each level and an additional white
ramus communicans at each of the upper two or three lumbar levels. More detailed
descriptions (Hovelacque, 1927; Pick & Sheehan, 1946; Bradley, 1951; Mitchell,
1953; Hollinshead, 1956), however, point out that multiple rami may occur at any
or at all levels. The present findings are in agreement with this. Hovelacque (1927)
quotes Cruveilhier as stating that it is not exceptional to find a ramus communicans

Fig. 5. Nerves to intervertebral discs from rami communicantes (see also Fig. 4C). The arrow
(C) indicates the cranial end of the specimen. (A) A branch to the right lateral aspect of an L3, 4
disc, lifted at its termination by a 0 75 mm probe (cf. Fig. 2, label 6). (B) A close up view of the
branch in (A) as it enters the connective tissue of the disc. (C) A cluster of nerves to the left
posterolateral aspect of an L4, 5 disc. The L4 rami communicantes have been retracted to
accentuate the branches (cf. Fig. 2, label 7). (D) A branch to the right posterolateral aspect
of an L5, SI disc. IVD, intervertebral disc; et, connective tissue covering disc; ps, remaining
fibres of psoas covering disc; VR, ventral ramus; rc, ramus communicans; st, sympathetic
trunk; n, nerves to intervertebral disc.
48 N. BOGDUK, WENDY TYNAN AND A. S. WILSON

i I ..

Fig. 6. For legend see opposite.

passing to a branch of the lumbar plexus, but Hovelacque himself had observed this
only once. The present observation of such a communication to the genitofemoral
nerve complements Hovelacque's description. The occurrence of rami communicantes
passing through the psoas, rather than under its tendinous arcade, is also not
unusual, but Hovelacque (1927) and Mitchell (1953) described specific muscular
branches from the sympathetic trunk, ending in the substance of psoas. Such
nerves were not identified in the present study. All rami penetrating the substance
of psoas were traceable ultimately to a ventral primary ramus.
The innervation of the anterior longitudinal ligament has been described by
 Innervation of lumbar intervertebral discs 49
6D
,uY.t.

sowig apaadicalrams3(dr crsiga/3-VnevreraDic(V) eosrce

sam,

from several close-up views of the region (cf. Fig. 2, label, 4). Note, incidentally, the ramus
communicans (reg) to the genitofemoral nerve (gfnt). VR, ventral ramus; rc, ramus communicans;
st, sympathetic trunk. (C) A close-up view of the paradiscal ramus, showing its origin from the
sympathetic trunk and how it disappears into the paradiscal connective tissue at (X). (D)A
close-up view of the paradiscal ramus on the L3-4 intervertebral disc. To reveal the nerve the
psoas major has to be resected from its origin from the disc. The nerve has, beenl teased off the
disc to improve photographic contrast.

Reilly et al. (1978) as coming from a recurrent branch of the sinuvertebral nerve.
This was clearly not the case in the present study. The sinuvertebral nerves are
distributed exclusively within the vertebral canal and no branches pass from them
to the external aspects of the vertebral column. The nerves to the anterior longi-
tudinal ligament arise independently from ramii communicans and the sympathetic
trun k. They are related to the sinuvertebral nerves only in as much as they are
connected at opposite ends of a common ramus communicans and it would be
erroneous to consider them to be recurrent branches of the sinuvertebral nerves.
Hovelacque (1927) does not specifically describe the innervation of the anterior
longitudinal ligament but the nerves described in the present study correspond to
Fig. 7. Representative transverse sections of the nerves described in the text. (A) to (C) are
branches to intervertebral discs from ventral ramii. (D) to (G) are branches to intervertebral
discs from r-ami comimunicantes. (H) is a branich to the aniterior longitudinal ligament. All sec-
tions stained by toluidine blue. (A) The branch to the L2 disc in Fig. 4A. (B) The cluster- of
nerves in Fig. 4B3, showing nierve fibr-es (ni) and per-ineurial fat (f). (C) The branch from the
ramus communicans to the [.4 disc in Fig. 4B, (D) The branich to the L3 disc in Fig. 5 A. (E)
The cluster of nerves in Fig. 5 C. showinig nerve fibres (it) and perineurial fat (f). (F) the branch
to the anterior longitudinal ligament in Fig. 3 A.
 2ewz*if
50 N. BOGDUK, WENDY TYNAN AND A. S. WILSON
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Innervation of lumbar intervertebral discs 51
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 52 N. BOGDUK, WENDY TYNAN AND A. S. WILSON
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 Innervation of lumbar intervertebral discs 53

Fig. 8. Nerve fibres in the intervertebral discs. (A) A nerve fibre (arrow) penetrating the outer
lamellae of the anulus fibrosus, near the distal end of the nerve depicted in Fig. (4B). Thearea
outlined is shown in higher magnifications in Fig. (8 B). (C) An example of a nerve fibre (arr-owed)
found more deeply in the disc tissue.
what he described as the osseous branches of the sympathetic trunk. That these
nerves ultimately enter the vertebral body with their companion vessels is not
disputed, but it is submitted that they innervate the anterior longitudinal ligament
along their course.
All the nerves which ramify on the lateral surface of the intervertebral discs
appeared on dissection to be directed specifically to the discs. Their disposition
differed distinctly from specific muscular branches to psoas from the lumbar plexus,.
which characteristically ran between fascicles of psoas well within its fleshy sub-
stance. In contrast, the disc branches from the ventral rami passed deep to psoas,
directly to disc tissue and ramified in the connective tissue on the outer surface of
the disc. Similarly, the disc branches from rami communicantes ran between fascicles'
of psoas but in a plane directly against the disc, and they ramified in the peridiscal
connective tissue rather than in psoas.
The rami communicantes which crossed intervertebral discs ('paradiscal' rami)
differed distinctly from rami which passed through psoas. They were bound down
to the disc by connective tissue and their integrity was not destroyed by resecting
the psoas from its origin. The presence of such rami has been noted previously
(Hovelacque, 1927), but whether or not they supplied the disc was not stated. That
these rami in fact innervated intervertebral discs was not specifically demonstrated
in the present study, but it would be surprising that such an intimately related nerve
would not supply some branches to the disc.
The histological verification of the macroscopic findings in this study had been
expected to present difficulties because of poor fixation due to delay between
54 N. BOGDUK, WENDY TYNAN AND A. S. WILSON
death and tissue fixation. However, in the samples of dissected nerves which were
studied, the neural tissue was unmistakable despite early autolytic changes. In the
silver impregnated sections of intervertebral discs, all the normally accepted criteria
for nerve fibre identification could not be applied, but the presence of 'beading' and
varicosity within the nerve fibres makes them conspicuous, and easily distinguishable
from surrounding connective tissue.
Owing to the techniques used, direct continuity between the macroscopically
traceable nerves and those within disc tissue was never clearly demonstrated, but
it seems a reasonable assumption that such continuity existed. Unfortunately,
normally obtained human material does not lend itself to more reliable histological
techniques such as intravital staining and serial sectioning followed by reconstruc-
tion. Accordingly, no claim is made as to the absolute accuracy of this part of the
present study. The failure to demonstrate all three types of disc branch at every
single level may well have been due to the limitations of the technique used, rather
than to a true absence of such nerves. Furthermore, it is acknowledged that other
branches to discs and ligaments, too fine to be recognised by microdissection, may
have been missed. Nevertheless, it is felt that the general pattern of innervation has
been delineated. Tn particular, a source of innervation from the ventral primary
rami of spinal nerves has been confirmed, a source described only once previously
in the literature (Taylor & Twomey, 1979) but unconfirmed by histological study.
One item worthy of consideration is whether the branches to intervertebral discs
from ventral primary rami and rami communicantes are indeed specific 'end'
branches to the discs. In view of the finding of deep paradiscal rami communicantes
it is possible that the apparent 'end' branches might represent opposite ends of
other, but finer, paradiscal rami. The resolving power of the dissecting microscope
and the size of dissecting instruments used precluded tracing the 'end' nerves
through the connective tissue of the disc. Like the larger paradiscal rami, they
may have formed a link, through the connective tissue, between ventral primary
rami and rami communicantes. In this way the human vertebral column may, in
fact, be supplied by a plexus of rami communicantes such as Stillwell (1956) des-
cribed in the monkey. Thus, rather than having specific 'end' branches, the lumbar
intervertebral discs might be innervated by a diffuse plexus in which somatic fibres to
the discs 'hitched a ride' upon the rami communicantes to reach their destination.
It is interesting to speculate upon the functional significance of neural com-
ponents within intervertebral discs. Although no definite conclusions can be made
from the present data, it is clear that the axis cylinders in nerves passing to discs
vary in dimension. Those which are of small calibre and paravascular in position
may be ascribed a vasomotor function, but those which are remote from vessels
may perform some other function such as nociception, or, in the case of larger
diameter fibres, propriception, as suggested by Malinsky (1959).
Clinically, the concept of 'disc pain' is now well accepted. The results of the
present study, however, show that the possible anatomical pathways for disc pain
are diffuse. The branches from ventral primary rami and rami communicantes
provide an anatomical substrate for anterior and lateral disc pain, and the dorsally
situated sinuvertebral nerves are not the only nerves supplying lumbar intervertebral
discs. Recently, 'anterior disc tenderness' has become an issue of interest (O'Brien,
1979; Gunn, 1979). It is hoped that this study may assist in any further investigation
of the clinical significance of this sign.
 Innervation of lumbar intervertebral discs 55
SUMMARY
The lumbar intervertebral discs are supplied by a variety of nerves. The posterior
aspects of the discs and the posterior longitudinal ligament are innervated by the
sinuvertebral nerves. The posterolateral aspects of the discs receive branches from
adjacent ventral primary rami and from the grey rami communicantes near their
junction with the ventral primary rami. The lateral aspects of the discs receive other
branches from the rami communicantes. Some rami communicantes cross inter-
vertebral discs and are embedded in the connective tissue of the disc deep to the
origin of psoas. Such paradiscal rami are likely to be another source of innervation
to the discs. The anterior longitudinal ligament is innervated by recurrent branches
of rami communicantes.
The authors would like to extend their appreciation to Mr L. Twomey and
Dr J. Taylor for inspiring the present study, and for assistance in obtaining materials;
and to Professor D. Allbrook for his consultations during the study. The illustrations
were prepared by the Departments of Medical Illustrations of the Universities of
Western Australia, and New South Wales.

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