The innervation of the spinal dura mater: Anatomy and clinical implications

Abstract

The nerves supplying the spinal dura mater were studied in four human foetuses (16-22 weeks) with the acetylcholinesterase in toto staining method. The ventral spinal dura contains a dense, longitudinally oriented, nerve plexus, which receives its contributions from: (I) the sinuvertebral nerves, (II) the nerve plexus of the posterior longitudinal ligament, (III) the nerve plexus of radicular branches of segmental arteries. Dorsal dural nerves are much smaller in number, do not form an evident plexus and do not reach the medial region of the dorsal dura. The dorsal nerves are derived from the ventral dural plexus at the level of the "intersleeval" parts of the dura mater. The ventral dural nerves may extend up to eight segments, with a great amount of overlap between adjacent nerves. This may provide an anatomical substrate for the understanding of extrasegmentally referred dural pain. The curled bundles of nerve fibres of pathways (I) and (II) provide an adequate adaptation to displacements of the spinal dura mater during flexion and extension. Pathway (III) has not been described before. The described nerve plexuses may be of importance in elucidating the mechanisms of epidural therapies in back pain and peripheral vascular disease.

Nerves and nerve plexuses of the human vertebral column

“…Furthermore the innervation of the ventral spinal dura is derived from direct branches of the nerve plexus of the PLL itself. These findings are in accordance with the general opinion, especially with the results of Edgar and Ghadially (19761, and were described more extensively in a n earlier study (Groen et al, 198813).…”

Postdiskogram CT Features of Lidocaine-Sensitive and Lidocaine-Insensitive Severely Painful Disks at Provocation Lumbar Diskography

“…[30][31][32] In the presence of disk degeneration, sensory fiber in-growth may occur, potentially stimulated by the presence of disk space inflammatory debris. In addition, epidural structures, including the dura, epidural vessels, and adjacent ligaments, are richly innervated by pain fibers, [33][34][35][36] and disk material in the epidural space is known to provoke an inflammatory response. [37][38][39][40][41][42] Our results demonstrate several features related to the significantly painful lumbar disk, including the following: 1) highly complex and overlapping morphology of degenerative changes in currently studied painful lumbar disks on postdiskogram CT; 2) the importance of diskographic contrast leakage is reinforced as a highly significant factor in the intradiskal lidocaine response of painful lumbar disks; 3) demonstration that RDs (AG and RT) and RT projecting into a circumferential annular tear are significant factors related to the intradiskal lidocaine response (separate from relationship to diskogenic pain); and 4) demonstration that AFrags is an additional factor associated with the intradiskal lidocaine response.…”

Catecholaminergic and acetylcholine esterase containing nerves of cranial and spinal dura mater in humans and rodents

“…Some recent studies (Groen et al, 1988;Kallakuri et al, 1998;Kumar et al, 1996;Yamada et al, 1998) have provided new light on this topic but, in any case, did not furnish an unequivocal interpretation of the different pattern of innervation. Our experimental observations are confined to human and rodents' dura mater and led us to describe some interesting findings in the examined species.…”