Low Back Pain: Why?

“Investigations have been performed in which thin nylon threads were surgically fastened to various structures and around the nerve root. Three to four weeks after surgery these structures were irritated by pulling on the threads, but pain resembling that which the patient had experienced previously could only be registered only from the outer part of the annulus” of the disc.

It had been established in the 1930s that herniation of the lumbar disc could put pressure on the nerve root or the cauda equina, resulting in sciatica. However, Dr. Nachemson in this context is saying something dramatically different;

He’s Claiming That A Non-Herniated Disc Problem Was
Causing Back Pain.

At the time (1976), claiming the intervertebral disc was capable of initiating pain was new and not only that, Nachemson claiming the disc to be the most probable source of back pain was both surprising AND revolutionary.

At the time, most authoritative reference texts stated the intervertebral disc was not even innervated with pain afferents and therefore not capable of initiating pain.

As an example, rheumatology professor Malcolm Jayson, MD (editor) in the 1987 text titled The Lumbar Spine and Back Pain, states

“in the mature human spine no nerve endings of any description
remain in the nucleus pulposus or annulus fibrosis of the intervertebral disc
in any region of the vertebral column.” (3)

A conclusion we now know to be 100% false.

Support for Dr. Nachemson’s contention of disc pain came in 1981 when anatomist and physician Nikoli Bogduk published an extensive review of the literature on the topic of disc innervation, along with his own primary research, in the prestigious Journal of Anatomy (4). Dr. Bogduk notes:

“In 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.”

Dr. Bogduk and his team concluded decisively:

“The Lumbar Intervertebral Discs Are
Supplied By A Variety Of Nerves.”

and

“Clinically, The Concept Of ‘Disc Pain’
Is Now Well Accepted.”

Dr. Bogduk returned in 1983 updating his research notes in SPINE, stating more specifically :

“THE LUMBAR INTERVERTEBRAL DISCS ARE INNERVATED
posteriorly by the sinuvertebral nerves, but laterally by
branches of the ventral rami and grey rami communicantes…

The posterior longitudinal ligament is innervated by the sinuvertebral nerves and
the anterior longitudinal ligament by branches of the grey rami.
Lateral and intermediate branches of the lumbar dorsal rami supply the iliocostalis lumborum and longissimus thoracis, respectively.
Medial branches supply the multifidus, intertransversarii mediales, interspinales, interspinous ligament, and the lumbar zygapophysial joints.”

“The distribution of the intrinsic nerves of the lumbar vertebral column
systematically identifies those structures that are
potential sources of primary low-back pain.”

Adding to the growing momentum of this “disc-pain” concept… In 1987, SPINE published Dr. Vert Mooney’s Presidential Address of the International Society for the Study of the Lumbar Spine.  It was delivered at the 13th Annual Meeting of the International Society for the Study of the Lumbar Spine, May 29-June 2, 1986, Dallas, Texas, and titled (6):