Rami communicans fibers in discogenic low back pain: The controversies

Intervertebral disc innervation and mechanism of discogenic low back pain is a subject of debate. There is no controversy regarding innervation of anterior and lateral annuli. Nociception from this part is carried by sympathetic pathway. Sinuvertebral nerves innervate posterior annulus, but there are controversies about nociceptive pathway from posterior annulus. It can be mixed somatic and sympathetic or can be completely sympathetic pathway through rami communicans fibers. Local anesthetic block of rami communicans fibers with or without steroid gives very good results in discogenic low back pain. But radio frequency ablation of rami communicans fibers do not give consistent result. This article has tried to find the literature about disc innervation, role of rami communicans nerves in transmission of discogenic back pain, and role of rami communicans nerve block in management of discogenic back pain.