Involvement of the sinuvertebral nerve in the treatment of chronic low back pain through dorsal root ganglion neurostimulation: an anatomical study.

Objective: Due to the anatomical proximity of the SVN to the dorsal root ganglion (DRG), several authors have highlighted the potential benefits of DRG stimulation in the management of chronic low back pain. However, the optimal vertebral level for electrode implantation remains debated. To determine the relevance of stimulating the sinuvertebral nerve (SVN) in the management of chronic low back pain and the most appropriate vertebral level for the implantation of this type of electrode.

Methods: We dissected the thoraco-lumbar spine (T12 to L5) of six anatomical specimens to highlight the path, innervation areas, and various branches of the SVN.

Results: We confirmed that the SVN innervates the posterior third of the intervertebral discs (IVD), the posterior longitudinal ligament (PLL), the anterior face of the dural sheath, the periosteum, the walls of the basivertebral veins, the segmental arteries, and their branches. Moreover, we demonstrated the dual somatic and sympathetic roles of the SVN. Finally, we observed an intra- and intersegmental network covering several adjacent vertebral levels. The superficial network of the SVN converges towards the L2 spinal nerve (SN).

Conclusion: We demonstrated the anatomical rationale for stimulating the DRG through rigorous anatomical dissection of the SVN. The most relevant indication appears to be for Persistant Spinal Pain Syndrome (PSPS) type 2 patients, with electrode implantation at the L2 vertebral level bilaterally.