• Ken Wakai, Seiji Ohtori, Masaomi Yamashita, Kazuyo Yamauchi, Gen Inoue, Munetaka Suzuki, Sumihisa Orita, Yawara Eguchi, Nobuyasu Ochiai, Shunji Kishida, Masashi Takaso, Yu Fukui, Yasushi Hayashi, Yasuchika Aoki, Kazuki Kuniyoshi, Junichi Nakamura, Tetsuhiro Ishikawa, Gen Arai, Masayuki Miyagi, Hiroto Kamoda, and Kazuhisa Takahashi.
• Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chuo-ku, Chiba, Japan.
• J Orthop Sci. 2010 May 1;15(3):402-6.

BackgroundClinically, the origin of low back pain is unknown. The pain may originate from the lumbar muscles directly, or it may be referred pain from the spine. Dorsal root ganglion (DRG) neurons with dichotomizing axons have been reported in several species and are thought to be related to referred pain. However, these neurons, which have dichotomizing axons to the lumbar facet joints and to the lumbar muscle, have not been fully investigated.MethodsTwo neurotracers - 1,1'-dioctadecyl-3,3,3',3'- tetramethyl-indocarbocyanine perchlorate (DiI) and fluorogold (FG) - were used in the present double-labeling study. DiI crystals were placed in the right L5/6 facet joint, and FG was applied to right multifidus muscles at the L5 level in 10 rats. Two weeks later, bilateral DRGs from L1 through L6 were harvested, sectioned, and observed under a fluorescence microscope.ResultsDiI-labeled DRG neurons innervating the L5/6 facet joint (5.17% of the total DRG neurons) were distributed from L1 to L6. FG-labeled DRG neurons innervating the lower back muscle (15.9% of the total) were also distributed from L1 to L6. Double-labeled DRG neurons were found from L1 to L6. The ratio of total double-labeled/total DiI-labeled DRG neurons was 17% and that of total double-labeled/total FG-labeled DRG neurons was 7%. Approximately 17% of all DRG neurons innervating the facet joints had other axons that extended to the lower back muscle.ConclusionsThis finding provides a possible neuroanatomical explanation for referred low back muscle pain from the lower facet joints.

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