The Basivertebral Nerve

and Its Role in Chronic Low Back Pain

Documenting the Basivertebral Nerve

Intraosseous nerves within the vertebral body were described in 1998 by Antonacci et al.1 The existence and distribution of these intraosseous nerves within the vertebral body were subsequently further detailed by Fras et al.2 in 2003 and Bailey et al.3 in 2011, who also described the source of the intraosseous nerves as the basivertebral nerve (BVN). The BVN enters the posterior vertebral body via the basivertebral foramen (Figure 1) and arborizes near the center of the vertebral body, sending branches to innervate the superior and inferior endplates.

Basivertebral Nerve Transmits Pain Signals

In 2003, Fras et al.2 reported on the presence of Substance P within the BVN, concluding that these nerves have the potential for transmitting pain signals. Subsequently in 2011, Bailey et al.3 showed that the basivertebral nerves are PGP 9.5-positive, establishing their role in pain transmission.

Degenerated Endplates and Chronic Low Back Pain

Lotz et al.4 documented increased innervation, via the basivertebral nerve, of the endplates with damaged and degenerated endplates. Vertebral body pathology, such as degenerated endplates, correlates with chronic low back pain (CLBP), as reported by the following:

  • Modic et al.5 described intraosseous MR imaging observed changes adjacent to the vertebral endplates in patients with CLBP. He described these changes as a “Type 1” or “Type 2” based on their appearance on MR imaging.
  • Carragee et al.6 determined that vertebral body and endplate MRI signal changes, indicative of intraosseous edema or inflammation, were well correlated with clinical low back pain.
  • Weishaupt et al.7 reported 100% specificity to pain in patients with Modic Type 1 and Type 2 changes.
  • Kuisma et al.8 found a 2.28 odds ratio for the presence of Modic changes at L5-S1 in patients with CLBP.

Collectively, these studies substantiate the role of the BVN in transmitting pain signals and provide a link between endplate degeneration and CLBP.

1 Antonacci MD, Mody DR, Heggeness MH. Innervation of the human vertebral body: a histologic study. Journal of Spinal Disorders 1998; 11(6):526-31.
2 Fras C, Kravetz P, Mody DR, Heggeness MH. Substance P-containing nerves within the human vertebral body: an immunohistochemical study of the basivertebral nerve. The Spine Journal: Official Journal of the North American Spine Society. 2003;3(1):63-7.
3 Bailey JF, Liebenberg E, Degmetich S, Lotz JC. Innervation patterns of PGP 9.5-positive nerve fibers within the human lumbar vertebra. Journal of Anatomy 2011;218(3):263-70.
4 Lotz JC, Fields AJ, Liebenberg EC. The Role of the Vertebral End Plate in Low Back Pain. Global Spine J 2013;03:153-64.
5 Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988;166:193-9.
6 Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. The Spine Journal: Official Journal of the North American Spine Society. 2005; 5(1):24-35.
7 Weishaupt D, Zanetti M, Hodler J, et al. Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging. Radiology 2001; 218(2):420-7.
8 Kuisma M, Karppinen J, Niinimaki J, et al. Modic changes in endplates of lumbar vertebral bodies: prevalence and association with low back and sciatic pain among middle-aged male workers. Spine 2007; 32(10):1116-22.