J. Richardson, N. Collinghan, A.J. Scally, S. Gupta

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Bilateral L1 and L2 dorsal root ganglion blocks for discogenic low-back pain J. Richardson, N. Collinghan, A.J. Scally, S. Gupta British Journal of Anaesthesia Volume 103, Issue 3, Pages 416-419 (September 2009) DOI: 10.1093/bja/aep166 Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 1 ‘Traditional’ understanding of lumbar intervertebral disc afferent pathways. The sinuvertebral nerve, being a branch of the anterior ramus and the sympathetic chain was originally thought to transmit all the afferent information (e.g. from the L5/S1 intervertebral disc) via the anterior ramus directly into the cauda equina. British Journal of Anaesthesia 2009 103, 416-419DOI: (10.1093/bja/aep166) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions

Fig 2 Afferents from the sinuvertebral nerve travel outside the spine, up the sympathetic chains before entering the neuroaxis via the L1 and L2 dorsal root ganglia. Anterior rami afferents also entering the neuroaxis at these levels carry afferent input from the skin of the groins. The false-localizing symptom of groin pain with low lumbar discogenic pain (e.g. from the L5/S1 in the diagram) is thus explained.1–4 British Journal of Anaesthesia 2009 103, 416-419DOI: (10.1093/bja/aep166) Copyright © 2009 British Journal of Anaesthesia Terms and Conditions