Anatomy of the basivertebral nerve and its implications in the vertebrogenic pain. Systematic review and mapping of evidence.

Abstract

Low back pain is one of the leading causes of impaired quality of life worldwide. Recently, new interpretations have emerged, suggesting that pain may originate from inflammation of the vertebral endplates (vertebrogenic pain). The aim of this study was to conduct a systematic review to characterize the anatomical features of the basivertebral nerve, which innervates the vertebral endplates. This study was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews and reported following PRISMA-ScR guidelines. A descriptive, mapping-based synthesis was performed. The following search terms were used: "basivertebral nerve", "basivertebral nerve ablation", "sinuvertebral nerve", "anatomy", "vertebrogenic low back pain", "discogenic low back pain", "endplate", and "vertebrogenic". The databases PubMed, Scopus, Embase, Ovid, EBSCOhost, and Google Scholar were searched from inception through February 2026. The Rayyan platform was used for study selection. All authors independently screened abstracts and applied the following inclusion criteria: systematic reviews, clinical trials, observational studies, case series, anatomical studies, and radiological studies. Narrative reviews and studies lacking anatomical description of the basivertebral nerve were excluded. A total of 348 articles were identified, and 13 studies were ultimately included. Three cadaveric anatomical studies specifically addressed the basivertebral nerve. None of the studies provided a macroscopic description of the nerve or clearly defined origin. In all cases, analysis began at the basivertebral foramen, and nerve identification was based on immunohistochemical study and association with vascular structures. The included studies related to the basivertebral foramen and the sinuvertebral nerve allow only to characterize these structures without giving more details related to the basivertebral nerve. Vertebrogenic pain has recently been identified as one of the causes of low back pain. It is caused by degenerative and inflammatory changes of the vertebral end plates. The onset of pain is related to the innervation of the vertebral body from the basivertebral nerve. Although this innervation has been confirmed by histological studies with immunohistochemistry, the macroscopic path, including its origin, has been difficult to characterize due to the difficulties inherent in intraosseous anatomical dissection. More studies are needed to better describe the basivertebral nerve.