The Sinuvertebral Nerve and Basivertebral Nerve: Analyzing the Central Role of the Vertebral-Disc Unit in Chronic Low Back Pain

Low back pain (LBP) is a leading cause of disability worldwide, and its chronic forms—discogenic low back pain (DLBP) and vertebrogenic low back pain (VLBP)—remain difficult to diagnose and treat precisely. This review aims to clarify the anatomical and neurophysiological roles of the sinuvertebral nerve (SVN) and basivertebral nerve (BVN) in chronic LBP and to examine their implications for targeted diagnosis and treatment. Recent advances in neuroanatomy and imaging have shown that the SVN primarily mediates pain from intervertebral disc pathology, whereas the BVN is closely associated with vertebral endplate and marrow changes, particularly Modic changes. These two nerves are anatomically and functionally linked and together form a “vertebral-disc sensory unit.” Emerging evidence supports nerve-targeted interventions, including sinuvertebral and basivertebral nerve radiofrequency ablation, which can improve pain relief and functional outcomes in carefully selected patients. Functional and molecular imaging techniques are also expanding the ability to identify pain-generating structures more precisely. The SVN and BVN are key neural pathways in the pathogenesis of chronic LBP and represent important targets for precision diagnosis and treatment. Recognizing the vertebral-disc sensory unit provides a more integrated understanding of DLBP and VLBP. A better anatomical, functional, and imaging-based characterization of these nerves may improve patient selection and clinical outcomes for nerve-targeted therapies.