Thoracolumbar Fascia Enthesopathy as a Cause of Low Back Pain: A Retrospective and Follow-up Study

Author(s): Ouidade A Tabesh, Roba Ghossan, Soha H Zebouni, Rafic Faddoul, Michel Revel, Fouad Fayad

Aim: To evaluate the ultrasonographic findings of Thoracolumbar Fascia (TLF) enthesis in patients with low back pain (LBP) due to iliac crest pain syndrome (ICPS).

Method: The ultrasonographic and clinical findings of 60 patients with LBP due to ICPS were compared to those of 30 healthy volunteers with no LBP. Thickness of the TLF was measured with ultrasound (US) at its insertion on the iliac crest.

Results: Forty-eight women and 12 men with a mean age of 42.1 ± 11.3 years were diagnosed with ICPS. In patients, the mean thickness of the TLF was 2.51 ± 0.70mm in affected sides compared to 1.81 ± 0.44mm in the contralateral unaffected sides. The mean thickness difference of 0.82mm between the affected and non-affected sides was statistically significant (95%CI, 0.64-0.99, P<0.0001). In volunteers, the mean thickness of the TLF was 1.6 ± 0.2mm. The mean thickness difference of 0.89mm between the affected sides of patients and volunteers was statistically significant (95%CI, 0.73-1.06, P<0.0001). Forty-two patients who didn’t improve with conservative therapy, received injections of methylprednisolone acetate and 1% lidocaine around the TLF enthesis. All patients reported complete relief of their LBP within 20 minutes of the injections thanks to the lidocaine anesthetic effect. Fifty-six (93.3%) patients were reached by phone for a long-term follow-up. Among them, 33 (58.9%) patients experienced a sustained complete pain relief after a mean follow-up of 45 ± 19.3 months (range, 3-74 months).

Conclusion: Our findings suggest that TLF enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US.

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