Have you seen those new compression garments athletes wear to try to improve performance? The idea is that by adding compression to the muscles, the ultratight shirts and pants will make the muscles contract better. This concept has been around for a while; it’s called fascia. Every muscle in your body is already surrounded by fascia that acts like these garments. One bit of “compression garment” that’s critical to the health of your low back is called the thoracodorsal fascia. Without this, you wouldn’t be able to transfer energy between your arms and legs. So let’s look, this morning, at what happens when this fascia gets injured by a LASER spine surgery procedure.
The Thoracodorsal Fascia
How are your legs and arms connected? One way is obvious—the spine connects the two. However, unlike the legs, for the arms, there is a limited connection through the bones (the shoulder blades float on the back of the rib cage and only connect to the sternum through the collarbone up front), so most of the connection is muscular and fascial. What does that mean?
We all know that we have muscles, but these muscles are surrounded by and often connected to one another through fascia. This tough covering is necessary for the muscles to work. However, in medicine, very little attention is paid to this important structure. The picture to the left shows how this covering not only surrounds the muscle as a whole but also the individual muscle-fiber bundles.
If there was one piece of fascia in your body that was critical for the normal function of your arms, legs, and spine, it would be the thoracodorsal fascia (TDF). This tough muscle covering surrounds your low-back muscles as well as connects your hamstring and butt muscles to the lat muscles. The image to the right shows how these connections happen.
The TDF also connects to important ligaments in the spine that are critical for providing stability to the individual vertebrae. The image to the left shows how tension through the TDF actually pulls and tightens stabilizing ligaments all the way down to the back of the spinal canal! So suffice it to say that the TDF is critical to normal low-back and arm/leg coordinated function.
There is, of course, no scientific reason why physicians treating low-back pain wouldn’t be very interested in knowing what’s going on with the TDF. However, most back-pain patients reading this blog (and many doctors) have never heard of this structure. Why? Up until now, fascia has been the redheaded stepchild of musculoskeletal medicine. However, I’d like to share a case with you, this morning, that hopefully will increase awareness of how the TDF can be injured by surgery.
A Thoracodorsal Fascia Injury Caused by Surgery?
I love to share interesting things that I find during my clinic day. A case in point is the patient I evaluated yesterday with one our fellows. This middle-aged guy had undergone two right-sided LASER spine surgeries to open the right L4–L5 foramen (the hole where the nerve comes out). The surgeries were ineffective and left him with a new pain right under the small surgical scar. As I examined him, he was very clear that most of his back pain lived at that spot. So is this new pain a result of LASER spine surgery side effects?
When I reviewed his MRI, something looked strange at the location of the surgical scar. In the MRI to the right, the course of the thoracodorsal fascia is outlined in red triangles. It’s normally a smooth black line at the back part of the muscles. However, this one has a “pooch,” or area where it’s bulging out, right at the location of the surgical site. On the sagittal and axial images to the right, I’ve noted this area with a yellow-dashed circle. However, this MRI is static without motion. If this patient really had a TDF injury as a result of LASER spine surgery side effects, it would show up on ultrasound imaging as well, as the fascia would fail to contain the muscle at that site.
The video above shows how the normal left and abnormal right TDF functioned as the patient contracted the low-back muscles by lifting one leg. Note that on the left, the muscle is contained by the TDF. However, on the right, the muscle easily bulges out past a portion of the TDF (inside the yellow-dashed circle). That bulge corresponds to the one seen on the MRI, and that was likely caused by the surgery.
The upshot? I hope you’ve been properly introduced to this critical piece of fascia that helps your back muscles function normally and allows the energy generated by your legs to be connected with the arms through the spine. In this case, it looks like the TDF injury was a result of LASER spine surgery side effects. For for this gentleman’s injury, we will use our advanced platelet rich plasma injected under precise ultrasound guidance into the damaged area. If that doesn’t work to heal this spot, we’ll use a precise stem cell injection procedure. The whole story in video format is at the top of the page.