Pain After Back Surgery? Did the Surgeon Leave a Big Hole in Your Fascia?

by Chris Centeno, MD /

In the world of human anatomy, there is a part of the body that doesn’t get a whole lot of attention despite the fact it has a huge job. This structure is the thoracodorsal fascia. If you’ve had low-back surgery, your surgeon cut through your thoracodorsal fascia to access your spine, but is it possible he or she left a big hole in your fascia? Are you experiencing pain after back surgery? If so, a big hole in the fascia could be the culprit.

The Thoracodorsal Fascia and Its Function

The thoracodorsal fascia is a semi-rigid, tight, wrap-like covering of the muscles and ligaments in the lower back. It lives behind the spine, and it hooks into structures all the way down into the spinal canal. It is a connective structure that holds the lower spine in place and is the cohesive core support between your arms and lower body. This strong covering also helps the back muscles it supports achieve maximum power.

In the short video above, I have provided images showing how the thoracodorsal fascia covers the multifidus muscles and connects into important ligaments (e.g., supraspinous, interspinous, ligamentum flavum). If you want to dig deeper into the details of function, this link will explain some of more of the structures the thoracodorsal fascia impacts and how they all work in precise harmony.

How Could There be a Hole in My Fascia?

We don’t hear a lot about the thoracodorsal fascia. Spine surgeons typically give it no more thought beyond cutting through it, just like they cut through the skin or subcutaneous tissues, to get to something else. Proper functioning of the thoracodorsal fascia isn’t their concern or focus if they are even aware the thoracodorsal fascia has a function (the truth is, many don’t really know what it is or what it does). And while pain after back surgery might be addressed with a brace or pain meds, checking to see if the thoracodorsal fascia is intact—making sure the hole that was created through the fascia to access the spine properly closed— after surgery is unlikely to hit their radar.

Also making it difficult to discover a hole in the thoracodorsal fascia after surgery is the fact that the finding is almost never read out on MRI reports. Also, without active ultrasound imaging of the surgical site (watch the video to see what these moving images look like), there’s no way to tell if this critical structure is performing correctly under load.

This is all unfortunate because if you are left with a hole in your fascia, it could be the cause of your pain after back surgery.

A Patient With a Hole in His Thoracodorsal Fascia

One of my patients had previously had LASER spine surgeries. These were not only unsuccessful, but he then had pain after back surgery right under the small surgical scar. On his MRI images, I discovered something strange in the way his thoracodorsal fascia looked. While this wasn’t read by the radiologist, an ultrasound exam where I had him stress his back muscles demonstrated a blow out of the fascia.

In the video above, I have a good side/bad side comparison of the patient’s MRI images that clearly shows a bump-out on one side of his thoracodorsal fascia. That bump-out is not normal but represents a blowout of the fascia, so I followed this up with active, moving ultrasound images of both sides, confirming the hole in the fascia when the patient contracted his muscle on the bad side.

Before and After High-Dose PRP Injection into the Fascial Damage

We treated the thoracodorsal hole with precise ultrasound-guided, high-dose platelet rich plasma (HD-PRP), and you can see his before and after images on the video. He still has a very slight pooch there on active ultrasound imaging, but it’s much improved, and he’s doing quite well.

The upshot? Without the thoracodorsal fascia, your lower back would lack support, and you would lack a major connection that allows you to transfer energy between your arms and legs. The fascia also connects to ligaments all the way down and deep into the spine, and this provides stability to the vertebrae. If the surgeon leaves a hole in your thoracodorsal fascia, this can lead to pain after back surgery, decreased muscle function, and other problems. However, as I’ve shown, you can’t rely on the radiologist’s report to find that hole, someone who knows what to look for needs to look.

Category: Back/lumbar, Videos

Leave a Reply

Your email address will not be published. Required fields are marked *

1 thought on “Pain After Back Surgery? Did the Surgeon Leave a Big Hole in Your Fascia?

  1. Brenda Bryson, PT

    I love to hear people talking about fascia!! Thanks for posting this. I think Myofascial release and stem cells do amazing things.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
View Profile

Get Blog Updates by Email

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Regenerative procedures are commonly used to treat musculoskelatal trauma, overuse injuries, and degenerative issues, including failed surgeries.
Select Your Problem Area
Shoulder

Shoulder

Many Shoulder and Rotator Cuff injuries are good candidates for regenerative treatments. Before considering shoulder arthroscopy or shoulder replacement, consider an evaluation of your condition with a regenerative treatment specialist.

  • Rotator Cuff Tears and Tendinitis
  • Shoulder Instability
  • SLAP Tear / Labral Tears
  • Shoulder Arthritis
  • Other Degenerative Conditions & Overuse Injuries
Learn More
Cervical Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Knee

Knees

Knees are the target of many common sports injuries. Sadly, they are also the target of a number of surgeries that research has frequently shown to be ineffective or minimally effective. Knee arthritis can also be a common cause for aging athletes to abandon the sports and activities they love. Regenerative procedures can be used to treat a wide range of knee injuries and conditions. They can even be used to reduce pain and delay knee replacement for more severe arthritis.

  • Knee Meniscus Tears
  • Knee ACL Tears
  • Knee Instability
  • Knee Osteoarthritis
  • Other Knee Ligaments / Tendons & Overuse Injuries
  • And more
Learn More
Lower Spine

Spine

Many spine injuries and degenerative conditions are good candidates for regenerative treatments and there are a number of studies showing promising results in treating a wide range of spine problems. Spine surgery should be a last resort for anyone, due to the cascade of negative effects it can have on the areas surrounding the surgery. And epidural steroid injections are problematic due to their long-term negative impact on bone density.

  • Herniated, Bulging, Protruding Discs
  • Degenerative Disc Disease
  • SI Joint Syndrome
  • Sciatica
  • Pinched Nerves and General Back Pain
  • And more
Learn More
Hand & Wrist

Hand & Wrist

Hand and wrist injuries and arthritis, carpal tunnel syndrome, and conditions relating to overuse of the thumb, are good candidates for regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Hand and Wrist Arthritis
  • Carpal Tunnel Syndrome
  • Trigger Finger
  • Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb)
  • Other conditions that cause pain
Learn More
Elbow

Elbow

Most injuries of the elbow’s tendons and ligaments, as well as arthritis, can be treated non-surgically with regenerative procedures.

  • Golfer’s elbow & Tennis elbow
  • Arthritis
  • Ulnar collateral ligament wear (common in baseball pitchers)
  • And more
Learn More
Hip

Hip

Hip injuries and degenerative conditions become more common with age. Do to the nature of the joint, it’s not quite as easy to injure as a knee, but it can take a beating and pain often develops over time. Whether a hip condition is acute or degenerative, regenerative procedures can help reduce pain and may help heal injured tissue, without the complications of invasive surgical hip procedures.

  • Labral Tear
  • Hip Arthritis
  • Hip Bursitis
  • Hip Sprain, Tendonitis or Inflammation
  • Hip Instability
Learn More
Foot & Ankle

Foot & Ankle

Foot and ankle injuries are common in athletes. These injuries can often benefit from non-surgical regenerative treatments. Before considering surgery, consider an evaluation of your condition with a regenerative treatment specialist.
  • Ankle Arthritis
  • Plantar fasciitis
  • Ligament sprains or tears
  • Other conditions that cause pain
Learn More

Is Regenexx Right For You?

Request a free Regenexx Info Packet

REGENEXX WEBINARS

Learn about the #1 Stem Cell & Platelet Procedures for treating arthritis, common joint injuries & spine pain.

Join a Webinar

RECEIVE BLOG ARTICLES BY EMAIL

Get fresh updates and insights from Regenexx delivered straight to your inbox.

Subscribe to the Blog

FOLLOW US

Copyright © Regenexx 2019. All rights reserved. | Privacy Policy

*DISCLAIMER: Like all medical procedures, Regenexx® Procedures have a success and failure rate. Patient reviews and testimonials on this site should not be interpreted as a statement on the effectiveness of our treatments for anyone else.

Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive.