Abstract
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.
Highlights
Low back pain (LBP) is a common cause of medical visits, with up to 84% of adults experiencing low back pain (LBP) at some time in their lives.[1]
Our findings suggest that Thoracolumbar Fascia (TLF) enthesopathy is a potential cause of nonspecific LBP that can be diagnosed using US
Musculoskeletal problems are the most common cause of LBP, with anatomic abnormalities identified on imaging studies in about 10-20% of patients with acute LBP and 1045% of patients with chronic LBP.[6,7,8,9] Abnormalities of the vertebral discs, facet joints, and sacroiliac joints are commonly found in these patients.[3]. LBP that is not explained by a specific pathology is called nonspecific low back pain.[10]
Summary
Low back pain (LBP) is a common cause of medical visits, with up to 84% of adults experiencing LBP at some time in their lives.[1]. Iliac crest pain syndrome (ICPS)(11) is a clinical entity characterized by nonspecific LBP, localized tenderness on the medial aspect of the posterior iliac crest, and normal conventional radiographic[12] and MR imaging[13] studies. ICPS has been attributed to abnormalities of the structures attached to the iliac crest, including the iliolumbar ligament,(14– 16) lumbar muscles, and multifidus triangle syndrome.[17] About 53% of patients with nonspecific LBP in general practice and 58% in rheumatology clinics have been reported to have ICPS.[18] The role of thoracolumbar fascia (TLF) abnormalities in patients with LBP is not well described.[19]. We evaluated patients with LBP and ICPS in order to better characterize the US findings of TLF attachment on the iliac crest and other clinical findings in these patients. We treated patients with LBP due to TLF enthesopathy with conservative treatment and/or local injections of corticosteroids and lidocaine and reported their outcomes
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