Lv Yingying, Wu Junzhen, Xu Yongming, Pu Shaofeng, Li Chen, Du Dongping
Pain Management Center, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 600, Yishan Road, Shanghai, China.
BMC Anesthesiol. 2025 May 15;25(1):243. doi: 10.1186/s12871-025-03046-6.
Fascial tissues have been overlooked in the past, and there are only few studies on the thoracolumbar fascia and its treatment methods. The present study aimed to investigate the effectiveness and safety of ultrasound-guided bilateral L3-4 thoracolumbar fascia injection in treating postoperative low back pain.
A prospective pilot study was conducted at a university hospital. Twenty-six patients with postoperative low back pain resistant to conservative therapies and US-guided bilateral L3-4 medial branch block (MBB) were included as participants. They were treated with US-guided L3-4 mid-thoracolumbar fascia injection. Using real-time fluoroscopy, we monitored the contrast medium's diffusion range and double-checked the needle tips' positions throughout the procedures. The pain numeric rating scales (NRS), lumbar anteflexion range of motion (ROM), and Oswestry disability index (ODI) were assessed through telephone interviews one, four, and twelve weeks after the procedures. All data were processed by SPSS software version 23.0 (IBM Corp., New York).
Compared with NRS at baseline, pain scores decreased throughout the observation period. Lumbar anteflexion range of motion of US-guided bilateral L3-4 mid-thoracolumbar fascia injection continuously improved during the first, fourth, and twelfth week. No intravascular injections or neurologic injuries were observed.
The US-guided bilateral L3-4 mid-thoracolumbar fascia injection facilitated a uniform dispersion of the medication, akin to the gentle spread of a goose feather, between the erector spinalis and quadratus lumborum muscles across the affected lumbar vertebrae. This technique demonstrated substantial clinical effectiveness in patients who were unresponsive to standard US-guided MBB.
筋膜组织在过去一直被忽视，关于胸腰筋膜及其治疗方法的研究很少。本研究旨在探讨超声引导下双侧L3 - 4胸腰筋膜注射治疗术后腰痛的有效性和安全性。
在一所大学医院进行了一项前瞻性试点研究。纳入26例术后腰痛且对保守治疗和超声引导下双侧L3 - 4内侧支阻滞（MBB）无效的患者作为参与者。他们接受了超声引导下L3 - 4胸腰段中部筋膜注射。在整个操作过程中，使用实时荧光透视法监测造影剂的扩散范围，并再次检查针尖位置。在操作后1周、4周和12周通过电话访谈评估疼痛数字评分量表（NRS）、腰椎前屈活动范围（ROM）和Oswestry功能障碍指数（ODI）。所有数据均使用SPSS 23.0软件（IBM公司，纽约）进行处理。
与基线时的NRS相比，在整个观察期内疼痛评分均下降。超声引导下双侧L3 - 4胸腰段中部筋膜注射后的腰椎前屈活动范围在第1周、第4周和第12周持续改善。未观察到血管内注射或神经损伤。
超声引导下双侧L3 - 4胸腰段中部筋膜注射使药物在竖脊肌和腰方肌之间沿着受影响的腰椎均匀扩散，宛如鹅毛轻柔铺展。该技术在对标准超声引导下MBB无反应的患者中显示出显著的临床疗效。
