Ultrasound-guided thoracolumbar fascia injections promising treatment option for patients with persistent low back pain following lumbar surgery: Study

In a recent prospective pilot study conducted between May 2021 and May 2023, the effectiveness and safety of ultrasound-guided bilateral L3-4 thoracolumbar fascia injections were evaluated in patients experiencing postoperative low back pain who had not responded to conservative treatments. A total of 26 participants were included, all of whom had undergone lumbar surgery at least six months prior and experienced isolated low back pain without lower limb radiation. Relevant exclusions included cases of lumbar disc herniation and spinal canal stenosis indicated by MRI.

Injection Procedure

The injection procedure involved placing the patient in a prone position to facilitate the ultrasound-guided targeting of the thoracolumbar fascia. An experienced physician performed the injections using a high-frequency convex array ultrasound probe to confirm anatomical landmarks, ensuring accurate needle placement. A mixture of local anesthetic and corticosteroid was injected after confirming proper needle tip positioning through a contrast medium.

Outcome Measures

Key outcome measures included numerical rating scale (NRS) scores for pain assessment, range of motion (ROM), and the Oswestry Disability Index (ODI) to evaluate quality of life, collected pre- and post-treatment at designated intervals of one, two, and twelve weeks. Statistical analysis was conducted using generalized linear mixed models, assessing changes in pain scores and other metrics over the follow-up period. Results indicated significant improvements in both pain and functionality. NRS scores demonstrated a marked decrease from baseline throughout the follow-up, while ODI revealed improved quality of life at 12 weeks post-injection. Notably, ROM also improved significantly during the evaluation period, with baseline measurements of 20.92° increasing substantially after treatment. The imaging confirmed successful dispersion of the injected contrast medium across the targeted lumbar segments, indicating effective delivery of the therapeutic agents.

Adverse Effects

Adverse effects were minimal, with no serious complications such as inadvertent vascular injection or neurological injuries reported. Temporary complications associated with the procedure were not observed.

Conclusions and Limitations

The findings suggest that ultrasound-guided thoracolumbar fascia injections may provide a promising treatment option for patients with persistent low back pain following lumbar surgery, highlighting the anatomical and functional significance of the thoracolumbar fascia in pain management. Limitations of the study included the absence of a control group and a small sample size, underscoring the need for larger, randomized controlled trials to confirm these findings and assess long-term effects.

Key Points

- A prospective pilot study was conducted over a two-year period to evaluate the effectiveness and safety of ultrasound-guided bilateral L3-4 thoracolumbar fascia injections in patients with postoperative low back pain unresponsive to conservative treatment, involving 26 participants who had experienced lumbar surgery at least six months prior and presented with isolated low back pain.

- The injection procedure was executed while patients were in a prone position, utilizing a high-frequency convex array ultrasound probe by an experienced physician to ensure accurate needle placement targeting the thoracolumbar fascia and confirming anatomical landmarks. A mixture of local anesthetic and corticosteroid was administered post confirmation of needle tip positioning via a contrast medium.

- Outcome measures included numerical rating scale (NRS) scores, range of motion (ROM), and the Oswestry Disability Index (ODI), assessed pre- and post-treatment at one, two, and twelve-week intervals. Analysis using generalized linear mixed models indicated significant improvements in pain scores and functional metrics throughout the follow-up period.

- Results showed a substantial decrease in NRS scores from baseline, with ODI scores reflecting improved quality of life at 12 weeks post-injection. ROM also demonstrated significant improvement with baseline measurements of 20.92° showing a marked increase post-treatment, supported by imaging that confirmed effective dispersion of the injected contrast medium.

- Adverse effects were notably minimal, with no serious complications such as vascular injuries or neurological damage reported, and no temporary complications observed during the procedure, indicating a favorable safety profile for the intervention.

- Findings suggest that ultrasound-guided thoracolumbar fascia injections may be an effective treatment for chronic low back pain following lumbar surgery. However, limitations such as the lack of a control group and the small sample size highlight the necessity for larger randomized controlled trials to validate the efficacy and long-term effects of the treatment approach.

Reference –

Yingying Lv et al. (2025). A Novel Approach To Ultrasound-Guided L3-4 Thoracolumbar Fascia Injection For Chronic Pain After Spine Surgery: A Prospective Pilot Study. *BMC Anesthesiology*, 25. https://doi.org/10.1186/s12871-025-03046-6.