The thoracolumbar fascia: anatomy, function and clinical considerations

Willard, Frank H.; Vleeming, Andry; Schuenke, Mark D.; Danneels, Lieven; Schleip, Robert

doi:10.1111/j.1469-7580.2012.01511.x

Cited by 444 publications

(422 citation statements)

References 113 publications

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“…The idea of fascial nociception is old and has led the way to a number of different treatments for neck pain. 1,7,10,11 This idea needs to be transferred to postoperative care. Anatomically, during a posterior cervical spine exposure, the surgeon must pass 2 different fascia layers while dissecting through the posterior cervical space: the trapezius muscle and the deep cervical fasciae, which lie over the deeper cervical muscles.…”

Section: Discussionmentioning

confidence: 99%

Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery

Duetzmann

Cole

Senft

et al. 2015

SPI

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OBJECT Incisional pain after posterior cervical spine surgery can be severe and very unpleasant to the patient. Ongoing incisional pain is one of the key disadvantages of posterior over anterior surgical approaches to the cervical spine. It prolongs hospital stays and delays return to work. In this study, the hypothesized that incisional pain in the immediate postoperative period is caused partially by tension on the skin as well as on the deep cervical fascia and the fascia overlying the trapezius, which are usually sewn together during closure. Reduction of this tension through retraction of the shoulders should therefore reduce pain as well as the amount of pain medication used in the early postoperative period. METHODS In this prospective randomized controlled study, 30 patients who had undergone posterior cervical spine surgery were randomized into 2 groups who either wore or did not wear a clavicle brace to retract the shoulders. Patients in the brace group began wearing the brace on postoperative day (POD) 4 and wore it continuously throughout the 30-day study period. Outcome was assessed by two measures: 1) the daily level of self reported pain according to the visual analog scale (VAS) and 2) the number of pain pills taken during the 30-day postoperative period. RESULTS Wearing a clavicle brace in the immediate postoperative period significantly reduced incisional pain and the amount of pain medication that patients took. Beginning on POD 4 and continuing until day POD 13, the mean daily VAS score for pain was significantly lower in the brace group than in the control group. Furthermore, patients who wore the clavicle brace took less pain medication from POD 4 to POD 12. At this point the difference lost significance until the end of the study period. Four patients were randomized but did not tolerate wearing the brace. CONCLUSIONS Patients who tolerated wearing the clavicle brace after posterior cervical spine surgery had reduced pain and used less pain medication.

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Section: Discussionmentioning

confidence: 99%

Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery

Duetzmann

Cole

Senft

et al. 2015

SPI

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“…W do stęp nym pi śmien nic twie pod kre śla ne są ta kże lep ko sprę ży ste wła ści wo ści głę bo kich mię śni grzbie tu, któ re dzia ła jąc sy ner gi stycz nie z po wię ziami, zmie nia ją ci śnie nie w kost no -włók ni stym komplek sie, w któ re go skład wcho dzą łu ki krę gów, wyrost ki że bro we, wy rost ki kol czy ste i po więź pier siowo -lę dźwio wa, za pew nia jąc w ten spo sób sta bil ność krę go słu pa [34]. Po więź pier sio wo -lę dźwio wa, ota czając głę bo kie i po wierz chow ne mię śnie grzbie tu i jedno cześnie po sia da jąc po łącze nie z mięśnia mi two rzą -cy mi ścia nę brzu cha, two rzy zwar tą struk tu rę w dolnej części tu ło wia, co ma istot ny wpływ na sta bi li zację lędźwio wo -krzyzȯwe go od cin ka kręgo słu pa [35].…”

Section: Functional Importance Of Posterior Branches Of the Lumbar Neunclassified

“…The available literature also emphasises the viscoelastic properties of deep muscles of the back, which act in synergy with fasciae and change the pressure in the osseofibrous complex consisting of vertebral arches, transverse processes, spinous processes and thoracolumbar fascia, thus ensuring spinal stability [34]. The thoracolumbar fascia, which surrounds deep and superficial muscles of the back and is also connected to the muscles forming the abdominal wall, forms a compact structure in the lower trunk, which significantly contributes to lumbosacral spinal stability [35].…”

Section: Functional Importance Of Posterior Branches Of the Lumbar Nementioning

confidence: 99%

Posterior Branches of Lumbar Spinal Nerves - Part I: Anatomy and Functional Importance

Kozera

Ciszek

2016

Ortop Traumatol Rehabil

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STRESZCZENIECe lem pra cy by ło po rów na nia opi sów ana to micz nych ga łę zi tyl nych ner wów lę dźwio wych i na ich pod sta wie przedsta wie nie prze bie gu tych struk tur. W więk szo ści pod ręcz ni ków ana to mii ner wy te nie są do kład nie opi sa ne. Sy tu ację tę mo żna tłu ma czyć fak tem, że przez wie le lat uwa ża no je za struk tu ry bez więk sze go zna cze nia kli nicz ne go. Stan wiedzy na te mat tych ner wów przez ostat nie 30 lat ule gły zmia nie. Zwró co no uwa gę na ich funk cję i zna cze nie za rów -no w dia gno sty ce, jak i le cze niu do le gli wo ści bó lo wych dol ne go od cin ka krę go słu pa.Pod su mo wu jąc do stęp ne do nie sie nia mo że my stwier dzić, że ga łąź przy środ ko wa i bocz na dzie lą się w miej scu skrzy żo wa nia sta wu mię dzy krę go we go i dal szej czę ści gór ne go brze gu wy rost ka że bro we go, wiel kość, prze bieg i zaopa try wa ny ob szar jest ró żny dla ga łę zi bocz nej i przy środ ko wej oraz, że sta wy mię dzy krę go we są uner wio ne wielo seg men to wo. Udo wod nio no, że ga łę zie przy środ ko we są mniej sze od od po wia da ją cych im ga łę zi bocz nych oraz mają bar dziej sta ły prze bieg. Ga łę zie przy środ ko we za opa tru ją oko li cę od li nii po środ ko wej cia ła do li nii sta wu mię dzykrę go we go, na to miast ga łę zie bocz ne struk tu ry znaj du ją ce się bocz nie od li nii sta wu mię dzy krę go we go.Prze gląd pi śmien nic twa zwra ca uwa gę na trud ność okre śle nia spe cy ficz nych punk tów ana to micz nych, wzglę dem któ rych mo żna by ło by do kład nie zlo ka li zo wać ga łąź bocz ną i dal szą część ga łę zi przy środ ko wej.Dra żnie nie włó kien czu cio wych w ob rę bie ga łę zi tyl nych ner wów lę dźwio wych mo że być spo wo do wa ne pa to logią sta wów mię dzy krę go wych, de for ma cją krę go słu pa, zmia na mi prze cią że nio wy mi i po ura zo wy mi. Zna jąc ana tomicz ny prze bieg ga łę zi tyl nych ner wów rdze nio wych, na le ży pa mię tać o mo żli wo ści ich uszko dze nia pod czas mało in wa zyj nych za bie gów prze ciw bó lo wych.Słowa kluczowe: anatomia układu nerwowego, nerwy rdzeniowe, gałęzie tylne nerwów rdzeniowych, ból dolnego odcinka kręgosłupa SUMMARYThe aim of this paper is to compare anatomic descriptions of posterior branches of the lumbar spinal nerves and, on this basis, present the location of these structures. The majority of anatomy textbooks do not describe these nerves in detail, which may be attributable to the fact that for many years they were regarded as structures of minor clinical importance. The state of knowledge on these nerves has changed within the last 30 years. Attention has been turned to their function and importance for both diagnostic practice and therapy of lower back pain.Summarising the available literature, we may conclude that the medial and lateral branches separate at the junction of the facet joint and the distal upper edge of the transverse process; that the size, course and area supplied differ between the lateral and the medial branch; and that facet joints receive multisegmental in...

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“…The anterior layer covers the anterior surface of the quadratus lumborum and is attached medially to the transverse processes of the lumbar vertebrae behind psoas major. Superiorly, it is attached to the inferior border of the twelfth rib and extends to the transverse process of the first lumbar vertebra, forming the lateral arcuate ligament of the diaphragm 109) . These three layers merge into one as they travel laterally.…”

Section: Thoracolumbar Fascia (Tlf)mentioning

confidence: 99%

“…Definitions of fascia vary between texts and between countries 109) . The retroperitoneal fascial planes are multilaminated rather than composed of single membranes.…”

Section: Membrane and Fasciaementioning

confidence: 99%

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

Kanemura

Satake

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Lateral approach spine surgery provides effective interbody stabilization, and correction and indirect neural decompression with minimal-incision and less invasive surgery compared with conventional open anterior lumbar fusion. It may also avoid the trauma to paraspinal muscles or facet joints found with transforaminal lumbar interbody fusion and posterior lumbar interbody fusion. However, because lateral approach surgery is fundamentally retroperitoneal approach surgery, it carries potential risk to intra-and retroperitoneal structures, as seen in a conventional open anterior approach. There is an innovative lateral approach technique that reveals different anatomical views; however, it requires reconsideration of the traditional surgical anatomy in more detail than a traditional open anterior approach. The retroperitoneum is the compartmentalized space bounded anteriorly by the posterior parietal peritoneum and posteriorly by the transversalis fascia. The retroperitoneum is divided into three compartments by fascial planes: anterior and posterior pararenal spaces and the perirenal space. Lateral approach surgery requires mobilization of the peritoneum and its content and accurate exposure to the posterior pararenal space. The posterior pararenal space is confined anteriorly by the posterior renal fascia, anteromedially by the lateroconal fascia, and posteriorly by the transversalis fascia. The posterior renal fascia, the lateroconal fascia or the peritoneum should be detached from the transversalis fascia and the psoas fascia to allow exposure to the posterior pararenal space. The posterior pararenal space, however, does not allow a clear view and identification of these fasciae as this relationship is variable and the medial extent of the posterior pararenal space varies among patients. Correct anatomical recognition of the retroperitoneum is essential to success in lateral approach surgery. Spine surgeons must be aware that the retroperitoneal membrane and fascia is multilayered and more complex than is commonly understood. Preoperative abdominal images would facilitate more efficient surgical considerations of retroperitoneal membrane and fascia in lateral approach surgery.

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The thoracolumbar fascia: anatomy, function and clinical considerations

Cited by 444 publications

References 113 publications

Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery

Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery

Posterior Branches of Lumbar Spinal Nerves - Part I: Anatomy and Functional Importance

Understanding Retroperitoneal Anatomy for Lateral Approach Spine Surgery

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