Sagging Posterior Layer Thoracolumbar Fascia

Can it be the Cause or Result of Adjacent Segment Diseases?

Abstract

Study Design: 

A retrospective study.

Objective: 

Thoracolumbar fascia (TLF) is an important anatomic structure that plays a role in integrating back muscles and maintaining the stability of lower back. Functional failure of TLF can be one of the factors in the vicious cycle of progressive spinal instability. The purpose of this study is to assess the TLF and correlate it with spinal stability in the instrumented lumbar surgery patients.

Materials and Methods: 

From January 2008 to March 2009, 68 consecutive postoperative lumbar or thoracolumbar spine magnetic resonance images were retrospectively reviewed to evaluate the morphologic changes of TLF. It was considered as “sagging posterior layer TLF” when it showed abrupt bulging appearance on parasagittal planes. To determine the spinal stability, flexion and extension lumbar lateral films were also reviewed. The correlation between sagging TLF and adjacent segment disease (ASD) were analyzed.

Result: 

Fifty patients (19 males and 31 females, mean age 52.4 y) showed sagging posterior layer TLF, and 32 of them developed ≥1 junctional problems, such as retrolistheses (n=25), compression fractures (n=5), spondylolistheses (n=4), progressive scoliosis (n=4), and segmental instability with bone marrow change (n=2). There was statistically significant correlation between the instrumented surgery and sagging TLF (P-value <0.001). And there was also significant correlation between the sagging TLF and ASD (P-value <0.001).

Conclusions: 

Morphologic changes of the TLF in postoperative magnetic resonance imaging can be the earliest and predictable findings in the progressive development of the ASD.