Pain After Back Surgery? Did the Surgeon Leave a Big Hole in Your Fascia?
POSTED ON 2/11/2017 IN Research BY Christopher Centeno
In the world of human anatomy, there is a part of the body that doesn't get a whole lot of attention despite the fact it has a huge job. This structure is the thoracodorsal fascia. If you've had low-back surgery, your surgeon cut through your thoracodorsal fascia to access your spine, but is it possible he or she left a big hole in your fascia? Are you experiencing pain after back surgery? If so, a big hole in the fascia could be the culprit.
The Thoracodorsal Fascia and Its Function
The thoracodorsal fascia is a semi-rigid, tight, wrap-like covering of the muscles and ligaments in the lower back. It lives behind the spine, and it hooks into structures all the way down into the spinal canal. It is a connective structure that holds the lower spine in place and is the cohesive core support between your arms and lower body. This strong covering also helps the back muscles it supports achieve maximum power.
In the short video above, I have provided images showing how the thoracodorsal fascia covers the multifidus muscles and connects into important ligaments (e.g., supraspinous, interspinous, ligamentum flavum). If you want to dig deeper into the details of function, this link will explain some of more of the structures the thoracodorsal fascia impacts and how they all work in precise harmony.
How Could There be a Hole in My Fascia?
We don't hear a lot about the thoracodorsal fascia. Spine surgeons typically give it no more thought beyond cutting through it, just like they cut through the skin or subcutaneous tissues, to get to something else. Proper functioning of the thoracodorsal fascia isn't their concern or focus if they are even aware the thoracodorsal fascia has a function (the truth is, many don't really know what it is or what it does). And while pain after back surgery might be addressed with a brace or pain meds, checking to see if the thoracodorsal fascia is intact—making sure the hole that was created through the fascia to access the spine properly closed— after surgery is unlikely to hit their radar.
Also making it difficult to discover a hole in the thoracodorsal fascia after surgery is the fact that the finding is almost never read out on MRI reports. Also, without active ultrasound imaging of the surgical site (watch the video to see what these moving images look like), there's no way to tell if this critical structure is performing correctly under load.
This is all unfortunate because if you are left with a hole in your fascia, it could be the cause of your pain after back surgery.
A Patient With a Hole in His Thoracodorsal Fascia
One of my patients had previously had LASER spine surgeries. These were not only unsuccessful, but he then had pain after back surgery right under the small surgical scar. On his MRI images, I discovered something strange in the way his thoracodorsal fascia looked. While this wasn't read by the radiologist, an ultrasound exam where I had him stress his back muscles demonstrated a blow out of the fascia.
In the video above, I have a good side/bad side comparison of the patient's MRI images that clearly shows a bump-out on one side of his thoracodorsal fascia. That bump-out is not normal but represents a blowout of the fascia, so I followed this up with active, moving ultrasound images of both sides, confirming the hole in the fascia when the patient contracted his muscle on the bad side.
Before and After High-Dose PRP Injection into the Fascial Damage
We treated the thoracodorsal hole with precise ultrasound-guided, high-dose platelet rich plasma (HD-PRP), and you can see his before and after images on the video. He still has a very slight pooch there on active ultrasound imaging, but it's much improved, and he's doing quite well.
The upshot? Without the thoracodorsal fascia, your lower back would lack support, and you would lack a major connection that allows you to transfer energy between your arms and legs. The fascia also connects to ligaments all the way down and deep into the spine, and this provides stability to the vertebrae. If the surgeon leaves a hole in your thoracodorsal fascia, this can lead to pain after back surgery, decreased muscle function, and other problems. However, as I've shown, you can't rely on the radiologist's report to find that hole, someone who knows what to look for needs to look.
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