Ultrasound-Guided Injection of the Thoracolumbar Fascia in the Treatment of Low Back Pain: Methodological Approach and Anatomical Study

Acta Chir Orthop Traumatol Cech. 2026 Mar;93(1):15-21. doi: 10.55095/achot2025/036.

ABSTRACT

PURPOSE OF THE STUDY: To develop an anatomically verified protocol for ultrasound-guided analgesic interventions targeting the thoracolumbar fascia region for the treatment of both acute and chronic back pain.

MATERIAL AND METHODS: One cadaver was embalmed using the Fix-4-Life method, which preserves tissue properties suitable for subsequent ultrasound visualization. Under ultrasound guidance, a needle was inserted to the thoracolumbar fascia at the level of the transverse process of the fourth lumbar vertebra. Upon contact with the transverse process, 5 ml of diluted red latex dye was injected. The distribution of the injected fluid was then observed through anatomical dissection.

RESULTS: This cadaveric study confirmed that ultrasound-guided injection into the middle layer of the thoracolumbar fascia is both accurate and technically feasible. The dye demonstrated substantial potential to spread within the targeted area, distributing mediolaterally among the structures of the m. erector trunci and cranio-caudally over a range exceeding 10 cm, encompassing nearly four spinal segments.

DISCUSSION: Back pain of various etiologies remains a major interdisciplinary challenge. Refining therapeutic techniques may improve the outcomes. The thoracolumbar fascia represents a promising target for delivering local anesthetics, depot corticosteroids, and next-generation hyaluronic acid derivatives.

CONCLUSIONS: This study confirms the accuracy and feasibility of ultrasound-guided interventions targeting the thoracolumbar fascia.

PMID:41873870 | DOI:10.55095/achot2025/036