Observations on the Pathomorphology of the Thoracolumbar... : Spine (original) (raw)

Point of View: PDF Only

Observations on the Pathomorphology of the Thoracolumbar Fascia in Chronic Mechanical Back Pain

A Microscopic Study

Bednar, Drew A. MD, FRCS(C), FAAOS*; Orr, F. William MD†; Simon, G. T. MD‡

* Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

‡ Department of Pathology, McMaster University, Hamilton, Ontario, Canada.

† Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.

Abstract

Study Design

Human tissues specimens were examined for the presence of neural end-organs under light and electron microscopy.

Objectives

To define the innervation of the thoracolumbar fascia in problem back pain patients who have articular abnormality defined through pain-provocation discography or facet blocks.

Summary of Background Data

Previous investigators have defined the presence of innervation in control (no back pain) tissue specimens.

Methods

Tissue specimens were harvested during surgery from 24 back pain patients who had not undergone previous lumbar surgery. Specimens were fixed immediately in the operating room and later processed and studied under light and electron microscopy.

Results

Structural and ultrastructural studies failed to identify specific neural end-organs in any of the specimens. Serendipiously, microscopic changes suggestive of ischemia or inflammation in this tissue were found.

Conclusions

These findings suggest that the thoracolumbar fascia may be deficiently innervated in problem back pain patients.