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Shane R Tubbs - One of the best experts on this subject based on the ideXlab platform.
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anatomic study of superior cluneal nerves revisiting the contribution of lumbar spinal nerves
World Neurosurgery, 2019Co-Authors: Joe Iwanaga, Maia Schumacher, Emily Simonds, Rod J. Oskouian, Shane R TubbsAbstract:Objective Superior cluneal nerve (SCN) entrapment neuropathy can result in low back pain and thus be confused with other pathologies (e.g., lumbar disk disease). Therefore we performed cadaveric dissection of the SCN to better understand its anatomy and segmental origin. Methods Twenty sides from 10 Caucasian fresh frozen cadavers (6 females and 4 males) were used in this study. The diameter of the SCN, distance between the exit point of the SCN from the Thoracolumbar Fascia and midline, and distance between the exit point of the SCN from the Thoracolumbar Fascia and the posterior superior iliac spine to the medial and lateral SCN were measured. The segmental origins of the SCNs were verified. Results Seventy-five percent of the dorsal rami of L1, 90% of L2, 95% of L3, 45% of L4, and 10% of L5 contributed to the SCN. The SCN was formed by 3 vertebral levels in 55% and by 4 vertebral levels in 30%. Three SCNs pierced the Thoracolumbar Fascia in 45%. Conclusions The origin of the SCN, which has been described in the textbook and literature for a long time, should be reconsidered on the basis of our study results.
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anatomic study of superior cluneal nerves application to low back pain and surgical approaches to lumbar vertebrae
World Neurosurgery, 2018Co-Authors: Emily Simonds, Mayank Patel, Rod J. Oskouian, Shane R TubbsAbstract:Objective The aim of this study was to investigate the anatomy of the superior cluneal nerves more proximal to the posterior layer of the Thoracolumbar Fascia. Methods Twelve sides of 6 fresh-frozen cadavers were used. The age at death ranged from 54 to 88 years. After a transverse skin incision 10 mm above the iliac crest, the superior cluneal nerves were detected by blunt dissection and traced back to the dorsal root ganglia. The diameter of the nerves from L1 to L3 was measured. Also, the relationship to the erector spinae muscle and dorsal ramus was recorded. Results The mean diameters of the origin of the L1, L2, and L3 were 1.71 ± 0.29 mm, 1.73 ± 0.40 mm, and 1.52 ± 0.55 mm, respectively. On 7 sides (58.3%) for L1, seven sides (58.3%) for L2, and 10 sides (83.3%) for L3, the nerves pierced the iliocostalis muscle. One side (8.3%) for L2 and one (8.3%) for L3 had no cutaneous branch. Conclusions The results of this study could help to elucidate the anatomy of the superior cluneal nerves and help avoid complications during surgical approaches to the lumbar spine.
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the decussating fibers of the lumbar Thoracolumbar Fascia a landmark for identifying the l5 spinous process
World Neurosurgery, 2017Co-Authors: Fernando Alonso, Brady Gardner, Doniel Drazin, Christian Fisahn, Tarush Rustagi, Joe Iwanaga, Jens R Chapman, Rod J. Oskouian, Shane R TubbsAbstract:Background The Thoracolumbar Fascia (TLF) has been well studied and is known to have crisscrossing fibers. Based on surgical experience, we hypothesized that the decussating fibers of the TLF may indicate a specific vertebral level and performed an anatomic study. Methods Twenty adult fresh frozen cadavers aged 72–84 years at death were placed in the prone position, and the skin of the lumbar and upper sacrum was removed. Careful attention was given to the TLF and any fibers of it that grossly crossed the midline to interdigitate with its contralateral counterpart. Once such decussations were identified, a metal wire was laid on them at their center, and fluoroscopy was performed to verify the vertebral level. Results Decussating fibers of the TLF were found on all but 1 specimen (95%). The central part of the decussation on the midline corresponded to the spinous process of L5 in 17/19 (89%) of specimens and the lower edge (L4-L5 interspace) of the spinous process of L4 in the remaining 2 specimens (11%). No specimens were found to have previous surgery in the area dissected or congenital anomalies of the spine. Conclusions In our cadaveric study, the decussating fibers of the TLF in the lumbar region helped predict the L5 spinous process in 89% of specimens and the L4 spinous process in 11% of specimens. This anatomic landmark might be used as an adjunct to palpation and intraoperative imaging during surgical exploration of the lower lumbar region.
Sharon M Henry - One of the best experts on this subject based on the ideXlab platform.
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Structural remodeling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A search for its potential determinants.
Journal of anatomy, 2020Co-Authors: Christian Larivière, Sharon M Henry, Richard PreussAbstract:Recently remodeling of lumbar soft tissues has received increased research attention. However, the major determinants that influence remodeling need to be elucidated in order to understand the impact of different rehabilitation modalities on tissue remodeling. The main aim of this study was to explore the between-subject variance of different measures of lumbar soft tissues quantified with rehabilitative ultrasound imaging (RUSI). RUSI measures (n = 8) were collected from 30 subjects without and 34 patients with LBP: (1) lumbar multifidus (LM) echogenicity (fatty infiltration/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1) (n = 3); (2) posterior layer thickness of the Thoracolumbar Fascia (n = 1); and (3) thickness of the Fasciae surrounding the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) (n = 4). Forward stepwise multivariate regression modeling was conducted with these RUSI measures as dependent variables, using the following independent variables as potential determinants: age, sex, the presence of LBP, body size/composition characteristics (height, weight, trunk length, subcutaneous tissue thickness over the abdominal, and LM muscles), trunk muscle function (or activation) as determined with the percent thickness change of LM, EO, IO, and TrA muscles during a standardized effort (RUSI measures), and physical activity level during sport and leisure activities as estimated with a self-report questionnaire. Two or three statistically significant predictors (or determinants) were selected in the regression model of each RUSI measure (n = 8 models), accounting for 26-64% of their total variance. The subcutaneous tissue thickness on the back accounted for 15-30% variance of LM echogenicity measures and Thoracolumbar Fascia thickness while the subcutaneous tissue thickness over the abdominals accounted for up to 42% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. The thickness of IO at rest accounted for 13-21% variance of all investigated abdominal Fasciae except the Fascia separating the subcutaneous adipose tissue and EO. Pain status accounted for 13-18% variance of the anterior and posterior Fasciae of the TrA. Age accounted for 11-14% variance of LM echogenicity at all investigated vertebral levels while sex accounted for 15-21% variance of LM echogenicity at L3/L4 and Fascia separating subcutaneous adipose tissue and EO muscle. The function (or activation) of EO and LM at L3/L4 accounted for 8-11% variance of the Thoracolumbar Fascia and Fascia separating TrA and intra-abdominal content (TrA posterior Fascia), respectively. Finally, the physical activity level during sport activities accounted for 7% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. These findings suggest that determinants other than body size characteristics may impact the remodeling of lumbar soft tissues, more importantly the subcutaneous adipose tissue deposits (thickness RUSI measures), which are associated with ectopic fat deposition in the LM and in the Fasciae that are more closely positioned to the surface. While age, sex, and pain status explain some variability, modifiable factors such as physical activity level as well as trunk muscle thickness and function were involved. Overall, these results suggest that rehabilitation can potentially impact tissue remodeling, particularly in terms of intramuscular and perimuscular adipose tissues.
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Structural remodelling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A cross-sectional and comparative ultrasound study
Journal of bodywork and movement therapies, 2020Co-Authors: Christian Larivière, Richard Preuss, Dany H. Gagnon, Hakim Mecheri, Sharon M HenryAbstract:Abstract Introduction With low back pain (LBP), remodelling of the lumbar soft tissues involves both trunk muscles and neighbouring passive connective tissues. The aim of the present study was to compare three quantitative measures of these tissues, using ultrasound imaging (USI), among healthy controls and individuals with LBP. Methods USI measures from 30 healthy subjects and 34 patients with non-acute LBP were compared between groups and sexes. The measures employed were (1) lumbar multifidus echogenicity (fatty/fibrosis infiltration) at three vertebral levels; (2) posterior layer thickness of the Thoracolumbar Fascia, and (3) thickness of the perimuscular tissues surrounding the external oblique, internal oblique and transversus abdominis (TrA). Results USI measures of (1) multifidus echogenicity showed statistically significant changes between vertebral levels and sexes (females > males; p = 0.02); (2) differences in Thoracolumbar Fascia thickness approached statistical significance between groups (LBP > controls; p = 0.09) and sexes (females Discussion The thinner perimuscular tissues surrounding the TrA in patients with LBP is a new finding, concurring with previous findings with regard to the lower activation of this deep muscle as well as more recent findings on other perimuscular tissue. Conclusion Overall, USI measures were sensitive to different potential changes (pain status, sex, vertebral level), and this is useful in studying the remodelling of various soft tissues of the trunk.
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Ultrasound Evaluation of the Combined Effects of Thoracolumbar Fascia Injury and Movement Restriction in a Porcine Model.
PloS one, 2016Co-Authors: James Bishop, Sharon M Henry, Gary J. Badger, James R. Fox, Rhonda L. Maple, Caitlin Loretan, Margaret A. Vizzard, Helene M. LangevinAbstract:The persistence of back pain following acute back "sprains" is a serious public health problem with poorly understood pathophysiology. The recent finding that human subjects with chronic low back pain (LBP) have increased thickness and decreased mobility of the Thoracolumbar Fascia measured with ultrasound suggest that the Fasciae of the back may be involved in LBP pathophysiology. This study used a porcine model to test the hypothesis that similar ultrasound findings can be produced experimentally in a porcine model by combining a local injury of Fascia with movement restriction using a "hobble" device linking one foot to a chest harness for 8 weeks. Ultrasound measurements of Thoracolumbar Fascia thickness and shear plane mobility (shear strain) during passive hip flexion were made at the 8 week time point on the non-intervention side (injury and/or hobble). Injury alone caused both an increase in Fascia thickness (p = .007) and a decrease in Fascia shear strain on the non-injured side (p = .027). Movement restriction alone did not change Fascia thickness but did decrease shear strain on the non-hobble side (p = .024). The combination of injury plus movement restriction had additive effects on reducing Fascia mobility with a 52% reduction in shear strain compared with controls and a 28% reduction compared to movement restriction alone. These results suggest that a back injury involving Fascia, even when healed, can affect the relative mobility of Fascia layers away from the injured area, especially when movement is also restricted.
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reduced Thoracolumbar Fascia shear strain in human chronic low back pain
BMC Musculoskeletal Disorders, 2011Co-Authors: Helene M. Langevin, Ann Greenan C Naumann, John J Triano, Elisa E. Konofagou, Cathryn Koptiuch, Gary J. Badger, Nicole A Bouffard, Sharon M HenryAbstract:The role played by the Thoracolumbar Fascia in chronic low back pain (LBP) is poorly understood. The Thoracolumbar Fascia is composed of dense connective tissue layers separated by layers of loose connective tissue that normally allow the dense layers to glide past one another during trunk motion. The goal of this study was to quantify shear plane motion within the Thoracolumbar Fascia using ultrasound elasticity imaging in human subjects with and without chronic low back pain (LBP). We tested 121 human subjects, 50 without LBP and 71 with LBP of greater than 12 months duration. In each subject, an ultrasound cine-recording was acquired on the right and left sides of the back during passive trunk flexion using a motorized articulated table with the hinge point of the table at L4-5 and the ultrasound probe located longitudinally 2 cm lateral to the midline at the level of the L2-3 interspace. Tissue displacement within the Thoracolumbar Fascia was calculated using cross correlation techniques and shear strain was derived from this displacement data. Additional measures included standard range of motion and physical performance evaluations as well as ultrasound measurement of perimuscular connective tissue thickness and echogenicity. Thoracolumbar Fascia shear strain was reduced in the LBP group compared with the No-LBP group (56.4% ± 3.1% vs. 70.2% ± 3.6% respectively, p < .01). There was no evidence that this difference was sex-specific (group by sex interaction p = .09), although overall, males had significantly lower shear strain than females (p = .02). Significant correlations were found in male subjects between Thoracolumbar Fascia shear strain and the following variables: perimuscular connective tissue thickness (r = -0.45, p <.001), echogenicity (r = -0.28, p < .05), trunk flexion range of motion (r = 0.36, p < .01), trunk extension range of motion (r = 0.41, p < .01), repeated forward bend task duration (r = -0.54, p < .0001) and repeated sit-to-stand task duration (r = -0.45, p < .001). Thoracolumbar Fascia shear strain was ~20% lower in human subjects with chronic low back pain. This reduction of shear plane motion may be due to abnormal trunk movement patterns and/or intrinsic connective tissue pathology. There appears to be some sex-related differences in Thoracolumbar Fascia shear strain that may also play a role in altered connective tissue function.
Richard Preuss - One of the best experts on this subject based on the ideXlab platform.
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Structural remodeling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A search for its potential determinants.
Journal of anatomy, 2020Co-Authors: Christian Larivière, Sharon M Henry, Richard PreussAbstract:Recently remodeling of lumbar soft tissues has received increased research attention. However, the major determinants that influence remodeling need to be elucidated in order to understand the impact of different rehabilitation modalities on tissue remodeling. The main aim of this study was to explore the between-subject variance of different measures of lumbar soft tissues quantified with rehabilitative ultrasound imaging (RUSI). RUSI measures (n = 8) were collected from 30 subjects without and 34 patients with LBP: (1) lumbar multifidus (LM) echogenicity (fatty infiltration/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1) (n = 3); (2) posterior layer thickness of the Thoracolumbar Fascia (n = 1); and (3) thickness of the Fasciae surrounding the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) (n = 4). Forward stepwise multivariate regression modeling was conducted with these RUSI measures as dependent variables, using the following independent variables as potential determinants: age, sex, the presence of LBP, body size/composition characteristics (height, weight, trunk length, subcutaneous tissue thickness over the abdominal, and LM muscles), trunk muscle function (or activation) as determined with the percent thickness change of LM, EO, IO, and TrA muscles during a standardized effort (RUSI measures), and physical activity level during sport and leisure activities as estimated with a self-report questionnaire. Two or three statistically significant predictors (or determinants) were selected in the regression model of each RUSI measure (n = 8 models), accounting for 26-64% of their total variance. The subcutaneous tissue thickness on the back accounted for 15-30% variance of LM echogenicity measures and Thoracolumbar Fascia thickness while the subcutaneous tissue thickness over the abdominals accounted for up to 42% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. The thickness of IO at rest accounted for 13-21% variance of all investigated abdominal Fasciae except the Fascia separating the subcutaneous adipose tissue and EO. Pain status accounted for 13-18% variance of the anterior and posterior Fasciae of the TrA. Age accounted for 11-14% variance of LM echogenicity at all investigated vertebral levels while sex accounted for 15-21% variance of LM echogenicity at L3/L4 and Fascia separating subcutaneous adipose tissue and EO muscle. The function (or activation) of EO and LM at L3/L4 accounted for 8-11% variance of the Thoracolumbar Fascia and Fascia separating TrA and intra-abdominal content (TrA posterior Fascia), respectively. Finally, the physical activity level during sport activities accounted for 7% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. These findings suggest that determinants other than body size characteristics may impact the remodeling of lumbar soft tissues, more importantly the subcutaneous adipose tissue deposits (thickness RUSI measures), which are associated with ectopic fat deposition in the LM and in the Fasciae that are more closely positioned to the surface. While age, sex, and pain status explain some variability, modifiable factors such as physical activity level as well as trunk muscle thickness and function were involved. Overall, these results suggest that rehabilitation can potentially impact tissue remodeling, particularly in terms of intramuscular and perimuscular adipose tissues.
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Structural remodelling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A cross-sectional and comparative ultrasound study
Journal of bodywork and movement therapies, 2020Co-Authors: Christian Larivière, Richard Preuss, Dany H. Gagnon, Hakim Mecheri, Sharon M HenryAbstract:Abstract Introduction With low back pain (LBP), remodelling of the lumbar soft tissues involves both trunk muscles and neighbouring passive connective tissues. The aim of the present study was to compare three quantitative measures of these tissues, using ultrasound imaging (USI), among healthy controls and individuals with LBP. Methods USI measures from 30 healthy subjects and 34 patients with non-acute LBP were compared between groups and sexes. The measures employed were (1) lumbar multifidus echogenicity (fatty/fibrosis infiltration) at three vertebral levels; (2) posterior layer thickness of the Thoracolumbar Fascia, and (3) thickness of the perimuscular tissues surrounding the external oblique, internal oblique and transversus abdominis (TrA). Results USI measures of (1) multifidus echogenicity showed statistically significant changes between vertebral levels and sexes (females > males; p = 0.02); (2) differences in Thoracolumbar Fascia thickness approached statistical significance between groups (LBP > controls; p = 0.09) and sexes (females Discussion The thinner perimuscular tissues surrounding the TrA in patients with LBP is a new finding, concurring with previous findings with regard to the lower activation of this deep muscle as well as more recent findings on other perimuscular tissue. Conclusion Overall, USI measures were sensitive to different potential changes (pain status, sex, vertebral level), and this is useful in studying the remodelling of various soft tissues of the trunk.
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Structural remodeling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: Medium-term test-retest reliability of ultrasound measures
Journal of Bodywork and Movement Therapies, 1Co-Authors: Christian Larivière, Dany H. Gagnon, Richard PreussAbstract:Abstract Introduction Growing interest is being paid to the lumbar multifidus (LM) intramuscular fatty infiltrations and fibrosis that are secondary to low back pain as well to the remodeling of perimuscular connective tissues (Fasciae) such as the Thoracolumbar Fascia and Fascia sheets separating the abdominal wall muscles. Magnetic resonance imaging and computed tomography have traditionally been used but rehabilitative ultrasound imaging (RUSI) is much more affordable and practical, which can accelerate research and clinical applications on this topic. The aim of this study was to test the medium-term (8 weeks) test-retest reliability of the corresponding RUSI measures. Methods Thirty-four participants with non-acute LBP and 30 healthy controls performed a RUSI assessment before and after an 8-week time interval. LM echogenicity was quantified to assess fatty infiltrations and fibrosis while Fasciae were quantified with thickness measures. Relative and absolute reliability were estimated using the generalizability theory as a framework, allowing to partition the different sources of error. Results Overall, the reliability findings were quite acceptable, with negligible systematic effects. Excellent relative reliability was reached in half of the investigated RUSI measures, particularly when averaging measures across trials. However, neither relative, nor absolute reliability results support the use of these RUSI measurements on an individual basis (e.g. clinical applications) but they are useful on a group basis (e.g. research applications). Discussion The different sources of error were distributed unequally across RUSI measures, pointing to different measurement strategies to mitigate the underlying errors. Conclusions The use of the generalizability theory allowed identifying the sources of error of the different RUSI measures. For each category of measure, depending of the distribution of errors, it was possible to recommend specific measurement strategies to mitigate them.
Christian Larivière - One of the best experts on this subject based on the ideXlab platform.
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Structural remodeling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A search for its potential determinants.
Journal of anatomy, 2020Co-Authors: Christian Larivière, Sharon M Henry, Richard PreussAbstract:Recently remodeling of lumbar soft tissues has received increased research attention. However, the major determinants that influence remodeling need to be elucidated in order to understand the impact of different rehabilitation modalities on tissue remodeling. The main aim of this study was to explore the between-subject variance of different measures of lumbar soft tissues quantified with rehabilitative ultrasound imaging (RUSI). RUSI measures (n = 8) were collected from 30 subjects without and 34 patients with LBP: (1) lumbar multifidus (LM) echogenicity (fatty infiltration/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1) (n = 3); (2) posterior layer thickness of the Thoracolumbar Fascia (n = 1); and (3) thickness of the Fasciae surrounding the external oblique (EO), internal oblique (IO), and transversus abdominis (TrA) (n = 4). Forward stepwise multivariate regression modeling was conducted with these RUSI measures as dependent variables, using the following independent variables as potential determinants: age, sex, the presence of LBP, body size/composition characteristics (height, weight, trunk length, subcutaneous tissue thickness over the abdominal, and LM muscles), trunk muscle function (or activation) as determined with the percent thickness change of LM, EO, IO, and TrA muscles during a standardized effort (RUSI measures), and physical activity level during sport and leisure activities as estimated with a self-report questionnaire. Two or three statistically significant predictors (or determinants) were selected in the regression model of each RUSI measure (n = 8 models), accounting for 26-64% of their total variance. The subcutaneous tissue thickness on the back accounted for 15-30% variance of LM echogenicity measures and Thoracolumbar Fascia thickness while the subcutaneous tissue thickness over the abdominals accounted for up to 42% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. The thickness of IO at rest accounted for 13-21% variance of all investigated abdominal Fasciae except the Fascia separating the subcutaneous adipose tissue and EO. Pain status accounted for 13-18% variance of the anterior and posterior Fasciae of the TrA. Age accounted for 11-14% variance of LM echogenicity at all investigated vertebral levels while sex accounted for 15-21% variance of LM echogenicity at L3/L4 and Fascia separating subcutaneous adipose tissue and EO muscle. The function (or activation) of EO and LM at L3/L4 accounted for 8-11% variance of the Thoracolumbar Fascia and Fascia separating TrA and intra-abdominal content (TrA posterior Fascia), respectively. Finally, the physical activity level during sport activities accounted for 7% variance of the Fascia separating the subcutaneous adipose tissues and the EO muscle. These findings suggest that determinants other than body size characteristics may impact the remodeling of lumbar soft tissues, more importantly the subcutaneous adipose tissue deposits (thickness RUSI measures), which are associated with ectopic fat deposition in the LM and in the Fasciae that are more closely positioned to the surface. While age, sex, and pain status explain some variability, modifiable factors such as physical activity level as well as trunk muscle thickness and function were involved. Overall, these results suggest that rehabilitation can potentially impact tissue remodeling, particularly in terms of intramuscular and perimuscular adipose tissues.
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Structural remodelling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: A cross-sectional and comparative ultrasound study
Journal of bodywork and movement therapies, 2020Co-Authors: Christian Larivière, Richard Preuss, Dany H. Gagnon, Hakim Mecheri, Sharon M HenryAbstract:Abstract Introduction With low back pain (LBP), remodelling of the lumbar soft tissues involves both trunk muscles and neighbouring passive connective tissues. The aim of the present study was to compare three quantitative measures of these tissues, using ultrasound imaging (USI), among healthy controls and individuals with LBP. Methods USI measures from 30 healthy subjects and 34 patients with non-acute LBP were compared between groups and sexes. The measures employed were (1) lumbar multifidus echogenicity (fatty/fibrosis infiltration) at three vertebral levels; (2) posterior layer thickness of the Thoracolumbar Fascia, and (3) thickness of the perimuscular tissues surrounding the external oblique, internal oblique and transversus abdominis (TrA). Results USI measures of (1) multifidus echogenicity showed statistically significant changes between vertebral levels and sexes (females > males; p = 0.02); (2) differences in Thoracolumbar Fascia thickness approached statistical significance between groups (LBP > controls; p = 0.09) and sexes (females Discussion The thinner perimuscular tissues surrounding the TrA in patients with LBP is a new finding, concurring with previous findings with regard to the lower activation of this deep muscle as well as more recent findings on other perimuscular tissue. Conclusion Overall, USI measures were sensitive to different potential changes (pain status, sex, vertebral level), and this is useful in studying the remodelling of various soft tissues of the trunk.
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Structural remodeling of the lumbar multifidus, Thoracolumbar Fascia and lateral abdominal wall perimuscular connective tissues: Medium-term test-retest reliability of ultrasound measures
Journal of Bodywork and Movement Therapies, 1Co-Authors: Christian Larivière, Dany H. Gagnon, Richard PreussAbstract:Abstract Introduction Growing interest is being paid to the lumbar multifidus (LM) intramuscular fatty infiltrations and fibrosis that are secondary to low back pain as well to the remodeling of perimuscular connective tissues (Fasciae) such as the Thoracolumbar Fascia and Fascia sheets separating the abdominal wall muscles. Magnetic resonance imaging and computed tomography have traditionally been used but rehabilitative ultrasound imaging (RUSI) is much more affordable and practical, which can accelerate research and clinical applications on this topic. The aim of this study was to test the medium-term (8 weeks) test-retest reliability of the corresponding RUSI measures. Methods Thirty-four participants with non-acute LBP and 30 healthy controls performed a RUSI assessment before and after an 8-week time interval. LM echogenicity was quantified to assess fatty infiltrations and fibrosis while Fasciae were quantified with thickness measures. Relative and absolute reliability were estimated using the generalizability theory as a framework, allowing to partition the different sources of error. Results Overall, the reliability findings were quite acceptable, with negligible systematic effects. Excellent relative reliability was reached in half of the investigated RUSI measures, particularly when averaging measures across trials. However, neither relative, nor absolute reliability results support the use of these RUSI measurements on an individual basis (e.g. clinical applications) but they are useful on a group basis (e.g. research applications). Discussion The different sources of error were distributed unequally across RUSI measures, pointing to different measurement strategies to mitigate the underlying errors. Conclusions The use of the generalizability theory allowed identifying the sources of error of the different RUSI measures. For each category of measure, depending of the distribution of errors, it was possible to recommend specific measurement strategies to mitigate them.
Andry Vleeming - One of the best experts on this subject based on the ideXlab platform.
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the functional coupling of the deep abdominal and paraspinal muscles the effects of simulated paraspinal muscle contraction on force transfer to the middle and posterior layer of the Thoracolumbar Fascia
Journal of Anatomy, 2014Co-Authors: Andry Vleeming, Lieven Danneels, Mark D. Schuenke, F H WillardAbstract:The Thoracolumbar Fascia (TLF) consists of aponeurotic and Fascial layers that interweave the paraspinal and abdominal muscles into a complex matrix stabilizing the lumbosacral spine. To better understand low back pain, it is essential to appreciate how these muscles cooperate to influence lumbopelvic stability. This study tested the following hypotheses: (i) pressure within the TLF's paraspinal muscular compartment (PMC) alters load transfer between the TLF's posterior and middle layers (PLF and MLF); and (ii) with increased tension of the common tendon of the transversus abdominis (CTrA) and internal oblique muscles and incremental PMC pressure, Fascial tension is primarily transferred to the PLF. In cadaveric axial sections, paraspinal muscles were replaced with inflatable tubes to simulate paraspinal muscle contraction. At each inflation increment, tension was created in the CTrA to simulate contraction of the deep abdominal muscles. Fluoroscopic images and load cells captured changes in the size, shape and tension of the PMC due to inflation, with and without tension to the CTrA. In the absence of PMC pressure, increasing tension on the CTrA resulted in anterior and lateral movement of the PMC. PMC inflation in the absence of tension to the CTrA resulted in a small increase in the PMC perimeter and a larger posterior displacement. Combining PMC inflation and tension to the CTrA resulted in an incremental increase in PLF tension without significantly altering tension in the MLF. Paraspinal muscle contraction leads to posterior displacement of the PLF. When expansion is combined with abdominal muscle contraction, the CTrA and internal oblique transfers tension almost exclusively to the PLF, thereby girdling the paraspinal muscles. The lateral border of the PMC is restrained from displacement to maintain integrity. Posterior movement of the PMC represents an increase of the PLF extension moment arm. Dysfunctional paraspinal muscles would reduce the posterior displacement of the PLF and increase the compliance of the lateral border. The resulting change in PMC geometry could diminish any effects of increased tension of the CTrA. This study reveals a co-dependent mechanism involving balanced tension between deep abdominal and lumbar spinal muscles, which are linked through the aponeurotic components of the TLF. This implies the existence of a point of equal tension between the paraspinal muscles and the transversus abdominis and internal oblique muscles, acting through the CTrA.
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the Thoracolumbar Fascia anatomy function and clinical considerations
Journal of Anatomy, 2012Co-Authors: F H Willard, Andry Vleeming, Lieven Danneels, Mark D. Schuenke, Robert SchleipAbstract:In this overview, new and existent material on the organization and composition of the Thoracolumbar Fascia (TLF) will be evaluated in respect to its anatomy, innervation biomechanics and clinical relevance. The integration of the passive connective tissues of the TLF and active muscular structures surrounding this structure are discussed, and the relevance of their mutual interactions in relation to low back and pelvic pain reviewed. The TLF is a girdling structure consisting of several aponeurotic and Fascial layers that separates the paraspinal muscles from the muscles of the posterior abdominal wall. The superficial lamina of the posterior layer of the TLF (PLF) is dominated by the aponeuroses of the latissimus dorsi and the serratus posterior inferior. The deeper lamina of the PLF forms an encapsulating retinacular sheath around the paraspinal muscles. The middle layer of the TLF (MLF) appears to derive from an intermuscular septum that developmentally separates the epaxial from the hypaxial musculature. This septum forms during the fifth and sixth weeks of gestation. The paraspinal retinacular sheath (PRS) is in a key position to act as a ‘hydraulic amplifier’, assisting the paraspinal muscles in supporting the lumbosacral spine. This sheath forms a lumbar interFascial triangle (LIFT) with the MLF and PLF. Along the lateral border of the PRS, a raphe forms where the sheath meets the aponeurosis of the transversus abdominis. This lateral raphe is a thickened complex of dense connective tissue marked by the presence of the LIFT, and represents the junction of the hypaxial myoFascial compartment (the abdominal muscles) with the paraspinal sheath of the epaxial muscles. The lateral raphe is in a position to distribute tension from the surrounding hypaxial and extremity muscles into the layers of the TLF. At the base of the lumbar spine all of the layers of the TLF fuse together into a thick composite that attaches firmly to the posterior superior iliac spine and the sacrotuberous ligament. This Thoracolumbar composite (TLC) is in a position to assist in maintaining the integrity of the lower lumbar spine and the sacroiliac joint. The three-dimensional structure of the TLF and its caudally positioned composite will be analyzed in light of recent studies concerning the cellular organization of Fascia, as well as its innervation. Finally, the concept of a TLC will be used to reassess biomechanical models of lumbopelvic stability, static posture and movement.
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a description of the lumbar interFascial triangle and its relation with the lateral raphe anatomical constituents of load transfer through the lateral margin of the Thoracolumbar Fascia
Journal of Anatomy, 2012Co-Authors: Mark D. Schuenke, Andry Vleeming, T Van Hoof, F H WillardAbstract:Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myoFascial planes associated with the Thoracolumbar Fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the Fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myoFascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the Fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interFascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different Fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.
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the posterior layer of the Thoracolumbar Fascia its function in load transfer from spine to legs
Spine, 1995Co-Authors: Andry Vleeming, Rob Stoeckart, Annelies Poolgoudzwaard, J P Van Wingerden, Christiaan Johannes SnijdersAbstract:STUDY DESIGN: The superficial and deep lamina of the posterior layer of the Thoracolumbar Fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster photography. OBJECTIVES: To study the role of the posterior layer of the Thoracolumbar Fascia in load transfer between spine, pelvis, legs, and arms. SUMMARY OF BACKGROUND DATA: It has been determined whether muscles such as the gluteus maximus, latissimus dorsi, erector muscle, and biceps femoris are functionally coupled via the Thoracolumbar Fascia. The caudal relations of the posterior layer of the Thoracolumbar Fascia have not been previously studied. METHODS: Dissection was directed to the bilaminar posterior layer of the Thoracolumbar Fascia of 10 human specimens. The superficial and deep lamina were studied using visual inspection and raster photography. Tension to the posterior layer of the Fascia was simulated by traction to various muscles and measured by studying the displacement in the posterior layer. RESULTS: Traction to a variety of muscles caused displacement of the posterior layer. This implies that in vivo, the superficial lamina will be tensed by contraction of various muscles, such as the latissimus dorsi, gluteus maximus and erector muscle, and the deep lamina by contraction of the biceps femoris. Caudal to the level of L4 (in some specimens, L2-L3), tension in the posterior layer was transmitted to the contralateral side. CONCLUSIONS: Anatomic structures normally described as hip, pelvic, and leg muscles interact with so-called arm and spinal muscles via the Thoracolumbar Fascia. This allows for effective load transfer between spine, pelvis, legs, and arms--an integrated system. Specific electromyographic studies should reveal whether the gluteus maximus muscle and contralateral latissimus dorsi muscle are functionally coupled, especially during rotation of the trunk. In that case, the combined action of these muscles assists in rotating the trunk, while simultaneously stabilizing the lower lumbar spine and sacroiliac joints.
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the posterior layer of the Thoracolumbar Fascia its function in load transfer from spine to legs
Spine, 1995Co-Authors: Andry Vleeming, Rob Stoeckart, Annelies Poolgoudzwaard, Janpaul Van Wingerden, Christiaan Johannes SnijdersAbstract:Study DesignThe superficial and deep lamina of the posterior layer of the Thoracolumbar Fascia have been studied anatomically and biomechanically. In embalmed human specimens, the posterior layer has been loaded by simulating the action of various muscles. The effect has been studied using raster ph
