Thoracolumbar Fascial Defect in Persistent Low Back Pain After Lumbar Surgery: Ultrasound Findings and Response to Fascial Plane Injection

Introduction: Persistent low back pain (LBP) after lumbar spine surgery is commonly attributed to recurrent stenosis, neural compression, or degenerative changes. Abnormalities of the thoracolumbar fascia (TLF) after lumbar surgery have rarely been reported as a potential source of pain. We describe a patient with persistent post-operative LBP in whom musculoskeletal ultrasound (US) demonstrated a focal fascial defect corresponding to the painful region. Case Report: A 65-year-old man presented with LBP 2 years after lumbar surgery for spinal stenosis. Evaluation revealed no neurological deficit or indication for further surgery. US demonstrated a focal midline defect of the TLF between the L2 and L3 levels. US-guided injection of 2 mL 0.5% bupivacaine and 3 mL normal saline beneath the affected fascial plane was performed. Pain decreased at both 1-week and 1-month follow-up. Conclusion: This case highlights a sonographically visible thoracolumbar fascial defect in a patient with persistent LBP following lumbar surgery. The favorable response to US-guided fascial plane injection suggests that post-operative fascial abnormalities may represent an underrecognized pain generator in selected patients. Studies are required to clarify their clinical significance and therapeutic implications.