title: Sagging posterior layer thoracolumbar fascia: can it be the cause or result of adjacent segment diseases?
abstract: METHODS
  A retrospective study.
  
  
  OBJECTIVE
  Thoracolumbar fascia (TLF) is an important anatomic structure that plays a role in integrating back muscles and maintaining the stability of lower back. Functional failure of TLF can be one of the factors in the vicious cycle of progressive spinal instability. The purpose of this study is to assess the TLF and correlate it with spinal stability in the instrumented lumbar surgery patients.
  
  
  METHODS
  From January 2008 to March 2009, 68 consecutive postoperative lumbar or thoracolumbar spine magnetic resonance images were retrospectively reviewed to evaluate the morphologic changes of TLF. It was considered as "sagging posterior layer TLF" when it showed abrupt bulging appearance on parasagittal planes. To determine the spinal stability, flexion and extension lumbar lateral films were also reviewed. The correlation between sagging TLF and adjacent segment disease (ASD) were analyzed.
  
  
  RESULTS
  Fifty patients (19 males and 31 females, mean age 52.4 y) showed sagging posterior layer TLF, and 32 of them developed ≥1 junctional problems, such as retrolistheses (n=25), compression fractures (n=5), spondylolistheses (n=4), progressive scoliosis (n=4), and segmental instability with bone marrow change (n=2). There was statistically significant correlation between the instrumented surgery and sagging TLF (P-value <0.001). And there was also significant correlation between the sagging TLF and ASD (P-value <0.001).
  
  
  CONCLUSIONS
  Morphologic changes of the TLF in postoperative magnetic resonance imaging can be the earliest and predictable findings in the progressive development of the ASD.
authors.affiliation: Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Jeong
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Shin
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Lee
authors.forename: Hye Won
authors.initials: HW
authors.lastname: Chung
mesh_terms: D000368:Aged; D064131:Back Muscles / Q000473:pathology* / Q000601:surgery; D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D009135:Muscular Diseases / Q000453:epidemiology* / Q000473:pathology*; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000453:epidemiology* / Q000473:pathology* / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000473:pathology