• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Home
  • About
  • Newsletter/Updates
  • Contact Us
  • Policies

Bone and Spine

Orthopedic health, conditions and treatment

  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors

Thoracolumbar Junction Syndrome

By Dr Arun Pal Singh

In this article
    • Relevant Anatomy
    • Causes of Thoracolumbar Junction Syndrome
    • Clinical Presentation of Thoracolumbar Syndrome
    • Diagnosis
    • Treatment of Thoracolumbar Junction Syndrome
    • References
      • Related

Last Updated on August 27, 2023

Thoracolumbar Junction Syndrome is characterized by pain that may originate at the thoracolumbar junction. Thoracolumbar junction syndrome is also called Maigne Syndrome or Dorsal Ramus Syndrome or posterior ramus syndrome. It is caused by the activation of the spinal nerve of the thoracolumbar region.

In the absence of any radiological signs, the diagnosis is made clinically.

The thoracolumbar junction (TLJ) is comprised of the T10-11, T11-12 and T12-L1 motion segments. This transitional area interposed between the thoracic and lumbar spine, is often the source of a characteristic pain syndrome characterized by a referral of the pain in the related dermatomes (T10 to L1).

thoracolumbar-junction-syndrome

Relevant Anatomy

The thoracolumbar junction is the junction between the thoracic spine and the lumbar spine usually spanning from the eleventh thoracic vertebra to the first lumbar vertebra. Here, the spinal curvature changes from kyphosis to lordosis, and the orientation of the facet joints changes from coronal to sagittal.

The change in vertebral anatomy adapting to lumbar anatomy can be noticed in last two thoracic vertebrae.

The thoracolumbar junction is important because it marks the change of region.

A thoracolumbar transitional vertebra is defined as a vertebra with partially retained features of the thoracic and lumbar segments at the thoracolumbar junction.

Maigne syndrome is due to activation or irritation of the dorsal or posterior ramus of the T 12 spinal nerve mostly.

spinal nerve formation and division into anterior and posterior rami
Spinal Nerve, Image from Wikipedia, in public domain

Each spinal nerve is formed by the combination of anterior and posterior roots for that particular spinal segment.

The spinal nerve emerges from the spinal column through the intervertebral foramen and divides into

  • dorsal or posterior ramus – supplies the posterior part of the trunk and skin
  • ventral or anterior ramus- supplies the anterior part of the trunk and skin
  • rami communicants – visceral motor and sensory function

The thoracolumbar primary rami [mainly T12, L1] divides after a few millimetres into medial and lateral branches.

  • The medial branch
    • Runs dorsally along the angle between the transverse and zygapophyseal processes of the corresponding vertebra
    • Gives off branches supplying the facet at that level.
  • Lateral branch
  • Directed caudally, laterally, and dorsally
  • Supplies the erector spinae
  • Supplies subcutaneous tissues of the lumbar and buttock area as distal as the greater trochanter.

The anterior ramus supplies the lower abdomen and groin.

Causes of Thoracolumbar Junction Syndrome

Irritation of the posterior ramus of the nerve is the major pain mechanism.

The most common cause of thoracolumbar junction syndrome is a minor intervertebral dysfunction at the thoracolumbar junction.

The nature of this dysfunction remains unknown, although the involvement of either the facets or the disc is very likely.

Thoracolumbar junction syndrome participates in the rotatory movements of the spine.

This may lead to an overuse of the motion segment which could initiate disc or facet degeneration. Disc herniation or a collapse of the vertebral body of T11, 12 or L1 may also be responsible.

A list of probable causes is given below

  • Inflammation and degeneration of thoracolumbar junction (T9-L2) facet joints
  • Intervertebral disc prolapse in the thoracolumbar region
  • Nerve lesions
  • Other degenerative processes
  • Traumatic fractures
  • Nerve entrapment
    • Cutaneous dorsal ramus of L1  at the iliac crest
    • Lateral cutaneous branch of the iliohypogastric nerve

Clinical Presentation of Thoracolumbar Syndrome

Thoracolumbar junction syndrome

Depending on the branch involved, the pain could refer to

  • Low back (cutaneous dorsal rami)
  • The groin (subcostal or iliohypogastric nerve)
  • Lateral aspect of the hip (lateral cutaneous rami of the subcostal or iliohypogastric nerve)

All combinations of these clinical presentations are possible.

The pain most frequently is only on one side (unilateral) of the spine and usually radiates along the pathway of the affected nerves leaving the TLJ.

Low Back Pain is certainly the most frequently encountered pain complaint. The pain is usually spread in the lateral part of the lower back without corresponding exactly to a specific dermatome.

Rarely, the pain is bilateral.

The pain is usually acute, of less than 2 or 3 months duration, often appearing after a  rotatory movement of the trunk, prolonged strenuous posture, lifting, and occasionally, without any obvious precipitating factors.

Less commonly, the pain may become chronic.

The pain is frequently increased by contralateral side bending.

On examination, there is pain and tenderness in the iliac crest at a point that is consistently located seven centimetres from the midline. The pressure at this point causes a sharp excruciating pain similar to the patient’s complaint.

The opposite iliac crest is commonly unaffected.

The pinch-roll test

It can be revealed by gently grasping a fold of skin between the thumbs and forefingers, lifting it away from the trunk, and rolling the subcutaneous surfaces against one another in a pinch-and-roll fashion. On the involved side, the skin overlying the buttock and iliac crest is found to be tender when compared to the opposite side.

Examination of the thoracolumbar junction area may produce tenderness.

The affected posterior ramus ends cutaneously causing trophic changes in the skin.

Diagnosis

Diagnosis is mainly clinical. Imaging may be used to rule out any lesions of the spine or nerves.

Imaging

Radiographic is non-contributory. MRI, CT, and myelography are generally inconclusive unless a lesion is present.

Diagnostic Block 

The pain is relieved by the injection of local anaesthetic into the correct facet joint. This diagnostic procedure can also be therapeutic.

Treatment of Thoracolumbar Junction Syndrome

The treatment involves the administration of anti-inflammatory drugs, spinal manipulation, and anaesthetic blocks.

The treatment has the following objectives

  • Reduction of inflammation and pain
  • Range of motion
    • Pelvic tilt
    • Hip exercises
  • Muscle strengthening
  • Posture training

For pain reduction following modalities may be used

  • Cold therapy
  • Electrical stimulation
  • NSAIDs
  • Intralesional corticosteroid injections

References

  • Kim SR, Lee MJ, Lee SJ, Suh YS, Kim DH, Hong JH. Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report. Korean J Fam Med. 2013 Mar;34(2):152-5. doi: 10.4082/kjfm.2013.34.2.152.  [Link]
  • Alptekin K, Örnek NI, Ayd?n T, Alkan M, Toprak M, A Balc? L, Öncü Alptekin J. Effectiveness of Exercise and Local Steroid Injections for the Thoracolumbar Junction Syndrome (The Maigne’s Syndrome) Treatment. Open Orthop J. 2017 May 31;11:467-477. doi: 10.2174/1874325001711010467. [Link]

Related

Spread the Knowledge
3
Shares
 
3
Shares
3    

Filed Under: Spine

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Primary Sidebar

Browse Articles

prepatellar bursitis image

Prepatellar Bursitis or Housemaid Knee

Prepatellar bursitis is inflammation and swelling of the prepatellar bursa which lies between the skin and the patella separating the patella from the patellar tendon and skin. Normally, it contains a minimal amount of fluid and is not appreciable but with inflammation, it could swell substantially. Prepatellar bursitis is also known as the beat knee, […]

Back Pain in children

How to Avoid Back Pain in Daily Life

Back pain is quite annoying and limits the activity to an extent that daily routine is affected. Back pain occurrence is very common but you can avoid back pain to an extent by taking some precautions in your daily life. The basic tenet is not to stress the spine and adjoining structures. Daily Life Tips […]

Lumbar plexus details, PD wiki

Lumbosacral Plexus Anatomy

Lumbosacral plexus is formed anterior or ventral rami of L1–S3 roots. All major nerves of the lower extremity are derived from lumbosacral plexus. Though functionally considered as one entity, the lumbosacral plexus is usually thought of anatomically as an upper lumbar plexus and a sacral plexus also called lower lumbosacral plexus [also receives lumbar contribution]. […]

Ligaments of shoulder joint

Shoulder Pain Causes, Diagnosis and Treatment

Term shoulder pain refers to any pain that arises in or around the shoulder. The origin of the pain may be in the shoulder joint or from surrounding structures like muscles, ligaments or tendons. Shoulder pain is the third most common musculoskeletal pain after low back pain and neck pain. This kind of pain usually […]

injection with medicine

Prolotherapy – Types, Mechanism and Uses

What is Prolotherapy? Prolotherapy is a procedure where the non-pharmacological and non-active irritant solution is injected into the body for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain. Prolotherapy is claimed to repair the weakened sites and produce new fibrous tissues. Other names are Proliferation therapy Regenerative injection therapy Proliferative injection therapy […]

Pain Management Program

What is Pain Management Program?

Pain management program is a multi-disciplinary approach that aims at providing pain relief and restoration of normal function by either drugs and/or interventions. Pain management program may be desirable in selected patients of back pain or sciatica, neck pain, failed back syndrome, reflex sympathetic dystrophy, myofascial pain, fibromyalgia, facial pain, neuropathic pain, headaches, cancer pain, shingles, […]

Suprascapular nerve arising from brachial plexus, Public domainimage

Suprascapular Nerve – Anatomy & Clinical Significance

Suprascapular nerve is derived from the upper trunk of brachial plexus and receives fibers from C5 and C6. It is a mixed nerve containing both sensory and motor fibers. [Read anatomy of brachial plexus] After it emerges,  it sends sensory branches to both the glenohumeral and acromioclavicular joints. It passes downward, laterally deep to the […]

© Copyright: BoneAndSpine.com
Manage Cookie Consent
The site uses cookies. Please accept cookies for a better visiting experience.
Functional Always active
The technical storage or access is strictly necessary for the legitimate purpose of enabling the use of a specific service explicitly requested by the subscriber or user, or for the sole purpose of carrying out the transmission of a communication over an electronic communications network.
Preferences
The technical storage or access is necessary for the legitimate purpose of storing preferences that are not requested by the subscriber or user.
Statistics
The technical storage or access that is used exclusively for statistical purposes. The technical storage or access that is used exclusively for anonymous statistical purposes. Without a subpoena, voluntary compliance on the part of your Internet Service Provider, or additional records from a third party, information stored or retrieved for this purpose alone cannot usually be used to identify you.
Marketing
The technical storage or access is required to create user profiles to send advertising, or to track the user on a website or across several websites for similar marketing purposes.
Manage options Manage services Manage {vendor_count} vendors Read more about these purposes
View preferences
{title} {title} {title}
 

Loading Comments...