As the only two areas of the lower spine that facilitate rotation, restriction in the TLJ could result in increased movement of the lumbosacral facet joints and vice versa. It is worth noting that the only part of the spine below the TLJ that is capable of providing rotation is the lumbosacral juncture, as the superior and inferior facets of L5 occupy the coronal and frontal planes, respectively. Previous studies have demonstrated that saline injections into the ligamentous structures of T12 and L1 reproduce low back pain that radiates into the buttock and greater trochanter, 3 further validating the potential role of the TLJ in low back and hip pain. 12,13 Notably, the pain and sensory disturbances associated with TLJ Pain Sydrome often correspond with branches of the T12 and L1 spinal nerve roots, resulting in referred, and often misleading, pain in the back, hip, and groin. Occasionally, a posterior branch will go through an osteoaponeurotic channel, which is defined as the space between the iliac crest below and dorso-lumbar fascia above, which can result in entrapment neuropathy and pain. 11 The posterior rami innervate the superior gluteal and inferior lumbar subcutaneous tissues. 3,7,9 The anterior rami (motor and sensory components) innervate the lower portion of the abdomen, groin, pubic region and superomedial thigh (60% of cases), while the lateral cutaneous branch innervates the trochanteric region from the “seam of trousers” to the mid-thigh (50% of cases). The symptoms associated with TLJ Pain Syndrome and PMID are consistent with the dorsal rami and cutaneous dorsal rami dermatome patterns associated with the facets joints from T11-L1. dorsal rami, and superior cluneal nerves) 4 3,8 In addition to its bony spinal components, the TLJ has attachments to 12 th rib, diaphragm, erector spinae, iliopsoas, quadratus lumborum and latissimus dorsi muscles along with the transverse ligament, thoracolumbar fascia, 1 and corresponding nerves (i.e. The TLJ, therefore, experiences a significant amount of motion, activity, and rotational distress throughout the course of daily life and sports, making it susceptible to stress and degenerative changes. As such, T12 is often considered a “transitional vertebrae” with rotation available at its thoracic-interfacing upper facets (frontal plane), and limited rotation at the lumbar-interfacing lower facets (coronal plane). While the “tethering effects” of the ribs limit the thoracic spine, this is not the case at T11-T12. 3 The TLJ is uniquely structured, as it connects the lumbar spine, which is structurally designed for flexion-extension, and the thoracic spine, which has a greater capacity for rotation. 3,7 PMID may result in localized or referred pain due to “a form of a self-sustaining minor strain of the vertebral segment,” but it is “generally reversible” with the right treatment approach. Maigne suggested that the symptoms associated with TLJ Pain Syndrome originate from “Painful, Minor Intervertebral Dysfunction” (PMID). Furthermore, given that radiographs commonly reveal changes in the lower lumbar region or hip with insignificant findings for the TLJ, clinicians often overlook this spinal region as a possible cause of the patient’s symptoms. 8 Thus, while the TLJ may be the primary culprit of the patient’s problem, it is not typically the patient’s primary complaint. gynecologic, urologic, testicular and lower GI pain) originating from dysfunction of the TLJ.
7,8 In doing so, he found that TLJ Pain Syndrome commonly presents as low back, hip, pubic, autonomic and/or pseudovisceral pain (i.e. 4-6 Robert Maigne first proposed the existence of Thoracolumbar Junction (TLT) Pain Syndrome in 1972. 3 While the TLJ has traditionally been thought to span T12-L1, various studies suggest that it may extend from T9-L2.
While dysfunction of the thoracolumbar junction (TLJ) is a common occurrence in adult patients, 1,2 there seems to be a paucity of evidence for how to conservatively manage the condition.