Virginia Research Day 2025

Medical Student Research Clinical

32 Shear Wave Elastography of the Thoracolumbar Fascia as a Biomarker for Chronic Low Back Pain

Faheem Farooq, OMS-II; Dylan Carlson, OMS-II; David Risov, DO; Nicole Fremarek, DO, MBA; Gunnar Brolinson, DO, FAOASM, FAOCFP; Matthew Chung, DO; Georgina Flynn-Smith, MBEE; Vincent Wang, PhD; Albert Kozar, DO, FAOASM, R-MSK Corresponding author: ffarooq@vcom.edu

Edward Via College of Osteopathic Medicine - Virginia Campus

of the poster and compared to our initial pilot study from 2020-2022. DISCUSSION: This preliminary report of a two year, dually funded study, suggests that SWE can demonstrate a significant increase in the stiffness of the TLF in specific key transition zones in subjects with CLBP compared to those with NLBP, indicating its potential use as a biomarker. The study is currently limited by the preliminary mid-study results. In addition, subjects with higher BMI made it difficult to interpret some TLF zones. Further research could include a larger sampling, as well as blinded prospective pre- and post-treatment studies of the regions noted to be significant. Approved by the VCOM IRB, protocol number 2023 154.

INTRODUCTION: The thoracolumbar fascia’s (TLF) role in proprioception, nociception, and both active and passive forces may contribute to low back pain (LBP). Although one of the most common reasons for medical consultations is LBP, the TLF’s specific involvement is not completely understood. Shear Wave Elastography (SWE) is a form of ultrasound that determines the stiffness of tissue by measuring the velocity of shear waves passing through soft tissues. Chen et al (2020) found that SWE was a reliable method of evaluating shear modulus of TLF in multiple body positions in patients with no low back pain (NLBP). However, to date, research on the use of SWE to measure the stiffness of TLF in relation to chronic low back pain (CLBP) has been limited. We hypothesize that changes in shear wave speed at key transition zones of myofascial connections may serve as a biomarker for chronic low back pain compared to control patients without pain.

METHODS: As a part of a larger study utilizing a convenience sample of male and female subjects between 18 and 50 years old with BMI less than 30, NLBP, acute LBP (ALBP), and CLBP subjects were recruited. Subjects were imaged at multiple key transition zones of the myofascial connections of the TLF including contributions from the upper extremity, abdominal region, and paraspinal regions. Two shear wave images were taken in each of the longitudinal and transverse probe directions at nine key transition zones bilaterally and 1 centrally (19 regions total) after a five second calibration period. Three ROIs were sampled on each image and averaged. The average stiffness measurements were assessed by an Analysis of Variance (ANOVA) testing to determine whether the mean value differs by pain group. RESULTS: Preliminary data of the first 36 subjects, 18 NLBP and 18 CLBP, will be presented at the time

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