Virginia Research Day 2025

Medical Student Research Clinical

Cara Satoskar, OMS2; Alexandra Reagan, OMS2; David Risov, DO; Nicole Fremarek DO, MBA; Gunnar Brolinson, DO; Matthew Chung, DO; Georgina Flynn Smith, MBEE; Vincent Wang, PhD; Albert Kozar, DO Corresponding author: csatoskar@vcom.edu 33 Ultrasound-Guided Hydrodissection of the Thoracolumbar Fascia for Chronic Lower Back Pain: Initial Assessment

Edward Via College of Osteopathic Medicine, Department of Defense

were obtained in longitudinal and transverse views of 19 key transition zones (9 per side, 1 central) of TLF. Each session produced 180 static images per patient, along with dynamic gliding motion images of the fascia during 2 different body movements: passive torso flexion and active ipsilateral and contralateral leg extension. Those CLBP individuals with TLF glide impairment entered a pilot treatment arm involving 3 US-guided TLF hydrodissection treatments at 2-week intervals using 120cc of 5% dextrose and 12cc of 0.2% ropivacaine. Two injections sites were used bilaterally to inject the solution between the fascial layers from T12-S2 bilaterally in a lateral to medial direction. Follow-up images and video were taken at 2, 4, 6, 12, and 24 weeks. RESULTS: This preliminary report summarizes findings from three patients who completed all three rounds of US-guided TLF hydrodissection (9 treatments total, we expect more by poster completion). At baseline, all patients reported moderate to severe CLBP and demonstrated restricted lumbar spine mobility. Immediate pain relief was observed in all 9 treatments. Two instances of

transient pain increase lasting 24 hours were reported, followed by gradual pain reduction. One patient experienced pain relief lasting five days after the second treatment. By the end of the third treatment, each patient exhibited improved lumbar spine function, with notable enhancements in passive hip extension, prone press-up with hip extension, and prone active straight leg raise. DISCUSSION: Preliminary results suggest that US-Guided TLF hydrodissection is a promising, minimally invasive intervention for reducing pain and enhancing functional mobility in patients with CLBP. The procedure was associated with immediate pain relief and improvements in spinal mobility, with transient pain flare-ups that resolved within 24 hours in some cases. These findings underscore the need for larger-scale studies and a randomized controlled trial to confirm efficacy and assess long-term benefits of USGH of the TLF. Approved by the Edward Via College of Osteopathic Medicine IRB, Board Ref #2023-154

INTRODUCTION: Chronic lower back pain (CLBP) is the most common musculoskeletal ailment worldwide. Emerging research highlights the thoracolumbar fascia (TLF)—a dense network of collagen fibers integral to the stability of the trunk- -as the most pain-sensitive soft tissue structure of the lower back. Ultrasound-guided hydrodissection (USGH) is a novel, minimally invasive technique that employs fluid to separate tissue planes, with current literature supporting its efficacy in alleviating pain and enhancing functionality in non-synovial tendons. Given the structural similarities between the TLF and non-synovial tendons, we hypothesized that USGH of the TLF would reduce pain and improve functional mobility in CLBP individuals with glide impairment. METHODS: Adults aged 18-50 with CLBP (> 3 months) and found to have at least one glide restriction on dynamic ultrasound (US) imaging of TLF were included for this analysis, from a larger dual-funded TLF prospective study. Subjects with CLBP self-selected for hydrodissection versus osteopathic manipulative treatment (OMT) at the time of initial consenting. US images, including grey scale, shear-wave elastography, and power doppler

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