Thoracolumbar fascia ultrasound and elastography biomarkers in low back pain: a systematic review of associations and responsiveness to intervention
Abstract
Background and aim Traditional imaging methods often fail to identify the causes of nonspecific low back pain (NSLBP). The thoracolumbar fascia (TLF) has gained attention as a potential target for assessment with Quantitative Ultrasound (QUS). This systematic review examines the relationships between TLF QUS biomarkers (stiffness, shear strain, morphology, and microstructure) and NSLBP and how these biomarkers respond to interventions. Methods: Adhering to PRISMA 2020 guidelines, searches were conducted in MEDLINE, EMBASE, CENTRAL, and Scopus up to February 2026 for studies evaluating TLF QUS biomarkers in adults with NSLBP. Risk of bias was assessed using RoB 2, ROBINS-I, and NOS. Due to methodological heterogeneity, a narrative synthesis was performed. Findings: Fourteen studies involving approximately 880 participants met the inclusion criteria. In chronic NSLBP, several studies reported greater TLF thickness, altered echogenicity or microstructural texture parameters, and differences in stiffness compared with asymptomatic controls. However, stiffness findings were inconsistent across elastography modalities, with both higher and lower stiffness-related measures reported. Functional mobility findings also varied by clinical population and measurement protocol: studies in acute LBP generally reported reduced deformation, whereas studies in chronic LBP reported either reduced or increased shear strain. Preliminary intervention studies indicated changes in TLF thickness and selected stiffness-related measures following manual interventions, whereas single-session massage did not produce detectable changes in shear strain measures. Interpretation QUS studies have identified differences in TLF morphology, mechanical properties, mobility, and microstructural texture parameters between some individuals with NSLBP and asymptomatic controls. The direction and magnitude of these differences are not uniform and vary across populations, imaging modalities, and acquisition protocols. The available findings may be consistent with different patterns of fascial mechanical behavior, but the existence of distinct biological or clinically actionable TLF phenotypes remains hypothetical and requires prospective validation. Evidence regarding responsiveness to intervention is preliminary, and the clinical utility of these parameters for diagnosis, treatment selection, or outcome monitoring has not yet been established.
Related
- Beyond responsiveness: Differentiated associations among product features, psychological needs, perceived enjoyment, and continuance intention toward AI learning devices
- Chronic Ultrasound (‘Emotional’) Stress in Mice Exacerbates Colitis Through GSK3β-Mediated Neuroimmune Dysregulation and Is Ameliorated by Probiotic Intervention
- A metabolomic signature of weight-loss and its associations with BMI-linked diseases: A post-hoc analysis of two intervention trials and a mendelian randomisation study
- DINOCT: robust skin surface localization for robotic noncontact dynamic optical coherence elastography
- Brain mechanics and cognition: the role of rodent MR elastography in identifying cellular mechanisms
BibTeX
@article{schleip2026thoracolumbar,
title = {{Thoracolumbar fascia ultrasound and elastography biomarkers in low back pain: a systematic review of associations and responsiveness to intervention}},
author = {Robert Schleip and Lea Overmann and Marcus Müller and Konstatin Warneke and Stanislav Dimitri Siegel and Katja Bartsch and Torsten Pohl and Sabine Bensamoun and Guillaume Haiat and Andreas Brandl},
journal = {European Spine Journal},
year = {2026},
month = aug,
doi = {10.1007/s00586-026-10298-4},
url = {https://hal.science/hal-05734233v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Thoracolumbar fascia ultrasound and elastography biomarkers in low back pain: a systematic review of associations and responsiveness to intervention
AU - Robert Schleip
AU - Lea Overmann
AU - Marcus Müller
AU - Konstatin Warneke
AU - Stanislav Dimitri Siegel
AU - Katja Bartsch
AU - Torsten Pohl
AU - Sabine Bensamoun
AU - Guillaume Haiat
AU - Andreas Brandl
PY - 2026
DA - 2026/08/26
JO - European Spine Journal
DO - 10.1007/s00586-026-10298-4
UR - https://hal.science/hal-05734233v1
AB - Background and aim Traditional imaging methods often fail to identify the causes of nonspecific low back pain (NSLBP). The thoracolumbar fascia (TLF) has gained attention as a potential target for assessment with Quantitative Ultrasound (QUS). This systematic review examines the relationships between TLF QUS biomarkers (stiffness, shear strain, morphology, and microstructure) and NSLBP and how these biomarkers respond to interventions. Methods: Adhering to PRISMA 2020 guidelines, searches were conducted in MEDLINE, EMBASE, CENTRAL, and Scopus up to February 2026 for studies evaluating TLF QUS biomarkers in adults with NSLBP. Risk of bias was assessed using RoB 2, ROBINS-I, and NOS. Due to methodological heterogeneity, a narrative synthesis was performed. Findings: Fourteen studies involving approximately 880 participants met the inclusion criteria. In chronic NSLBP, several studies reported greater TLF thickness, altered echogenicity or microstructural texture parameters, and differences in stiffness compared with asymptomatic controls. However, stiffness findings were inconsistent across elastography modalities, with both higher and lower stiffness-related measures reported. Functional mobility findings also varied by clinical population and measurement protocol: studies in acute LBP generally reported reduced deformation, whereas studies in chronic LBP reported either reduced or increased shear strain. Preliminary intervention studies indicated changes in TLF thickness and selected stiffness-related measures following manual interventions, whereas single-session massage did not produce detectable changes in shear strain measures. Interpretation QUS studies have identified differences in TLF morphology, mechanical properties, mobility, and microstructural texture parameters between some individuals with NSLBP and asymptomatic controls. The direction and magnitude of these differences are not uniform and vary across populations, imaging modalities, and acquisition protocols. The available findings may be consistent with different patterns of fascial mechanical behavior, but the existence of distinct biological or clinically actionable TLF phenotypes remains hypothetical and requires prospective validation. Evidence regarding responsiveness to intervention is preliminary, and the clinical utility of these parameters for diagnosis, treatment selection, or outcome monitoring has not yet been established.
SN - 0940-6719
SN - 1432-0932
ER -