An Anatomical Exploration of the Structures Associated with Low Back Pain Caused by Maigne's Syndrome

Background Low back pain (LBP) is one of the leading causes of activity limitation and work absence throughout much of the world. One potential cause of LBP that is frequently unrecognized is referred pain from the dorsal rami originating from the thoracolumbar junction (TLJ). The dorsal rami traverse in close proximity to the zygapophyseal (facet) joints, which have been proven to be a source of LBP since 1911. Dr. Robert Maigne, a French physician and cofounder of the French Society of Manual Rehabilitation, performed extensive research on the relationship between these two anatomical structures and their correlation to LBP. He defined “Maigne's Syndrome” as segmental dysfunction of the facet joints at the TLJ (T12‐L1), and secondary referred pain to the ipsilateral iliac crest and buttock regions. He also noted a similar pain presentation due to entrapment of the superior cluneal nerves (SCNs) as they pierce the thoracolumbar fascia (TLF) at the peak of the iliac crest. Objective An independent dissection of the dorsal primary rami and branches of T12 to L2 was performed to highlight the areas involved with lesions seen with Maigne's Syndrome, and a comprehensive literature review on the topic was also conducted. A further goal was to develop a dissection technique for the dorsal rami that could be used in first‐year medical and health sciences gross anatomy courses. Discussion Maigne's Syndrome is said to account for 10% to 30% 18 of LBP. Although specific mechanisms associated with the etiology of Maigne's Syndrome remain unclear, researchers do agree that the thoracolumbar region (T12‐L1) serves as a transitional segment prone to excessive stresses by inordinate rotational movements. Disruption in the transition of forces through the spine at the TLJ can lead to segmental dysfunction contributing to the syndrome. Maigne's Syndrome is underdiagnosed because pain is rarely felt at the thoracolumbar region, but rather presents in a similar fashion to LBP of lumbosacral origin. This dissection illustrates the close relationship between the facet joints and the dorsal primary rami located in the TLJ, other potential entrapment sites, and the unique distribution of the SCNs as they originate from the TLJ and supply the skin over the gluteal region. No anatomical variations were discovered during the dissection and the anatomy represented in this dissection matches that described by Bogduk et al., Maigne et al., and Zhou et al. Conclusions A dissection protocol was developed highlighting the dorsal primary ramus and its branches that could be replicated by first‐year gross anatomy students with moderate assistance from laboratory faculty. The results from the present cadaveric dissection and review of the literature provide clinicians with a better understanding of the anatomy associated with Maigne's Syndrome and its associated pain referral patterns. However, further research is required to better demonstrate the role of the dorsal primary rami in the genesis of LBP, and to determine appropriate clinical interventions for this type of back pain. Support or Funding Information No funding was received in support of this research. This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal .