Ross Hauser, MD; Danielle Matias, PA-C; Demi Foster, APRN
A 2022 paper in the Journal of Back and Musculoskeletal Rehabilitation (1) writes “Maigne’s Syndrome (also diagnosed as thoracolumbar junction syndrome) is an often unrecognized and treatable cause of low back pain. It can be separated into two distinct entities. The central variant is a result of nerve afferent input (pain signals) secondary to changes in facet joint arthropathy (degenerative spine disease) at the thoracolumbar junction. The peripheral variant is a result of impingement of the medial branch of the superior cluneal nerve and results in similar clinical symptoms and signs.” These signs and symptoms could include pain on one side of the body, problems in the hamstrings, numbness running down the back of the leg, pain in the groin, and pain in the testicles.
The thoracolumbar joint is where the thoracic spine meets the lumber spine. There is great stress at this joint as the thoracic spine is more rigid in structure and the lumbar spine is more flexible to account for low back range of motion.
As stated, Maigne’s syndrome can often be misdiagnosed as lower back pain, sacroiliac joint (SI joint) problems, or hip pain, or it can mimic other problems such as urinary infections.
The treatment of Maigne’s syndrome typically follows that of low back pain as symptoms typically manifest themselves in the low back, and buttock regions with pain running down into the legs. These treatments include:
- Painkillers and anti-inflammatory medications.
- Physical therapy and exercise.
- Corticosteroids injections.
- Spinal manipulation
- Acupuncture
A June 2023 study in the journal Medicine (2) assessed the effectiveness of acupuncture for patients with Maigne’s syndrome. In this case series, six patients with low back pain were treated with acupuncture targeting the T11-L2 facet joints, with additional acupoints selected based on the specific nerve entrapment of Maigne’s syndrome including the superior cluneal, subcostal, and iliohypogastric nerves. Following acupuncture therapy, all patients reported improvements in their low back pain symptoms, while four patients also showed improvement in their thoracic vertebrae compression test (the clinician presses between the shoulder blades to recreate pain) results.
A May 2017 study in the Open Orthopaedics Journal (3) assessed the effectiveness of exercise and local steroid injections for Thoracolumbar Junction Syndrome (Maigne’s Syndrome). In this study, thirty patients were divided into 3 treatment groups and the results of each modality were compared.
- The first group received exercise therapy,
- the second group was treated with local steroid injections, and,
- the third group was the combination therapy group of both injection and exercise.
While showing all three treatment groups in the scores at rest or at movement, the best results were obtained in the group administered the combined injection and exercise therapy.
Cluneal nerve entrapment
Maigne’s syndrome summary video and discussion of Prolotherapy
Danielle R. Steilen-Matias, MMS, PA-C
Hi everyone, I am Danielle Matias here at Caring Medical, Florida.
I wanted to share with you a recent case that I saw that was really interesting involving thoracolumbar syndrome. Patients with this syndrome, while considered not very common although, we’re finding that it actually might be a little bit more common than we think, patients with this syndrome complain of low back pain, maybe in that lumbar, or pelvic area but the pain generator is actually coming from a little bit farther the spine.
So we have our cervical spine, our neck, our thoracic spine, and our midback and then lumbar to sacrum. So this area here, where that thoracic spine meets the lumbar, that’s the area that we’re talking about.
So patients with this syndrome will oftentimes come in complaining of pain down here, they have pain in the back right by their SI joint, pelvis, their buttock, they might even get pain down into their hip area and so you would think intuitively oh let’s see what’s going on here right that’s where the pain is that’s got to be right where the pain generator is but people with thoracolumbar syndrome lumbar syndrome actually it’s coming from way up here.
This patient that I had came in for low back pain down by that pelvis, SI joint and we really in my opinion did a very good job doing Prolotherapy to the lumbar spine but we weren’t quite getting rid of his pain, things are better but they’re kind of moving slowly it’s not quite meeting the treatment goals.
So we did a motion x-ray and focusing on T11 / T12 and could see a “step-like” pattern that while not generating pain in that area, was generating pain in the lumbar region. We started targeting our Prolotherapy into the Thoracolumbar joint and in this patient’s case, he started to feel so much better so we did three more additional treatments on that area and he finally got back to exercising and doing the things he wanted to do and it wasn’t that he wasn’t improving when we did the lumbar spine he wasn’t making as many gains as we both expected until we really started targeting that area.
Video Player
To learn more about Prolotherapy see:
1 Randhawa S, Garvin G, Roth M, Wozniak A, Miller T. Maigne syndrome–a potentially treatable yet underdiagnosed cause of low back pain: a review. Journal of Back and Musculoskeletal Rehabilitation. 2022 Jan 1;35(1):153-9. [Google Scholar]
2 Lee H, Chae H, Ryu M, Yang C, Kim S. Acupuncture for patients with Maigne’s syndrome: A case series. Medicine. 2023 Jun 9;102(23):e33999. [Google Scholar]
3 Alptekin K, Örnek NI, Aydın T, Alkan M, Toprak M, Balcı LA, Alptekin JÖ. Effectiveness of exercise and local steroid injections for the thoracolumbar junction syndrome (The Maigne’s syndrome) treatment. The open orthopaedics journal. 2017;11:467. [Google Scholar]