Functional Anatomy of the Lumbar Spine
Nabil A. Ebraheim, MD,* Ali Hassan, MD,
Ming Lee, MS,
and Rongming Xu, MD
The dysfunction of the lumbar spine has a pivotal role in etiology of low back pain. A thorough knowledge of the functional anatomy of the lumbar spine is needed to aid inunderstanding the mechanisms that lead to low back pain and to provide rationale ofmanagement. This article reviews functional anatomy of the lumbar spine involving thebony structures, articulation, ligaments, muscles, blood supply, and neural structures.Semin Pain Med 2:131-137 © 2004 Elsevier Inc. All rights reserved.
anatomy, lumbar spine, low back pain
he dysfunction of the lumbar spine has a pivotal role inetiology of low back pain. A thorough knowledge of thefunctional anatomy of the lumbar spine is needed to aid inunderstanding of the mechanisms that cause low back painand to provide rationale of management. This article reviewsthe functional anatomy of the lumbar spine involving thebony structures, articulation, ligaments, muscles, blood sup-ply, and neural structures.
There are 5 lumbar vertebrae, followed by the sacrum. Eachlumber vertebra has 2 parts, the vertebral body and neuralarch. The vertebral body lies anteriorly, and its dimensionsgradually increase from cephalad to caudal. The neural archlies posterior to vertebral body and consists of a pair of pedicles emerging from the postero-lateral surface of the up-per portion of vertebral body that joins with paired laminae,which are located further posteriorly (Fig. 1). When viewedfrom above, the superior surface of vertebral body is widertransversely and resembles to kidney’s shape. The spinal ca-nalistriangular,whichismostdistinguishableattheL5level.The angled lateral borders of the spinal canal are called thelateral recesses, which constitute the bony canal of the spinalnerve root. Pedicles are short and have a slight medial incli-nation.In general, the pedicle width increases gradually from L1toL5butthepedicleheightvariesbetweenindividuals(Table1).
The pedicle lengths measured between the dorsal andventral cortex of the vertebra averages between 40 and 50mm. The medial inclination of the lumbar pedicle increasesconsistently from L1 to L5. The projection point of the pedi-cle axis is located above the midline of the transverse processat the levels above L4. At L4, the projection point is close tothe midline of the transverse process. At L5, this point islocated inferior to the midline of the transverse process.
The lamina is thicker and oriented in a more vertical di-rectioninthesagittalplaneascomparedwiththecervicalandthoracic spines. The lamina may be divided into 2 portions:the cephalic and caudal.
The cephalic portion is arched andhas a smooth inner surface, whereas the caudal portion has arough inner surface, which is the site for the attachment of the ligamentum ﬂavum.The portion of the lamina between the superior and infe-riorarticularprocessesandjustbelowthelevelofthepedicleis the isthmus or pars interarticularis, which is the commonsite of stress fractures. The superior and inferior articularfacets are quite different from the cervical and thoracic re-gions, which are orientated in the sagittal plane. In lumberregion, the superior articular surface is concave and facesposteromedially, and the inferior articular surface is convexand faces anterolaterally. The facet angles relative to the sag-ittal plane ranges from 120° to 150°, with a trend of consis-tent decrease from L1 to L5.
From the junction of 2 lamina,a spinous process arises posteriorly. It is almost horizontal,quadrangular, and thickened along its posterior and inferiorborders.
Articulations and Ligaments
The articulations include the intervertebral disc anteriorlyand a pair of the facet or zygapophyseal joints posteriorly,reinforced by ligaments. The intervertebral discs, which are
*DepartmentofOrthopaedicSurgery,MedicalCollegeofOhio,Toledo,OH.†Department of Anesthesiology, Medical College of Ohio, Toledo, OH.‡Department of Orthopaedic Surgery, Ningbo 6th Hospital, Ningbo, Zhe- jiang, P.R. China. Address correspondence to Nabil A. Ebraheim, MD, Department of Ortho-paedic Surgery, Medical College of Ohio, 3000 Arlington Avenue, To-ledo, OH 43614.
1537-5897/04/$-see front matter © 2004 Elsevier Inc. All rights reserved.doi:10.1016/j.spmd.2004.08.004