The morphology and function of the lumbar region is poorly understood. Better understanding of lumbar regional anatomy may enable improved understanding of lumbar stability and may also improve the clinical management of low back pain. Extensive researches have been carried out on the thoracolumbar anatomy and biomechanics. However, these studies lacked detailed anatomical knowledge about the morphology and function of the lumbar region. This study aims to provide a precise and detailed description of the anatomy of the lumbar spine and its supporting structures. A detailed and thorough literature review of background data was undertaken. Gross degenerative features in the lumbar vertebrae were documented. Three dimensional models of the superior and inferior lumbar articular facets were created by Microscribe. This allowed calculation of the facet orientation and surface area by Rhinoceros software. The surface area was increased towards the inferior vertebral levels, while the orientation became less sagittal inferiorly. The investigations suggest that the coronally oriented facet protects and supports the facet joint, while the sagittal orientation may predispose the facet joint to degenerative spondylisthesis. Gross observation of the thoracolumbar fascia documented the superficial myofascial thickenings, decussation and connections. The posterior and middle layers of the thoracolumbar fascia were identified. A three dimensional model enabled visualization of the bilaminar layers of the fascia which was reconstructed in a virtual space. The morphological measurements of the lumbar multifidus, longissimus and iliocostalis muscles were taken. The cross sectional area of the multifidus muscle was increased gradually towards the L5 level. The foot prints of the multifidus, longissimus, iliocostalis lumborum and inter-spinalis muscles enabled the measurement of the surface areas of the attachments of these muscles. The histological study revealed the fibrous enthesis of the iliocostalis muscle and its indirect attachment to the transverse process of the lumbar spine. The multifidus muscle is attached by a fibrocartilaginous enthesis to the articular process and the facet joint capsule. This study suggests that multifidus muscle supports and stabilizes the facet joints. The lumbar enthesis investigation should receive more attention in future studies. The clinical implications of different lumbar structures and functions may provide insight about the lumbar dysfunction. The ability to identify such differences in situ may facilitate varied clinical management of the various types of lumbar disorders.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:656247 |
| Date | January 2015 |
| Creators | Sami, Bahgat Abdulkareem |
| Publisher | University of Glasgow |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://theses.gla.ac.uk/6506/ |
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