Skip to main content
SpringerLink
Log in

The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

The anatomy of the middle layer of lumbar fascia (MLF) is of biomechanical interest and potential clinical relevance, yet it has been inconsistently described. Avulsion fractures of the lumbar transverse processes (LxTP’s) are traditionally attributed to traction from psoas major or quadratus lumborum (QL), rather than transversus abdominis (TrA) acting via the MLF. This attachment is also absent from many biomechanical models of segmental control. The aims of this study were to document: (1) the morphology and attachments of the MLF and (2) the attachments of psoas and QL to the LxTP’s. Eighteen embalmed cadavers were dissected, measuring the thickness, fibre angle and width of the MLF and documenting the attachments of MLF, psoas and QL. The MLF was thicker at the level of the LxTP’s than between them (mean 0.62: 0.40 mm). Psoas attached to the anteromedial surface of each process and QL and TrA to its lateral border; QL at its upper and lower corners and TrA (via the MLF) to its tip. In three cadavers, tension applied to the MLF fractured a transverse process. The MLF has a substantial and thickened attachment to the tips of the LxTP’s which supports the involvement of TrA in lumbar segmental control and/ or avulsion fracture of the LxTP’s.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Armstrong JR (1965) Lumbar disc lesions; pathogenesis and treatment of low back pain and sciatica, 3rd edn. E. & S. Livingstone, Edinburgh

    Google Scholar 

  2. Barker PJ, Briggs CA (1999) Attachments of the posterior layer of lumbar fascia. Spine 24(17):1757–1764

    Article  PubMed  CAS  Google Scholar 

  3. Barker PJ, Briggs CA, Bogeski G (2004) Tensile transmission across the lumbar fasciae in unembalmed cadavers: effects of tension to various muscular attachments. Spine 29(2):129–138

    Article  PubMed  Google Scholar 

  4. Barker PJ, Guggenheimer KT, Grkovic I, Briggs CA, Jones DC, Thomas CD et al (2006) Effects of tensioning the lumbar fasciae on segmental stiffness during flexion and extension: young investigator award winner. Spine 31(4):397–405

    Article  PubMed  Google Scholar 

  5. Basmajian JV, Slonecker CE (1989) Grant’s method of anatomy: a clinical problem-solving approach, 11th edn. Williams & Wilkins, Baltimore, p 37

  6. Cresswell AG, Grundstrom H, Thorstensson A (1992) Observations on intra-abdominal pressure and patterns of abdominal intra-muscular activity in man. Acta Physiol Scand 144(4):409–418

    PubMed  CAS  Google Scholar 

  7. Dandy DJ, Edwards DJ (1998) Essentials of orthopaedics and trauma, 3rd edn. Churchill Livingstone, New York, p 157

  8. Davies-Colley JNC (1894) The muscles. J & A Churchill, New York, pp 433–434

    Google Scholar 

  9. Debrunner HU (1971) Biomechanics of the spine. Z Unfallmed Berufskr 64(4):245–254

    PubMed  CAS  Google Scholar 

  10. Frazer JE (1933) The anatomy of the human skeleton, 3rd edn. J. & A. Churchill, London, pp 31–43

  11. Gilsanz V, Miranda J, Cleveland R, Willi U (1980) Scoliosis secondary to fractures of the transverse processes of lumbar vertebrae. Radiology 134(3):627–629

    PubMed  CAS  Google Scholar 

  12. Hides JA, Jull GA, Richardson CA (2001) Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 26(11):E243–E248

    Article  PubMed  CAS  Google Scholar 

  13. Hodges PW, Richardson CA (1996) Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine 21(22):2640–2650

    Article  PubMed  CAS  Google Scholar 

  14. Hodges PW, Richardson CA (1998) Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord 11(1):46–56

    Article  PubMed  CAS  Google Scholar 

  15. Hollinshead WH (1962) Textbook of anatomy. Harper & Row Publishers, New York, pp 348–431

  16. Howarth MB, Petrie JG (1964) Injuries of the spine. Williams & Wilkins, Baltimore, p 265

  17. Krueger MA, Green DA, Hoyt D, Garfin SR (1996) Overlooked spine injuries associated with lumbar transverse process fractures. Clin Orthop 327:191–195

    Article  PubMed  Google Scholar 

  18. Marshall R (2001) Living anatomy: structure as the mirror of function. Melbourne University Press, Melbourne, pp 280–283

  19. McRae R (1998) Practical fracture treatment, 3rd edn. Churchill Livingstone, Edinburgh, p 230

  20. Miller CD, Blyth P, Civil ID (2000) Lumbar transverse process fractures- a sentinel marker of abdominal organ injuries. Injury 31(10):773–776

    Article  PubMed  CAS  Google Scholar 

  21. O’Sullivan PB, Twomey LT, Allison GT (1997) Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 22(24):2959–2967

    Article  PubMed  CAS  Google Scholar 

  22. Otte D, Sandor L, Zwipp H (1990) Significance and mechanism of thoracic and lumbar spine injuries in traffic accidents. Unfallchirurg 93(9):418–425

    PubMed  CAS  Google Scholar 

  23. Panjabi M, Abumi K, Duranceau J, Oxland T (1989) Spinal stability and intersegmental muscle forces. A biomechanical model. Spine 14(2):194–200

    Article  PubMed  CAS  Google Scholar 

  24. Panjabi MM (1992) The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord 5(4):390–396

    Article  PubMed  CAS  Google Scholar 

  25. Patten RM, Gunberg SR, Brandenburger DK (2000) Frequency and importance of transverse process fractures in the lumbar vertebrae at helical abdominal CT in patients with trauma. Radiology 215(3):831–834

    PubMed  CAS  Google Scholar 

  26. Poirier P (1901) Myologie. In: Poirer P, Charpy A (eds) Traite d’Anatomie Humaine. Masson et Compagnie, Paris, pp189–190, 497

  27. Salmhofer W, Rieger E, Soyer HP, Smolle J, Kerl H (1996) Influence of skin tension and formalin fixation on sonographic measurement of tumor thickness. J Am Acad Dermatol 34(1):34–39

    Article  PubMed  CAS  Google Scholar 

  28. Sharpey W, Thomson A, Cleland J (eds) (1867) Quain’s elements of anatomy, 7th edn. James Walton Publishing, London, pp 248–253, 266

  29. Tesh KM (1986) The abdominal muscles and vertebral stability. PhD Thesis, University of Strathclyde, Glasgow, pp 166–349

  30. Tesh KM, Dunn JS, Evans JH (1987) The abdominal muscles and vertebral stability. Spine 12(5):501–508

    Article  PubMed  CAS  Google Scholar 

  31. Testut L, Latarjet A (1948) Traite d’anatomie humaine, 9th edn. G. Doin & Compagnie, Paris, pp 944–952, 1107–1109

  32. Urquhart DM, Barker PJ, Hodges PW, Story IH, Briggs CA (2005) Regional morphology of the transversus abdominis and obliquus internus and externus abdominis muscles. Clin Biomech (Bristol, Avon) 20(3):233–241

    Article  Google Scholar 

  33. Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE et al (eds) (1995) Gray’s anatomy, 38th edn. Churchill Livingstone, New York, pp 809–829

Download references

Acknowledgments

The authors sincerely thank Dr Colin Anderson (Department of Anatomy and Cell Biology, The University of Melbourne), Mr. Robert Marshall (Surgeon’s Rooms: 24 Collins Street, Melbourne) and Dr. Alex Pitman (Diagnostic Imaging, Peter MacCallum Cancer Institute) for valued advice. Thanks also to Stuart Thyer for photography, Mathew Jackson and Diana Keshtiar (Department of Anatomy and Cell Biology, The University of Melbourne) for technical assistance.

Author information

Authors and Affiliations

  1. Department of Anatomy and Cell Biology, The University of Melbourne, Parkville, VIC, 3010, Australia

    Priscilla J. Barker, Marius Fahrer & Christopher A. Briggs

  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Donna M. Urquhart

  3. School of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia

    Donna M. Urquhart & Ian H. Story

  4. Faculty of Health and Behavioural Sciences, Deakin University, Burwood, VIC, Australia

    Ian H. Story

Authors
  1. Priscilla J. Barker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donna M. Urquhart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ian H. Story
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marius Fahrer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher A. Briggs
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Priscilla J. Barker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Barker, P.J., Urquhart, D.M., Story, I.H. et al. The middle layer of lumbar fascia and attachments to lumbar transverse processes: implications for segmental control and fracture. Eur Spine J 16, 2232–2237 (2007). https://doi.org/10.1007/s00586-007-0502-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-007-0502-z

Keywords

Search

Navigation