Back Muscles in the Lumbar Spine With Reference to Biomechanical Modeling: Erector Spinae (sacrospinalis)

 

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Erector Spinae (sacrospinalis)

Morphology and Function

According to Gray et al,[53] the erector spinae occurs from the anterior surface of a broad and thick tendon (i.e., the erector spinae aponeurosis). The muscle fibers form a large fleshy mass, which in the upper lumbar region, splits into 3 columns: spinalis (medial), longissimus (intermediate), and iliocostalis (lateral). The muscles lie in the groove on the side of the vertebral column, lateral to the multifidi, and are covered by the thoracolumbar fascia (Figure 3), in this case referred to as sacrospinalis. In general, the erector spinae cross the lumbar region without attachment to the lumbar vertebrae.[53]

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Figure 3.

The abdominal wall. Transverse section through the posterior abdominal wall. The erector spinae muscles lie in a groove on each side of the vertebral column, lateral to the multifidi, and are covered by a fascia. Reprinted with permission from Longman; 1973.[53]
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Figure 3.

The abdominal wall. Transverse section through the posterior abdominal wall. The erector spinae muscles lie in a groove on each side of the vertebral column, lateral to the multifidi, and are covered by a fascia. Reprinted with permission from Longman; 1973.[53]

Later studies have shown that it is too simple to describe the lumbar erector spinae as common muscles.[47,94] It was shown that the musculotendinous fibers of the lumbar erector spinae consist of 2 parts (a medial and a lateral division),[47,95] which are labeled as longissimus thoracis pars lumborum and iliocostalis lumborum pars lumborum, or simply a superficial and deep part.[94] A large part of the fibers from both parts of the lumbar origin is attached to the erector spinae aponeurosis.[47,94,96] Macintosh and Bogduk[16] provided a detailed description of the anatomy of the lumbar erector spinae. They subdivided the medial and lateral parts into 2 more divisions to 4 parts: (1) and (2) longissimus thoracis pars lumborum and pars thoracis, respectively; and (3) and (4) iliocostalis lumborum pars lumborum and pars thoracis, respectively.

The 2 lumbar parts consist of fascicles occurring from lumbar vertebrae, whereas the thoracic parts consist of fascicles occurring from thoracic vertebrae or ribs. The lumbar fibers attach differently from the thoracic fibers. They do not attach to the erector spinae aponeurosis as they pass between the lumbar vertebrae and ilium. Thus, the lumbar vertebrae are anchored directly to the ilium.[22] Macintosh and Bogduk[16] identified 5 fascicles belonging to the longissimus thoracis pars lumborum, each occurring from the accessory process and medial three quarters the transverse process of its respective lumbar vertebra. These fascicles insert on the posterior superior iliac spine either directly (L5) or with tendons forming the lumbar intermuscular aponeurosis. The iliocostalis lumborum pars lumborum consists of 4 large fascicles occurring from the lateral one quarter of the transverse process of L1-L4 and to the adjacent surface of the thoracolumbar fascia.

Each fascicle attaches directly to the iliac crest. The fascicle of both partes lumborum (longissimus and iliocostalis) can be resolved into horizontal and vertical vectors. Unilateral contractions flex the vertebral column in lateral direction, and bilateral contraction produces posterior sagittal rotation. Thus, they are well suited to cooperate with multifidi to oppose the flexion effect of the abdominal muscles when they act to rotate the trunk.[22] The 2 thoracic parts consist of fascicles occurring from thoracic vertebrae and ribs. The longissimus pars thoracis consists of 2 series of fascicles occurring from the thoracic transverse processes or ribs (below T3 or T4). Each of the 11 or 12 small fascicles consists of a cranial tendon, muscle belly, and caudal tendon. Each muscle belly overlaps those from lower levels, and is inserted via the erector spinae aponeurosis into the lumbar and sacral spinous processes, sacrum, and ilium.[5] The fascicle from the T2 level attaches to the L3 spinous process, and the fascicles from the remaining levels insert into processes at progressively lower levels.[22]

The iliocostalis lumborum pars thoracis consists of 8 or 9 small fascicles from the lower 8 or 9 ribs at the angulus, orientated in a parallel, caudomedial direction.[16] Each fascicle continues as a tendon, contributing to the erector spinae aponeurosis and ultimately attaching to the posterior superior iliac spine.[22] Physiologic cross-sectional area as well as length, angle, and force for the fascicles are presented in Table 6 . The thoracic parts act indirectly on the lumbar vertebral column. When contracting bilaterally, they can increase the lordosis of the lumbar spine and, acting unilaterally, they move the thoracic cage laterally and, thereby, indirectly flex the lumbar vertebral column.[22] Bustami[94] concluded that the deep part of the lumbar erector spinae acts primarily on the lumbar and lower thoracic vertebrae, while the superficial part acts directly on the lower 10 ribs and indirectly on the corresponding vertebrae.

The erector spinae aponeurosis is a broad sheet of tendinous fibers from which the erector spinae muscles occur. It is attached to the median sacral crest, spinous processes of the lumbar vertebrae, and ilium.[53] According to Bogduk,[22] it is formed exclusively by the tendons of the longissimus thoracis pars thoracis (medial half) and iliocostalis pars thoracis (lateral half). The fact that the lumbar fibers of the erector spinae do not attach to the aponeurosis suggests that these fibers may act independently from the rest of the erector spinae.

According to fiber type, a majority of ST fibers are present in the erector spinae. Mannion et al [97] found 66% (±7.7) ST fibers in male and 66.5% (±12) ST fibers in female erector spinae. Jorgensen et al [98] found 65% to 73% ST fibers in the lumbar longissimus and 52% to 58% ST fibers in the lumbar iliocostalis. In addition, Rantanen et al [86] found 66% ST fibers in the lumbar iliocostalis (male and female). Values for cross-sectional area, length, and moment arms are presented in Table 7 .

 
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Table 1. Ranges of Segmental Motion for the Lumbar Spine (in Degrees)

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Table 2. Muscle Contraction Force (Force/Cross—Sectional Area)

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Table 3. The Fascicles of Psoas Major

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Table 3. The Fascicles of Psoas Major

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Table 4. Data for the Psoas Major Muscle

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Table 5. Fascicles of Multifidi and Erector Spinae

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Table 6. Data for the Multifidi Muscles

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Table 6. Data for the Multifidi Muscles

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Table 7. Data for Erector Spinae

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Table 8. Data for Quadratus Lumborum

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Authors and Disclosures

Lone Hansen, PhD,* Mark de Zee, PhD,† John Rasmussen, PhD,† Thomas B. Andersen, PhD,‡ Christian Wong, PhD,§ and Erik B. Simonsen, PhD*

*Institute of Medical Anatomy, Biomech. and Motor Control, University of Copenhagen, Denmark
†Institute of Mechanical Engineering, Aalborg University, Denmark
‡Department of Sport Sciences, University of Aarhus, Denmark
§Department of Orthopaedics, University Hospital Malmö, Sweden

 
 
 
 
 
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