Thoracolumbar injury classification and severity score. Posterior layer covering all of the muscles from the lumbosacral region through the thoracic region, as far up as the cervical splenii attachments. The thoracolumbar spine describes the area containing both the thoracic and lumbar vertebrae of the spine, states radiology master class. Thoracolumbar aponeurosis definition of thoracolumbar.
Thoracolumbar fracturedislocation spine orthobullets. The most lateral fibres from latissimus dorsi attach via short tendons directly to the iliac crest and do not contribute to the posterior layer of the. The biomechanics of the thoracolumbar fascia sciencedirect. From the posterolateral sacrum, thoracolumbar fascia, aponeurosis of erector spinae, posterior ilium and iliac crest, dorsal sacroiliac ligaments, sacrotuberous ligament and coccygeal vertebrae to merge into the iliotibial band of fascia lata anterior fibers and to insert into the gluteal tuberosity posterior fibers. The thoracolumbar fascia lumbodorsal fascia is a deep investing membrane which covers the deep muscles of the back of the trunk in the cervical region, it passes in front of the serratus posterior superior and is continuous with a similar investing layer. This is the junction between the thoracic spine and the lumbar spine. The thoracolumbar fascia also plays an essential role in walking as it harnesses and facilitates many of the forces required for gait especially contralateral, or alternating, movement.
From the posterolateral sacrum, thoracolumbar fascia, aponeurosis of erector spinae, posterior. The fascia which covers the deep muscles of the back. The thoracolumbar fascia is a richly innervated, with marked differences in the distribution of the nerve endings, over various fascial layers. Speciwc attention was given to the attachments of the. This latter tissue has also been termed axial or appendicular fascia based on its location willard. You may be thinking that a tendon also attaches muscle to bone, and you are correct.
Pdf the anatomy of the middle layer of lumbar fascia mlf is of. Thoracolumbar spine anatomy and pathology midlumbar vertebra. The superficial fascia contains a dense presence of sensory mechanoreceptors such as pacini receptors and ruffini endings. Uams department of neurobiology and developmental sciences. What is the difference between an aponeurosis and a tendon. Thoracolumbar fascia does not influence proprioceptive signaling from lumbar. The thoracolumbar fascia plays an important role in human movement as it not only serves as an attachment site for numerous muscles in the. Surgical treatment has been performed through the posterior fixation pedicle fixation systems, and where necessary complemented by decompression of the spinal arthrodesis and previous channel.
The thoracolumbar fascia plays an important role in human movement as it not only serves as an attachment site for numerous muscles in the lumbar, thoracic, and sacral regions, but also is an important area of transition between the upper and lower extremities where forces are transferred to allow for coordinated function. Attachment of the paraspinal muscles to the inside wall of the sheath is accomplished through very loose connective tissue fascia posteriorly. Thoracolumbar aponeurosis what structure is a fibrous membrane, which, in the neck, represents the supraspinal ligaments of the lower vertebra. An aponeurosis is a type of connective tissue that provides a point for a muscle to attach to a bone or cartilage. The thoracolumbar fascia is a band of connective tissue present in the lower back. Thoracolumbar syndrome definition of thoracolumbar. Anatomy and biomechanics of the vertebral aponeurosis part. The thoracolumbar spine is the anatomical frontier where the thoracic spinal region meets the lumbar spinal region. It is typically referred to in the case of a spinal injury. May 11, 2020 the thoracolumbar fascia is a large, roughly diamondshaped area of connective tissue constituted by the thoracic and lumbar parts of the deep fascia enclosing the intrinsic back muscles. Thoracicolumbar definition is of, relating to, arising in, or involving the thoracic and lumbar regions. To a certain degree every step we take is a spinal twist and this twist is expedited through the thoracolumbar fascia. Understanding thoraco lumbar functional anatomy and biomechanics is essential for any clinician treating low back pain. First is pannicular or superficial lancerotto et al.
The thoracolumbar fascia is a vital intersection of muscles that not only give us. The erector spinae x1 has the following attachments origin. For some thoracolumbar fractureluxation scenarios, both basic plating equipment see pp. The thoracolumbar fascia has quite a few important muscles and tendon around it. The thoracolumbar segment fractures are the most frequent along the spine, and surgical treatment is indicated in unstable fractures. The erector spinae aponeurosis is a common aponeurosis that blends with the thoracolumbar fascia, with a proximal attachment on the sacrum an the spinous processes of the lumbar vertebrae, for the three erector spinae muscles iliocostalis, longissimus, and spinalis and overlying the inferior portion of the erector spinae muscles. This blog post article is an overview of the muscles of the lumbar spine of the trunk. The deep fascia of the back attaches medially to the nuchal ligament, the tips of the spinous processes of the vertebrae, the supraspinous ligament, and. An aponeurosis is a type or a variant of the deep fascia, in the form of a sheet of pearlywhite fibrous tissue that attaches sheetlike muscles needing a wide area of attachment. How to care for yourself after thoracolumbar spinal fusion what is thoracolumbar spinal fusion. Thoracic spinal fusion is the placement of screws and rods to steady the spine. The threelayered model 2 differs from the model containing two layers as follows. You can think of it as a flat sheet of tendons merged together.
For more complete coverage of the structure and function of the low back and pelvis, the muscular system manual the skeletal muscles of the human body, 4th ed. The thoracolumbar fascia tlf is a specialized form of fascia known as an aponeurosis. Via its extensive attachment to vertebral spines, the thoracolumbar fascia is. Thoracolumbar aponeurosis information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. An aponeurosis is defined as a white tendinous extension of a muscle, connecting it to the structures that it moves. Thoracolumbar definition of thoracolumbar by the free.
The posterior layer is composed of 2 layers referred to as the superficial and deep laminae, and has strong connections with the sacrum, psis, l4 and l5, lpsl, and to the aponeurosis of the es. Here the spinal curvature changes from kyphosis to lordosis, and the orientation of the facet joints changes from coronal to. Fractures associated with posterior facet dislocation occuring at the thoracolumbar junction ao type c epidemiology. It originates posteriorly from the medial process of the tuberosity of calcaneus heel bone. In the region of the l5 the lower most lumbar vertebrae and the sacrum, the erector spinae aponeurosis is fused with the posterior layer of the prs as well as the more superficial layers of the thoracolumbar fascia, generally portions of the aponeurosis of the latissimus dorsai, to form a composite structure called the thoracolumbar composite. This is a place of transition, since the middle back is primary designed for support and protection, while the lumbar spine is designed for incredible flexibility and a diverse range of motion. Pdf the middle layer of lumbar fascia and attachments to lumbar. The difference between a bursa and a tendon is that a bursa is a synovial pocket insterted between a tendon and a bony prominance. Some of the material presented in these tables is contained in the book. In the thorax it forms the dorsal investment of the epaxial and serratus posterior superior muscle and separates these muscles from the limb muscles that project onto the dorsum of the trunk. The junction consists of the part of the vertebral column from the eleventh thoracic vertebra to the first lumbar vertebra. Pathological fracture of a midlumbar vertebra that had been weakened by a hypernephroma metastasis.
The thoracolumbar fascia is the name given to the investing fascia of the body wall musculature in the dorsal aspect of the trunk. The thoracolumbar fascia is a vital intersection of muscles that not only give us stability through our low back, but also allow for an efficient transfer of motion both from our upper body to. Below, it is attached to the iliolumbar ligament, the iliac crest and the sacroiliac joint. Low back pain is easier to understand when you consider it in terms of the thoracolumbar fascia. Over the last several decades, incremental improvements in understanding the natural history of. Thoracolumbar medical definition merriamwebster medical. The thoracolumbar fascia lumbodorsal fascia or thoracodorsal fascia is a deep investing membrane throughout most of the posterior thorax and abdomen although it is a thin fibrous lamina in the thoracic region. The thoracolumbar fascia is the complex layering of fascia that surrounds the body wall muscles of the thoracic and lumbar regions of the trunk. Thoracic spine, also know as tspine, pertains to the upper back and abdomen area, and is one of three major sections of the spinal column, states. The attachment of the aponeurosis of the spi begins on the lateral border of the posterior wall of the prs deep lamina of the posterior tlf and extends medially to reach the spinous processes and supraspinal ligament of the lumbar vertebrae. Thoracolumbar junction dysfunction maigne syndrome written by kieran macphail on september, 2011. Their primary function is to join muscles and the body parts they act upon, whether it be bone or other muscles.
The thoracolumbar fascia is a large, roughly diamondshaped area of connective tissue constituted by the thoracic and lumbar parts of the deep fascia enclosing the intrinsic back muscles. Carolyn goslett view essential orthopaedics and trauma. They have a shiny, whitishsilvery color, are histologically similar to tendons, and are very sparingly supplied with blood vessels and nerves. Vleeming et al 2007 note that, through thoracolumbar fascia, gluteus maximus is coupled to the. Both the upper and the lower endplates have yielded in an almost symmetrical fashion and triangular bone fragments are tilted so as to create the appearance of a fish vertebra. Thoracolumbar fascia an overview sciencedirect topics. How to care for yourself after thoracolumbar spinal fusion. Above, it is continuous with a similar investing layer on the back of the neckthe nuchal fascia it is formed of longitudinal and transverse fibers that bridge the aponeuroses of. Classification systems for thoracolumbar trauma continue to evolve. It has three planes that attach to the spines and transverse processes of the vertebral column and the iliac crest and sacrum. The function of the palmar aponeurosis is purely mechanical.
Via its extensive attachment to vertebral spines, the thoracolumbar fascia is attached to the supraspinous and interspinous ligaments and to the capsule of the facet joints. When dissected, aponeuroses are papery and peel off by sections. The superficial lamina is formed by the aponeurosis of latissimus dorsi. Surgical treatment of the thoracolumbar spine fractures. Thoracolumbar fascia an area rich with activity mike reinold. Using a generalized system of classification, the fascial system contains four fundamental types. It acts as an attachment site for the trapezius muscle, latissimus dorsi, gluteus maximus and the hamstrings group of muscles thus playing an important role in body. Lumbar fascia is the fascia enclosing the deep muscles of the back. Helen langevin is back as part of a yet another team of researchers from several universities studying the thoracolumbar fascia. Pain over the hips is frequently a result of dysfunction in the thoracolumbar junction. Thoracolumbar junction dysfunction maigne syndrome. Thoracicolumbar definition of thoracicolumbar by merriam.
The thoracolumbar fascia is a deep investing membrane throughout most of the posterior thorax and abdomen although it is a thin fibrous lamina in the thoracic. Pdf anatomy and biomechanics of the vertebral aponeurosis part. Thoracolumbar definition at, a free online dictionary with pronunciation, synonyms and translation. The neurosurgical instrumentation required for surgery of the thoracolumbar spine is essentially the same as that used for brain p. Kellgren 1939 first established that injection of the thoracolumbar interspinous ligaments in healthy volunteers. The thoracolumbar fascia the footballsized diamondshaped area of fascia in the small of the back is unique because its made up of several layers of musculotendinous attachments and fascia from around the body. Of or relating to the thoracic and lumbar parts of the spinal column. An aponeurosis is a broad sheet of dense fibrous connective tissue that covers and forms the endpoints and attachments of several muscles.