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A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia

Mark Schuenke, Adriaan Vleeming UGent, Tom Van Hoof UGent and Frank Willard (2012) JOURNAL OF ANATOMY. 221(6). p.568-576
abstract
Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myofascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
lateral raphe, lumbar interfascial triangle, lumbar spine, paraspinal retinacular sheath, pelvis, transversus abdominis, thoracolumbar fascia, LOW-BACK-PAIN, TRANSVERSUS ABDOMINIS, POSTERIOR LAYER, SPINE, MUSCLES, ATTACHMENTS, MORPHOLOGY, TRANSMISSION, CONTRACTION, STIFFNESS
journal title
JOURNAL OF ANATOMY
J. Anat.
volume
221
issue
6
pages
568 - 576
Web of Science type
Article
Web of Science id
000310392500006
JCR category
ANATOMY & MORPHOLOGY
JCR impact factor
2.357 (2012)
JCR rank
5/20 (2012)
JCR quartile
2 (2012)
ISSN
0021-8782
DOI
10.1111/j.1469-7580.2012.01517.x
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2112585
handle
http://hdl.handle.net/1854/LU-2112585
date created
2012-05-24 16:48:51
date last changed
2013-05-14 13:34:39
@article{2112585,
  abstract     = {Movement and stability of the lumbosacral region is contingent on the balance of forces distributed through the myofascial planes associated with the thoracolumbar fascia (TLF). This structure is located at the common intersection of several extremity muscles (e.g. latissimus dorsi and gluteus maximus), as well as hypaxial (e.g. ventral trunk muscles) and epaxial (paraspinal) muscles. The mechanical properties of the fascial constituents establish the parameters guiding the dynamic interaction of muscle groups that stabilize the lumbosacral spine. Understanding the construction of this complex myofascial junction is fundamental to biomechanical analysis and implementation of effective rehabilitation in individuals with low back and pelvic girdle pain. Therefore, the main objectives of this study were to describe the anatomy of the lateral margin of the TLF, and specifically the interface between the fascial sheath surrounding the paraspinal muscles and the aponeurosis of the transversus abdominis (TA) and internal oblique (IO) muscles. The lateral margin of the TLF was exposed via serial reduction dissections from anterior and posterior approaches. Axial sections (cadaveric and magnetic resonance imaging) were examined to characterize the region between the TA and IO aponeurosis and the paraspinal muscles. It is confirmed that the paraspinal muscles are enveloped by a continuous paraspinal retinacular sheath (PRS), formed by the deep lamina of the posterior layer of the TLF. The PRS extends from the spinous process to transverse process, and is distinct from both the superficial lamina of the posterior layer and middle layer of the TLF. As the aponeurosis approaches the lateral border of the PRS, it appears to separate into two distinct laminae, which join the anterior and posterior walls of the PRS. This configuration creates a previously undescribed fat-filled lumbar interfascial triangle situated along the lateral border of the paraspinal muscles from the 12th rib to the iliac crest. This triangle results in the unification of different fascial sheaths along the lateral border of the TLF, creating a ridged-union of dense connective tissue that has been termed the lateral raphe (Spine, 9,1984, 163). This triangle may function in the distribution of laterally mediated tension to balance different viscoelastic moduli, along either the middle or posterior layers of the TLF.},
  author       = {Schuenke, Mark and Vleeming, Adriaan and Van Hoof, Tom and Willard, Frank},
  issn         = {0021-8782},
  journal      = {JOURNAL OF ANATOMY},
  keyword      = {lateral raphe,lumbar interfascial triangle,lumbar spine,paraspinal retinacular sheath,pelvis,transversus abdominis,thoracolumbar fascia,LOW-BACK-PAIN,TRANSVERSUS ABDOMINIS,POSTERIOR LAYER,SPINE,MUSCLES,ATTACHMENTS,MORPHOLOGY,TRANSMISSION,CONTRACTION,STIFFNESS},
  language     = {eng},
  number       = {6},
  pages        = {568--576},
  title        = {A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia},
  url          = {http://dx.doi.org/10.1111/j.1469-7580.2012.01517.x},
  volume       = {221},
  year         = {2012},
}

Chicago
Schuenke, Mark, Adriaan Vleeming, Tom Van Hoof, and Frank Willard. 2012. “A Description of the Lumbar Interfascial Triangle and Its Relation with the Lateral Raphe: Anatomical Constituents of Load Transfer Through the Lateral Margin of the Thoracolumbar Fascia.” Journal of Anatomy 221 (6): 568–576.
APA
Schuenke, M., Vleeming, A., Van Hoof, T., & Willard, F. (2012). A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. JOURNAL OF ANATOMY, 221(6), 568–576.
Vancouver
1.
Schuenke M, Vleeming A, Van Hoof T, Willard F. A description of the lumbar interfascial triangle and its relation with the lateral raphe: anatomical constituents of load transfer through the lateral margin of the thoracolumbar fascia. JOURNAL OF ANATOMY. 2012;221(6):568–76.
MLA
Schuenke, Mark, Adriaan Vleeming, Tom Van Hoof, et al. “A Description of the Lumbar Interfascial Triangle and Its Relation with the Lateral Raphe: Anatomical Constituents of Load Transfer Through the Lateral Margin of the Thoracolumbar Fascia.” JOURNAL OF ANATOMY 221.6 (2012): 568–576. Print.