Table 2 Studies describing the fiber trajectory of LM
From: Inconsistent descriptions of lumbar multifidus morphology: A scoping review
Author year | Method1 | Spine Level | L2 | Fiber trajectory of LM |
[26] Beneck 2012 | 1 | L4-S1 | S | The LM morphology best captures span the L4-L5 or L5-S1 functional spinal units |
[35] Bogduk 1992 | 6 | L5-S1 | U | LM origin is tip or shaft of spinous process L1-L5. LM insertion is medial and lateral next to the posterior sacral foramen |
[36] Bojadsen 2000 | 4 | T1-S1 | D | LM insertion at the spinous process of L5 and of T12 and T11 contains vertical fibers. The most caudal fibers of LM run a vertical trajectory between the medial portion of the sacrum and the spinous process of L5. |
[37] Creze 2017 | 2, 4 | L3 | D & S | On the first inspection, the multifidus represented a homogenous muscular mass with a triangular shape. It comprised many millimetric tendinous and fleshy fascicles originating from the spinous processes to the mammillary processes located 1–3 spinal levels above. The muscular organization was unclear and the multifidus appeared as a multiceps and multipennate muscle. Multifidus fascicles were arranged in three or four layers from superficial too deep with few or no cleavage planes between them. Some interdigitations attached fascicles between them. For each lumbar level, the muscular fascicles and fibers were oriented from 98 to 228 to the line of spinous processes. |
[38] Creze 2018 | 4 | - | S | The ES aponeurosis (ESA) had different anatomical relationships with the longissimus, the iliocostalis, and the LM. Along the lumbar and sacral regions, close to the SPL medially, some muscle fibers of superficial fascicles of the LM were attached directly (without pennation) to the ESA. Each fascicle of the LM (i.e., the group of muscles originating from a spinous process) was covered by a thin pearly white aponeurosis corresponding to a fascial expansion of the cranial attachment on the spinous process. Connectives fibers were all oriented longitudinally along the muscle belly. The thickness of the LM aponeurosis decreased along the rostrocaudal axis of each fascicle and was too thin to be measured with the material used. Connective fibers of the LM aponeurosis were oriented parallel to the longitudinal axis of the fascicle. |
[39] Creze 2019 | 4 | - | S | The cranial attachment was located on the spinous processes and caudal attachments on the mammillary processes of the three to four vertebras below, the sacrum and on the ESA. There was no tendon at the level of the sacrum, but there were aponeuroses as well as muscle fibers. |
[40] De Foa 1989 | 4 | L1-L2 | D | LM fibers run parallel to a line between the posterior superior iliac spine and the L1-L2 interspinous space |
[41] Jemmett 2004 | 4,5 | L2-S1 | D & S | The superficial LM fibers of the first fascicle of the LM originated at the caudolateral tip of the L1 spinous process. The deep LM fibers of the first fascicle originated from the caudolateral base of the L2 spinous process. This first fascicle inserted at the mamillary process and lamina of L4 as well as the capsule of the L4/5 zygapophysial joint and the most cranial aspect of the PSIS. The second fascicle originated in the same manner from the L2 andL3 spinous processes and inserted near the PSIS and just adjacent to the superior articular process of S1. |
[42] Kader 2000 | 1 | L3-S1 | S | LM consists of five separate bands, each originating from a spinous process and spreading caudolaterally from the midline to be inserted into the mammillary processes of the facet joints, the iliac crest, and the sacrum. In an axial MR image the LM is displayed as two, three or four bands, depending on the level of the image |
[18] Kim 2015 | 6 | L1-L5 | D | LM consists of laminar fibers, fascicles from the shaft and from the tip of the spinous process. |
[43] Kramer 2001 | 1, 5 | - | S | LM activity was measured with EMG at the level of the vertebral body of L2. |
[44] Macintosh 1986 | 4, 5 | L1-L5 | D & S | The principal fascicles of the LM arise as a common tendon from the tubercle and from the lateral surface of the caudal edge of the spinous process. The caudal attachments of these fascicles are the mammillary processes, the iliac crest and dorsal surface of the sacrum |
[19] Moseley 2002 | 2, 5 | L4 | D & S | LM EMG: The first electrode was inserted ± 4 cm lateral to the midline and directed medially until it reached the lamina to make recordings from the LM fibers immediately adjacent to the lamina of L4, most likely those arising from the inferior edge of the L3 spinous process (i.e., deep multifidus). The second electrode was inserted ± 4 cm from the midline and advanced to a depth of approximately 1 cm, medial to the lateral border of LM, to record the superficial LM fibers that arise from the upper lumbar vertebras. The third electrode was inserted ± 2 cm lateral to the midline and advanced until it reached the spinous process ± 1 cm from the superficial border of LM to record the superficial fibers of LM adjacent to the L4 spinous process |
[45] Lonnemann 2008 | 4, 5 | L1-S1 | D & S | The superficial LM layer originated from the mamillary process to insert onto the tip of two spinous processes and supraspinous ligaments at the same vertebral level and one above. Tendinous slips and muscle tissue extended dorsally to the overlying ES aponeurosis. The second LM layer originated from the posteroinferior lateral aspect of the spinous processes as a common tendon. The third LM layer originated from the lateral aspect of the inferior aspect of the spinous processes as a muscular band of origin. |
[29] Rosatelli 2008 | 4, 5 | - | D & S | Superficial LM fibers originate via a common tendon from the tips of the spinous processes (L1–L5) and pass inferolateral to the mammillary processes of L5, S1, sacrum, and ilium. Intermediate LM fibers originate from the spinous processes of L1–L4. Distally, L1, L2, and L3 portions attach as tendons to the L4, L5, and S1 mammillary processes, respectively. However, the L4 portion attached to the sacrum at the S2 level. The deep LM contains five entirely muscular segments (L1–L5). Each segment attached superiorly to the lamina of L1–L5, and inferiorly two levels more caudal to the L3, L4, L5, and S1 mammillary process, respectively, while the L5 fascicle attached to the sacrum |
[46] Vialle 2005 | 4 | L4 - L5 | S | An anatomical cleavage plane between LM and the longissimus part of the sacrospinalis muscle is present. The level of the natural cleavage plane between LM and longissimus was noted and measured between this level and the midline at the level of the spinous process of L4 |
[22] Ward 2009 | 4, 5 | T12-S1 | D & S | LM was identified by its position adjacent to the spinous process and the cranial/medial to caudal/lateral projection of its fibers. LM had isolated muscle bellies on the posterolateral region between L4 and S1. |