Lumbar spine

Last revised by Egidio Cespedes on 22 Aug 2022

The lumbar spine (often shortened to L-spine) consists of five adjacent vertebrae of the lower vertebral column, in some cases it is possible to find 4 or 6 vertebrae as an anatomical variant. They participate in the lumbar lordosis, a natural curve in the spine, that is convex anteriorly. 

Articulations of the facet (zygapophyseal) joints permit flexion/extension and abduction movements. Rotation is greatly limited, and may occur only slightly at the lumbosacral joints.

For a basic description of the anatomy of a generic vertebra, see vertebrae.

Similar to other vertebrae, the osteology of each lumbar vertebrae can be subdivided anteriorly to posteriorly:

  • body: kidney shaped, convex anteriorly, flattened posteriorly; resulting vertebral canal is triangular in cross-section
  • pedicles: project directly posteriorly, attached to the upper half of the body
  • transverse processes: spatulate, project laterally on both sides; L3 most often has the longest transverse processes of the lumbar spine, a fact that can be used to number the vertebrae
  • lamina: broad, thick, overlap minimally
  • articular processes (superior and inferior): lie at the lateral angle of the laminae (junction with pedicle), connected via the pars interarticularis
  • spinous process: single, short, thick, roughly horizontal, hatchet-shaped (upper border is straight, lower border curves down)

L1 to L4 are considered typical lumbar vertebrae, whereas due to various and distinctive differences the fifth lumbar vertebra is considered atypical.

Vertebrae articulate with one another via:

  • intervertebral discs (superior and inferior): wedge shaped (taller anterior, shorter posterior), and contribute most to the lumbar lordosis
  • facet (zygapophyseal) joints: obliquely oriented, cylindrically-shaped articular surfaces
    • superior articular facets are concave and face posteromedially
    • inferior articular facets are convex, and face anteriorly

Inferior articular process of the vertebrae above always lies posterior to the superior articular process of the vertebrae below.

A large number of attachments occur at the transverse process. On its anterior surface, a vertical ridge serves as an important landmark.

  • medial to ridge: psoas muscle
  • at the ridge: psoas fascia, anterior layer of the lumbar fascia, medial and lateral arcuate ligaments (at L1)
  • lateral to ridge: quadratus lumborum partially inserts
  • transverse process tip: middle layer of lumbar fascia

Posterior surface receives attachments of erector spinae. Back muscles (multifidus, longissimus) attach to the mammillary process and accessory tubercle:

  • mammillary process: located on the superior articular process, behind the margin of the articular facet, projects posteriorly
  • accessory tubercle: located at the root of the transverse process, projects posteriorly

Can be superimposed onto the three-column concept.

Arterial supply comes from regional/segmental lumbar arteries.

Venous drainage is complex. Lumbar vertebral bodies are posteriorly perforated by a pair of basivertebral veins that drain into the internal vertebral venous plexus. Regional/segmental lumbar veins also contribute.

  • transitional vertebrae of the lumbar spine are possible at multiple levels in the lumbar spine
  • limbus vertebrae represent herniation of the disc nucleus pulposus through the superior endplate and can simulate a fracture

Ossification centers of generic vertebrae are covered here. Transverse processes are actually fused ribs. Mammillary process and the accessory tubercle are the remnants of the true transverse process, typically seen on thoracic vertebrae.

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Cases and figures

  • Figure 1a: typical lumbar vertebra (Gray's illustration)
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  • Figure 1b: typical lumbar vertebra (Gray's illustration)
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  • Figure 1c: typical lumbar vertebra (Gray's illustration)
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  • Figure 1d: typical lumbar vertebra (Gray's illustration)
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  • Figure 2: superior view
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  • Figure 3: lateral view
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  • Figure 5: facet joints
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  • Figure 6: annotated oblique projection
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  • Figure 7: ossification centers
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  • Case 1: MRI normal lumbar spine
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  • Figure 8: lateral spine anatomy (Gray's illustration)
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  • Figure 9: ligaments of the lumbar spine (Gray's illustration)
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