Anatomical study of the lumbar multifidus muscle and its innervation in human adults and fetuses Department Hisao Shindo of Anatomy, Nippon Medical Sc

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1 Anatomical study of the lumbar multifidus muscle and its innervation in human adults and fetuses Department Hisao Shindo of Anatomy, Nippon Medical School The lumbar multifidus muscle was dissected with particular reference to its innervation in 10 Japanese adults and 10 fetuses from 5 to 10 months old. The results were as follows: 1) The multifidus muscle attached to the spinous process of a lumbar vertebra was segmentally innervated by the medial branch of the dorsal ramus of the lumbar nerve on a level with the spinous process. 2) The motor point of the nerve innervating the multifidus muscle in adults was slightly ventro-caudal to that portion of the lumbar spinous process with muscle attached. 3) The multifidus muscle in fetuses was thinner and flatter than that in adults. The motor point of the nerve innervating this muscle was slightly caudal at the lateral margin of the muscle to that portion of the lumbar spinous process with the muscle attached. These differences can be attributed to the fact that muscles used to oppose gravity are undeveloped in fetuses. 4) There was variation in 5 fascicles in total, in which the medial branch of the dorsal ramus of a lumbar nerve entered the multifidus muscle originating at the spinous process of a lower lumbar vertebra. Key words: multifidus muscle, lumbar region, fetus, medial branch of dorsal ramus Correspondence to Hisao Shindo, Department of Anatomy, Nippon Medical School, Sendagi, Bunkyo-ku, Tokyo, 113 Japan

2 Table 1 Materials Table 2 Materials (Fetal)

3 Table 3 Variations

4 Fig. 1 Schematic illustration of the lumbar multifidus muscle as seen in a lateral view. One segment fascicle attached to the spinous process of the first lumbar vertebra. Fig. 2 Morphological classification of the trunk musculature and the their relation to the course of the spinal nerves. (after Nisi) D3: Submultifidus, D2: multifidus, D1: Longissimus, L: Illiocostalis

1) Bagnall, K.M., Ford, D.M, McFadden, K.D., Creenhill, B.J., Raso, U.J., and Eng, P.: The histochemical composition of human vertebral muscle. Spine, 9, 470-473, 1984. 2) Fidler, M.W., Jowett, L.

5 1) Bagnall, K.M., Ford, D.M, McFadden, K.D., Creenhill, B.J., Raso, U.J., and Eng, P.: The histochemical composition of human vertebral muscle. Spine, 9, , ) Fidler, M.W., Jowett, L., and Troup, J.D.G.: Myosin ATPase activity in multifidus muscle from cases of spinal derangement. J. Bone Joint Surg., 57 B, , ) Hides, J.A., Cooper, D.H., and Stokes, M.J.: Diagnostic ultrasound imaging for measurement of the lumbar multifidus muscle in normal young adults. Physiother Theory Pract., 8, 19-26, ) Hides, J.A., Stokes, M.J., Said, M. Jull, G.A., and Cooper, D.H.: Evidence of lumbar multifidus muscle wasting ipsilateral to symptoms in patients with acute/subacute low back pain. Spine, 19, , ) Donish, E.W., and Basmajian, J.V.: Electromyography of deep back muscle in man.am.j. Anat., 133, 25-36, ) Valencia, F.P., and Munro, R.R.: An electromyographic study of the lumbar multifidus in man. Electromyogr. Clin. Neurophysiol., 25, , ) Machintosh, J.E., Valencia, F., Bogduk, N., and Munro, R.R.: The morphology of the human lumbar multifidus. Clin. Biomech., 1, , ) Bogduk, N., Wilson, A.S., and Tynan, W.: The human lumbar dorsal rami. J. Anat., 134, , ) Machintosh, J.E., Bogduk, N.: The biomechanics of the lumbar multifidus. Clin. Biomech., 1, , 1986, 10) Warwick, R., and Williams, P.L.: Gray's ana-

6 tomy.35th.edn.p , London, Longmans, ) Lewin, T., Moffet, B., and Viidik, A.: The morphology of the lumbar synovial intervertebral joints. Acta Morphol. Neerlando-Scandinay., 4, , ) Bogduk, N.: The lumbar mamillo-accessory ligament. Its anatomical and Neurosurgical significance. Spine, 6, , ) Hollinshead, W.H.: The back and limbs. Anatomy for surgeons. Harper. Row., 3, , ) Warwick, R., and Williams, P.L.: Gray's anatomy.35th.edn.p , London, Longmans, adults. attached to the spinous process of the 17) Bogduk, N.: The dorsal lumbar muscles of the cat. Anat. Anz., 148, 55-67, ) Carlson, fr.: Morphology and contraction properties of cat lumbar back muscles. Acta Physiol. Scand., 103, , 1978, Abbreviations SP: Spinous process CP: Costal process MP: Mamillary process AP: Accessory process MAL: Mamillo-accessory ligament SAP: Superior articular process IAP: Inferior articular process ZJ: Zygapophysial joint DR: Dorsal ramus mb: Medial branch of dorsal ramus lb: Lateral branch of dorsal ramus VR: Ventral rami MF: Multifidus muscle S: Sacrum M: Motor point Legends of Photos Photo 1 Dorsal view of the multifidus muscle in an adult. Photo 2 Postero-lateral view of the multifidus muscle attached to the spinous process of the second lumbar vertebra in an adult. The medial branch of the dorsal ramus of the second lumbar nerve passing below the mamillo-accessory ligament runs medio-dorsally to the multifidus muscle atached to the spinous process of the second lumbar vertebra. Photo 3 The multifidus muscle attached to the spinous process of the second lumbar vertebra is turned laterally in an adult. The medial branch of the dorsal ramus of the second lumbar nerve innervating the multifidus muscle attached to the spinous process of the second lumbar vertebra is indicated by arrows. The nerve enters this muscle from the ventral aspect of the upper portion. Photo 4 Dorsal view of the right side of the multifidus muscles in a five months old fetus. The multifidus muscles are flat in shape and less developed than those in Photo 5 A piece of the right multifidus muscle first lumbar vertebra in a five months old fetus. The nerve innervating this muscle enters from the lateral margin of the upper portion. Photo 6 A variation case of the medial branch of the dorsal ramus of the second lumbar nerve innervating the multifidus muscles of two segments attached to the spinous processes of the second and third lumbar vertebra in an adult. The medial branch of the dorsal ramus of the second lumbar nerve innervating the multifidus muscle attached to the spinous process of the second lumbar vertebra enters the muscle from the ventral aspect of the upper portion, and also enters the multifidus muscle attached to the spinous process of the third lumbar vertebra from the dorso-lateral porsion. The nerve innervating the multifidus muscles with two segments is indicated by arrows. Photo 7 A variation case of the medial branch of the dorsal ramus of the third lumbar nerve innervating the multifidus muscles with two segments attached to the spinous processes of the third and fourth lumbar vertebrae in a ten months old fetus. The nerve innervating these muscles is indicated by arows. Photo 8 Showing the ossified mamillo-accessory ligament and the medial branch of the dorsal ramus of the lumbar nerve passing bellow it with a piece of wire in its place in a skeletal specimen.

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8 (446) Plate (2)

Table 2 Cases of Nail Deformity Associated with upward Distortion of Distal Soft Tissue No. Age Sex Affected RegionsDuration Results M Both grea

Table 2 Cases of Nail Deformity Associated with upward Distortion of Distal Soft Tissue No. Age Sex Affected RegionsDuration Results 1. 49 M Both great toes 2 years Cured after 4 months 2. 11 F Both great