The Decussating Fibers of the Lumbar Thoracolumbar Fascia: A Landmark for Identifying the L5 Spinous Process?

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The Decussating Fibers of the Lumbar Thoracolumbar Fascia: A Landmark for Identifying the L5 Spinous Process?

World Neurosurg. 2017 Apr 20;:

Authors: Alonso F, Rustagi T, Fisahn C, Drazin D, Gardner B, Iwanaga J, Chapman JR, Oskouian RJ, Tubbs RS

Abstract
INTRODUCTION: The thoracolumbar fascia has been well studied and is known to have crisscrossing fibers. Based on surgical experience, we have hypothesized that the decussating fibers of this fascia may indicate a specific vertebral level. Therefore, the following anatomical study was performed.
METHODS: Twenty adult fresh frozen cadavers aged 72-84 years old at death were placed in the prone position and the skin of the lumbar and upper sacrum was removed. Careful attention was given to the thoracolumbar fascia and any fibers of it that grossly crossed the midline to inderdigitate with its contralateral counterpart. Once such decussations were identified, a metal wire was laid on them at their center and fluoroscopy was performed to verify the vertebral level.
RESULTS: Decussating fibers of the thoracolumbar fascia were found on all but one specimen (95%). The central part of the decussation on the midline corresponded to the spinous process of L5 in 89% and the lower edge (L4-L5 interspace) of the spinous process of L4 in the remaining two specimens (11%). No specimens were found to have previous surgery in the area dissected or congenital anomalies of the spine.
CONCLUSIONS: Based on our cadaveric study, the decussating fibers of the thoracolumbar fascia in the lumbar region can help predict the L5 spinous process in 89% and the L4 spinous process in 11% of cases. This finding might be used as an adjunct to palpation and intraoperative imaging during surgical exploration of the lower lumbar region.

PMID: 28435114 [PubMed - as supplied by publisher]

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