Lumbar Anatomy

The lower back or lumbar spine is composed of 5 bones, called vertebrae and the sacrum. Each vertebrae is connected to each adjacent vertebrae by 3 joints, 1 at the front (anteriorly) and 2 at the back (posteriorly). The joint at the front is called an intervertebral disc and is a common cause of surgical pathology. The joints at the back are called facet joints and are present as pairs straddling the midline. In addition to these 3 joints and bony structures, there are numerous ligaments and muscles. One of the more important ligaments is called the ligamentum flavum.  This yellow ligament bridges between adjacent vertebrae and can thicken with age and cause compression of nerves. The spinal cord sits inside a bony tunnel in the posterior half of each vertebrae which is called the spinal canal. The ligamentum flavum lines the back half of this canal. The back half of the spinal canal is formed by wing shaped pieces of bone called laminae. At each level, 2 lamina united and form a spinous process which is like a midline keel of bone and can be felt in the midline through the skin in the back. Holes at regular levels on each side of the spinal canal form intervertebral foramina. Each foramen allows 1 nerve to exit and in the lumbar spine there are 5 on each side. The spinal cord finishes at the lower border of the first lumbar vertebra and then becomes a leash of nerves (the cauda equina). Below this point only nerves are present and no spinal cord is present. Consequently most surgery on the lower back is on and around nerves rather than spinal cord. The spinal nerves in the lumbar spine supply strength in the legs, sensation from the groin down and bladder and bowel function. Injury to one nerve may cause no problem or may affect some or all of the previously mentioned modalities.