Functional Partitioning of the Human Lumbar Multifidus: An Analysis of Muscle Architecture, Nerve and Fiber Type Distribution using a Novel 3D in Situ Approach

Muscle architecture, innervation pattern and fiber type distribution of lumbar multifidus (LMT) throughout its volume was quantified. Musculotendinous (n=10) and neural components (n=3) were dissected and digitized from thirteen embalmed cadaveric specimens. The data were imported into Autodesk® Maya® 2008 to generate 3D neuromuscular models of each specimen. Architectural parameters (fiber bundle length, FBL; fiber bundle angle, FBA; tendon length) were quantified from the models using customized software. The medial branch of the posterior rami (L1-L5) was traced through LMT to determine its distribution. Using immunohistochemistry, Type I/II muscle fibers were identified in 29 muscle biopsies from one fresh frozen specimen. The total area and number of each cell type was calculated using Visiopharm® (image analysis software). Architectural and fiber type data were analyzed using ANOVA with Tukey’s post-hoc test (p ≤ 0.05). From L1-L4, LMT had three architecturally distinct regions: superficial, intermediate and deep. At L5, intermediate LMT was absent. Mean FBL decreased significantly from superficial (5.8 ± 1.6cm) to deep regions (2.9 ± 1.1cm) as did volume (superficial, 5.6 ± 2.3ml; deep, 0.7 ± 0.3ml). In contrast, mean FBA increased from superficial to deep. The medial branch of the posterior ramus (L1-L5) supplied the five bands of LMT. Each medial branch in turn divided to supply the deep, intermediate and superficial regions separately. The area occupied by Type I fibers was significantly less (p< 0.01) in the deep (56%) compared with the superficial regions (75%). Based on architecture and morphology, superficial LMT with the longest FBL and relatively small FBA is well designed for torque production and controlling the lumbar lordosis. Intermediate LMT with significantly longer FBL compared with the deep region and with its caudal to cranial line of action may help to control intersegmental stability. Furthermore, the absence of intermediate LMT at L5 and may contribute to the higher incidence of instability observed at the lumbosacral junction. Deep LMT with its short FBL, large FBA and proximity to the axis of spinal rotation may function to provide proprioceptive input to the CNS rather than a primary stabilizer of the lumbar spine.Ph