Lumbar region

Lumbar region (regio lumbalis) - part of the back of the abdominal wall, limited inside the spinous processes of II-V of the lumbar vertebrae (the border between the right and left lumbar region); above the line drawn from the spinous apophysis II lumbar vertebra through the end of the twelfth ribs to the XI that intersects this line at the boundary between the outer and middle third; bottom - iliac crest; the outside is a vertical line drawn from the late eleventh rib to the iliac crest. Since XI edge variabelno in size, the outer border of the lumbar region is a continuation or a medium, or (more often) the posterior axillary line.
Lumbar region can be divided into medial and lateral departments, the border between them forms the outer edge of the muscles, rectifying the trunk. Medial Department acts, whereas in the lateral lean people significantly deepening, even notch.
Leather lumbar region is relatively easy was going to fold. Under the superficial fascia, between it and its own fascia back, there is the added layer of subcutaneous fat, most pronounced in the lower division area, where he goes into the gluteal region; it is called a lumbar-buttock fat pillow (massa adiposa lumboglutealis).
Own fascia back covers in the form of a thin plate surface muscles of the lumbar region.
In the medial part of the lumbar region under its own fascia lies surface (rear) sheet lumbar-pectoral fascia (fascia thoracolumbalis). It has a dense structure of the aponeurosis and contains a significant amount of tendon fibers, giving it a shiny appearance. Deeper is located muscle, straightening the trunk (m. erector spinae); it's laying in the gutter, which is in the lumbar region was formed spinous and transverse processes of the vertebrae, and above expanded initial segments of edges. Muscle is made in the bone-fibrous vagina, in the formation of the front wall of which involved deep (front) sheet fascia thoracolumbalis. In front of this paper, i.e., the deeper it is the square of the muscle of the lower back (to m. quadratus lumborum), and in front of her and closer to the spine is greater psoas muscle (m. psoas major). Finally, toward the front from these muscles are part vnutrennee fascia belly, which are referred to here fascia quadrata and fascia psoatis. The sealed parcels of these fascia form two ligaments, passing one another,- curved chords aperture (lig. arcuatum mediale et laterale) (Fig. 1 and 2).

layers of the lumbar region
Fig. 1. Layers of the lumbar region: 1 - m. trapezius; 2 and 18 m. latissimus dorsi; 3 - m. serratus post, inf.; 4 - costa; 5 - m. intercostalis ext.; 6 - m. intercostalis int.; 7 - costa XII; 8 - aponeurosis m. transversus (the bottom of the diamond Grinfelde - Lesgaft); 9 - n. intercostalis XI; 10 - a. intercostalis, n. intercostalis XII; 11 - m. obliquus int. abdominis; 12 and 16 m. obliquus ext. abdominis; 13 - m. gluteus maximus; 14 - m. gluteus medis (covered own fascia); 15 - m. obliquus Int. abdominis (the bottom of the lumbar triangle); 17 - fascia thoracolumbalis.
the back wall of the abdominal cavity
Fig. 2. The back wall of the abdominal cavity: 1 and 18 - diaphragma; 2 - esophagus; 3 - trigonum costolumbale; 4 - hiatus aorticus; 5 - costa XII; 6 - n. intercostalis; 7 and 14 m. quadratus lumborum; 8 - n. iliohypogastric 9 - n. genitofemoralis; 10 - promontorium; 11 - m. iliacus; 12 - crista iliaia; 13 - m. psoas major; 15 - foot aperture; 16 - arcus lumbocostalis; 17 - arcus lumbocostalis med.

types of lumbar hernia
Fig. 3. Types of lumbar hernia:
1 - hernia lumbar triangle; 2 - hernia diamond Grinfelde - Lesgaft.

In lateral Department lumbar region first muscular layer are latissimus dorsi muscles and external oblique muscle of the abdomen (mm. latissimus dorsi et obliquus externus abdominis), and fibre first comes from the bottom up and from back and fiber second - from top to down and back to front. In those cases, when the edges of both muscles near the iliac crest diverge, formed a triangular period, called the lumbar, or platovym, triangle (trigonum lumbale). The reason it is the iliac crest, and bottom - internal oblique muscle of the abdomen. These may penetrate ulcers retroperitoneal fat and very rarely appear here lumbar hernia (Fig. 3).
Second muscular layer lateral Department lumbar region form the lower rear gear and internal oblique muscle of the abdomen (mm. serratus posterior inferior et obliquus internus abdominis).
Fiber them go from the bottom up and the inside outwards. Facing each other edge of both muscles do not touch, resulting in between them a period of triangular or quadrangular form, known as the triangle, or lozenge, Grinfelde - Lesgaft (spatium lumbale). It is limited, in addition to the lower rear gear and internal oblique muscle of the abdomen, the lateral edge of the rectifier of the body and, in some cases, XII edge (then the diamond). The bottom of the gap formed by the aponeurosis of the transverse abdominal muscles, and on the surface it covered only with a wide muscles and the skin. Therefore, triangle, or lozenge, Grinfelde - Lesgaft is most malleable plot the back of the abdominal wall, especially in the aponeurosis of the transverse muscles there is quite a significant hole, through which pass podreberie vessels and nerve (vasa subcostalia et n. subcostalis), followed by the loose tissue. The latter links retroperitoneal fat with intermuscular fiber lumbar region and even with subcutaneous, resulting in the limits of the triangle Grinfelde-Lesgaft often overlook retroperitoneal bleeding, and sometimes lumbar hernia (Fig. 3).
Deeper second muscular layer is transverse muscle of the abdomen, the initial division which has the appearance of dense aponeurosis, which is a continuation of deep sheet (fascia thoracolumbalis). Due to the aponeurosis of the transverse muscles formed lumbar-costal bundle (lig. lumbocostal), stretched between the first lumbar vertebra and XII edge; this combination is sometimes cut if necessary to gain wider access to the kidney.


Fig. 4. Sagittal section through the area of the right kidney and pelvis (schematically):
1 - pleura diaphragmatica;
2 - diaphragma;
3 - fascia diaphragmatica;
4 - hepar;
5 - giandula suprarenalis;
6 - duplicatura fascia praerenalis;
7 - ren dexter;
8 - peritoneum;
9 - fascia prae-renalis;
10 - fascia retroperitonealis;
11 - fascia praeureterica;
12 - fascia Toldti;
13 - ureter;
14 - appendix;
15 - fascia surrounding vasa iliaca communia;
16 - m. iliacus int.;
17 - fascia iliaca;
18 - crista ossis ilii;
19 - fascia retroperitonealis;
20 - m. erector spinae;
21 - fascia m. quadrati lumborum;
22 - m. quadratus lumborum;
23 - arcus lumbocostalis lat.;
24 - aponeurosis m. transversi;
25 - costa XII;
26 - fascia lumbodorsalis;
27 - costa XI;
28 - pleura costalis.

Anterior to the muscles of both departments of the lumbar region is located transverse fascia (transversalis fascia), which is part of the overall fascia belly, and deeper than the first layer of retroperitoneal fat. The next deeper layer is pozadina fascia (fascia retroperitonealis); it is divided into posudomoechnaja and pre-renal fascia implicating the kidney (adrenal gland) and the ureter, surrounded by a thick layer of tissue (Fig. 4).
Artery lumbar region (AA. lumbales) were branches of the abdominal aorta (four of them) and median sacral artery (the fifth lumbar artery called the bottom - a. lumbalis ima). At the top they anastomosis with branches intercostal arteries, below - with the branches of the iliac arteries. Concomitant veins are for hollow vein, and in layers retroperitoneal fat, particularly in fatty kidney capsule form Porto kavalenya anastomoses (system v. cava superior - v. cava inferior - v. portae).
Nerves lumbar region are derived from the rear and front of the branches of the lumbar nerves (see Lumbosacral plexus). Skin medial Department of the lumbar region and the muscle, straightening torso, nerviruet rear branches lumbar nerves and Quad waist and big lumbar muscle - muscle branches lumbar plexus. The skin and muscles of the lateral Department lumbar region nerviruet podreberie nerve (n. subcostalis), nerves lumbar plexus (n. iliohypogastrics) and ilio-inguinal (n. ilioinguinalis). All three nerve pass between square muscle back and covering its fascia, and through the thickness great lumbar muscles and fascia penetrates into the retroperitoneal fat n. genitofemoralis (Fig. 2). Wide muscle back innervates the chest-spinal nerve (n. thoracodorsalis).



Fig. 5. Expressed posterior lumbar plexus to the right and to the left.

Nerves arising from the back of the branches of the lumbar nerves, exchange connecting branches arranged m in thickness. erector spinae and on the back surface m. quadratus lumborum. If these bonds are formed between all posterior lumbar nerves, we can speak about the presence of posterior lumbar plexus (Fig. 5). And between the front and rear branches lumbar nerves sometimes communication in the form of long collateral nervous arcs through the gluteal region and the region of the big spit; especially characteristic of these relations for the branches arising from a segment LII.
Lymph from the skin of the upper section of the lumbar region is to intercostal lymph nodes, and from the skin of the lower section is to superficial inguinal nodes. Between the lymphatic vessels of both departments have anastomoses. The lymphatic vessels of the back muscles diverge in four directions in the course of muscular arteries. From fascia thoracolumbalis and lumbar muscles lymph outflow occurs mainly in the direction of the lumbar lymph nodes.
Pathology. For the lumbar region quite often painful symptom is the so-called chamber, lumbago (see). Frequent inflammatory diseases and injuries of the lumbar part of the spine and pelvic organs (kidneys, ureters). Purulent inflammatory processes can be localized in the muscles of the lumbar region (see Pait) and in the different layers of retroperitoneal fat (parametric, parabolic, retroperitoneal), and the melting of the fascial partitions purulent process becomes diffuse character, causing extensive retroperitoneal cellulitis.
Tumors of the lumbar region can arise from various tissues retroperitoneal space and hit retroperitoneal organs, and malignant tumors of the retroperitoneal fat found in five times more often than benign. The largest group of malignant tumors - lymphosarcoma, on the second place - teratogenic cancer. Benign tumor tissue of origin (fibroma, fibromyoma and others) are extremely rare. Tumor retroperitoneal organs - see Kidney, Ureter, Adrenal gland.
Frequent operational acceptance within the lumbar region is perirenal blockade (see Blockade procaine). The cuts in the lumbar region (lumbotomia) produce for opening retroperitoneal ulcers, surgical treatment of lumbar hernia, surgeries on organs of retroperitoneal space (see). Incisions to access these bodies are often modifications vnebrachnogo lumbar-ilio-inguinal incision Pirogov, proposed it to exposure of the abdominal aorta and the common iliac artery. Of these modifications often cuts S. P. Fedorova and Bergmann - Israel.