Lumbar Spine Anatomy

Several studies have revealed that back pain is among the top reasons for absenteeism in the workplace, according to extensive research.

While the fact that episodes of back pain have a tendency to resolve on their own is widely acknowledged, industrialized societies are witnessing an increasing occurrence and duration of this ailment. Therefore, healthcare experts express worry that the rate of disability caused by back pain is escalating at a faster pace than the growth of the population.

According to a literature review examining the lifetime prevalence of sciatica, findings indicate that approximately 40% of adults have experienced sciatica at some point in their lives. The aforementioned study highlights that low back pain accompanied by sciatica is a prevalent issue, with multiple factors being cited as potential causes.

The epidemiological studies available exhibit variations in the definitions employed for sciatica. Pain that extends along the pathway of the sciatic nerve and reaches below the knee is generally recognized as the defining characteristic of sciatica.

While a herniated nucleus pulposus of the disc remains the predominant cause of sciatica, it is essential to note that it is not the sole explanation for this condition. Approximately 25% of cases involving back problems can be attributed to conditions such as spondylolysis, spondylolisthesis, facet joint hypertrophy, and lateral canal stenosis, all of which have the potential to cause sciatica.

Nonoperative treatments are typically employed for the management of sciatica; however, a small proportion of patients may necessitate hospitalization and surgical intervention. The incidence rates may fluctuate, but it is estimated that there are more than 450 cases per 100,000 individuals in the United States.

In certain patients, the cause of back pain cannot be pinpointed, as it is a multifactorial disorder with numerous potential underlying causes. Consequently, these patients undergo a range of surgical procedures, including fusion techniques, which yield diverse outcomes.

A hypothesis suggests that the compression of the nerve root by the transforaminal ligaments is a potential cause of lateral canal stenosis. Anatomical and biomechanical details regarding these ligaments, as well as their involvement in nerve root entrapment, are rarely covered in the existing literature.

Transforaminal Ligaments Of The Lumbar Spine

Previous anatomical studies have already identified variations in the lumbosacral ligament and the radiating ligament within the lumbar region, with few instances where their configuration could potentially result in nerve root compression.

The exact nature and origin of the transforaminal ligaments remain unclear, but in most cases, they seem to be a concentration of the fascia that covers the foraminal exit. This condensation significantly reduces the available space for the nerve root as it emerges. Predicting the extent to which age or pathology influences the variation is challenging due to several factors.

These factors include patients having passed away with various pathologies, including different types of malignant diseases. Moreover, the biomechanical analysis of weight-bearing and range of movement in the lumbar spine was constrained by limited geometric data available.

Ligaments Associated With Lumbar Intervertebral Foramina At L1–L4 Level

According to literature, there are instances where the ligaments are found to exhibit a random arrangement and are distributed in nonsymmetrical patterns without any specific order.

These ligaments are not considered anomalous and likely have their origins in the developmental process. Additionally, it is proposed that these ligaments are inherent and normal characteristics of the intervertebral foramen.

The presence of the ligament aligns with the normal functions of the lumbar spine, as changes in the dimensions of the intervertebral foramen during movement do not pose a risk to its contents.

The probability of nerve impingement is contingent upon the condition of the ligament, the narrowing of the intervertebral foramen, or pathological alterations to structures within the foramen.

These biomechanical factors contribute to the occurrence of nerve impingement. No evidence suggests that the ligament originates during fetal development. Instead, it is proposed that the ligament evolves gradually from the muscle and matures over time in response to localized strain and stress, particularly as age advances.

Ligaments Associated With Lumbar Intervertebral Foramina. The Fifth Lumbar Level

Early studies on biomechanics have revealed that the L-4 vertebra withstands higher compressive forces compared to the L-5 vertebra. Upon the fusion of the L-5 vertebra with the fixed sacrum, it assumes a prominent role as a substantial load-bearing element within the pelvic girdle.

The presence of this feature restricts the motion of the segment while offering stability to the overall structure. The intervertebral foraminal ligaments within the L1-4 segment were categorized into three types: internal, intraforaminal, and external.

The ligaments found within the intervertebral foramen in the L1-4 segment are categorized into three types: internal, intraforaminal, and external. Each ligament contributes to the formation of a distinct compartment in the intervertebral foramen, providing a pathway for neural and vascular structures.

Nonetheless, due to its positioning within the transitional region of the vertebral column, the morphological characteristics of L-5 were given greater emphasis in order to ascertain its relationship with extraspinal structures.

The positioning of the zygapophyseal joint facets is of importance since it defines both the anterior and posterior limits of the foramen. The significance of the transverse process of L-5 lies in its role as the anterior margin of the intervertebral foramen.

The intervertebral foramen contains four ligaments: the lumbosacral ligament, connecting the transverse process and sacrum, and the lumbosacral hood, which creates a protective covering over the ventral ramus.

Neural Foraminal Ligaments of the Lumbar Spine: Appearance At Ct And MR Imaging

Lumbar neural foraminal ligaments potentially limit the movement of spinal nerves. To explore this, advanced imaging techniques like CT and MR are employed, along with anatomical examination utilizing fresh unfixed specimens.

Additional investigations should be conducted, including the extension of the study to individuals with low back pain and the implementation of kinetic studies to evaluate how the ligament affects nerve root compression. Moreover, examining pathological changes between the ligament and intervertebral structures can offer valuable insights into the role of degenerative factors in this condition.

The Effects Of Transforaminal Ligaments On The Sizes Of T-11 To L-5 Human Intervertebral Foramina

Strong evidence suggests that the transforaminal ligament is a normal component of the spinal structure rather than an anomaly. Measurements of the intervertebral foramen (IVF) dimensions were taken from T-11 to L-5, comparing IVFs with and without the ligament.

Generally, there are no significant differences in the superoinferior dimensions of T-12 through L-4, except for L-5, which exhibited a smaller dimension. The presence of transforaminal ligaments within the IVF could reduce the space available for the ventral ramus of the spinal nerve. The transforaminal ligament occupies additional space within the foramen.

However, there is no evidence linking IVF size to unexplained low back pain. Conditions such as disc prolapse or facet joint hypertrophy can cause reduced spaces, but gradual pathological changes in patients can also contribute to this reduction.

Lumbar Foraminal Stenosis: Critical Heights Of The Intervertebral Discs And Foramina

To thoroughly investigate the biomechanical changes that occur in nerve roots, it is crucial to have a comprehensive understanding of all the tissue components within the neural structure. Within the intervertebral foramen, the largest and most common structure observed was the dorsal root ganglion.

It was noted that the shape of the foramen can be altered due to the narrowing of the disc space. The ratio between the nerve root and the cross-sectional area of the foramen is considered an indicator of the risk of nerve root compression. Notably, in the lower lumbar spine, the positioning of the dorsal root ganglion can potentially lead to compression of the nerve root.

Understanding the biomechanical deformation of nerve roots requires a comprehensive understanding of all tissue components within the neural structure. This study focuses on stenosis within the intervertebral foramen, identifying the boundaries and observing changes in shape due to disc space narrowing.

The ratio between the nerve root and foramen area is proposed as an indicator of compression risk. The impact of the transforaminal ligament and its correlation with disc height and nerve compression remain unclear.

In the lower lumbar spine, the dorsal root ganglion may compress the nerve root due to increased rotation range and axial load. Factors increasing the ratio between nerve root sectional area and intraforaminal cross-sectional area may raise the risk of nerve root entrapment.

The relationship between the lumbosacral nerve root, surrounding tissue, and transforaminal ligaments is often overlooked in research. Recent studies have demonstrated the presence of lumbar intervertebral foraminal ligaments, but their clinical significance and impact on nerve compression and low back pain are still unclear.

Standardization of terminology is needed. Future research should focus on correlating these ligaments with radiological findings and investigating their effects on nerve roots during movement.

Diagnostic methods like CT scan and MRI can help visualize their relationship, and the use of an operating microscope can confirm the relief of nerve compression upon ligament sectioning.

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22:46 07 Sep 23
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14:41 30 Jun 23
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00:52 30 May 23
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00:24 30 May 23
I had such a wonderful experience with Complete Orthopedics in Stony Brook. Not only did Dr. Kuo fix my broken wrist with such kindness and care, but the office staff, including Billing, Reception and the X-Ray Technician, was always so helpful, going out of their way to ensure that each patient felt welcome, answering any questions with a smile, and ensuring any issues with insurance/billing were handled with the utmost professionalism. I highly recommend their practice!
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19:49 10 May 23
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15:02 02 Mar 23
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21:23 25 Feb 23
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20:20 19 Feb 23
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16:46 19 Jan 23
Dr. Karkare is an amazing doctor, very caring and attentive, the girl at the front desk is very kind and helpful. .elizabeth .thank you so much .
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21:32 26 Oct 22
Been going to this place before my accident and after I had my knee surgery. So happy how I been treated and how well I am getting. Thank you all and specially Dr. VAKSHA for everything and getting back on track.
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19:01 25 Oct 22
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21:28 23 May 22
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23:31 19 May 22
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17:39 18 May 22
The staff is very professional and helpful. Dr. Vaksha is excellent. He takes time to listen and offer suggestions to help you get better. I’m very thankful and happy to be a patient here at Complete Orthopedics.
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19:54 16 May 22
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00:48 13 May 22
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23:17 12 May 22
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19:37 09 May 22
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19:54 05 May 22
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20:01 28 Apr 22
Amazing team!! Very caring, profesional, and friendly!! Dr. Kevin Kuo, you are the best, very passionate, caring, and helping thank you for getting me better and being so kind to me! Elizabeth you the best thank you for you help always and you big smile and positive actitud❤️🙏🏼
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19:01 22 Apr 22
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03:25 09 Apr 22
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22:45 05 Apr 22
This was my 1st time breaking something in my 27 years on this planet. I was recommended here by a friend Dr. Vashka helped me from day 1 and still continues to check in on me and my healing ankle. Would highly recommend
tyron davis
16:06 01 Apr 22
Brand new office, same great doctors! Rooms are clean, plenty of parking, physical therapy attached, Dr. Karkare and his staff are awesome. Thank you!
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02:49 24 Mar 22
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14:53 03 Mar 22
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01:24 23 Feb 22
After suffering from a severe ankle injury Dr. V was able to help me heal and return back to work completely to a job where I stand for 12 hours a day. The office is very clean and I appreciated the reminders of my appointments via phone call and through text. The patient portal made it easy for me to access all my documents including work notes. The office staff is wonderful and Rebecca was able to schedule me with a busy schedule and awesome at answering all of my questions including referring me to a great physical therapy office. I highly recommend this office to anyone who’s looking for knowledgeable and kind orthopedic office.
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21:31 28 Jan 21
The staff here are great, I was seen at the time of my appointment and was well taken care of!
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18:14 07 Jan 21
They are an excellent practice. The front and back office people are amazing and so helpful. Rebecca is such a kind and understanding person. I had an issue with paperwork and she cleared it right up. Dr. Karkare is very knowledgeable, helpful, and caring.
Matt S.
19:31 18 Nov 20
Rebecca K. - What a true burst of sunshine. Very friendly and definitely an asset to the practice!
Laura Aston
18:17 17 Nov 20
Great experience, the Doctor is nice but the staff is incredible. I worked with Linda, who was profession and assisted me beyond what any person has done at other practices. Complete Ortho should be complimented for having such a person on their staff.I highly recommend this place!!!
Joe Allen
17:26 17 Nov 20
Linda and Becca they are so good ever time I come they are very nice I would tell everyone I no to come to this office..
Barbara Victor
16:45 17 Nov 20
I was rear ended in an auto accident , Dr Vashka was recommended by a friend of mine .I was experiencing Back , neck , and shoulder pain . After a thorough examination and given exercises to do at home , I am feeling much better , and I ended up avoiding surgery . The staff at Complete Ortho is extremely attentive and show great care when making an appointment and are very friendly and i never waited more than 5 minutes for my appointment . So I would strongly recommend Complete Orthopedics for any aches and pains that one might be experiencing.....
Bill Becht
04:44 17 Nov 20
It was the afternoon of Friday Sept. 24. We were in Pt. Jefferson and my wife, Mary Ann, broke her hip. We went to Mather Hospital and it was determined that she would have to have an operation to have it repaired. This would be her third time under the knife in the past year. It just so happened that we were very fortunate enough to have Dr. Karkare, who was on standby, perform the surgery. He put in a rod and two screws in her hip. She spent a few days in the hospital and then went to Gurwin rehabilitee for another few weeks.It has now been almost six weeks and we both worked the election the other day. If it wasn’t for Dr. Karkare’s expertise she never would have been able to work. She is able to walk with a walker and is doing physical therapy three times a week.We can not thank the doctor enough for the compassion and dedication that he puts into his work. It allows Mary Ann do the things that she likes to do, even on a limited basis for a while. I know that with her will, perseverance and the great work that the surgeon performed she will be back on her feet in no time.Sincerely:John V. PlumpEast Northport, NY 11731
Jack Harris
14:36 06 Nov 20
In the year of 2018 I was referred to Dr. Karkare because I was experiencing severe knee joint pain. After exhausting physical therapy and trying to labor through the pain, I had to make a quality of life decision. Total knee replacement was the only viable option. Dr. Karkare made my decision easy as he walked me through the whole process from surgery to recovery.On 12/13/19 ( Friday the 13th) I enter Lenox Hill Hospital in great hands. From the time I entered Dr. Karkare’s office for the first time until now, his staff has been amazing. Andrea the medical coordinator walked me through all the paper work and necessary preparations for the surgery. Courtesy and kind would be an understatement. Dr. Karkare went over and beyond from the wellness checks and phone calls all to assure me that I was important to him. This was the right decision no pain and no limp. Complete Orthopedics should be your choice!
Kenneth Randolph
22:18 25 Sep 20
Dr. Vadshka has a great bedside manner. He really takes his time and explains treatment options.
T Lee
12:33 09 Sep 20
I suffered with pain in both knees for years. My orthopedic doctor kept recommending knee replacement . I fought it for years, as I was just afraid. When I had no choice and could barely walk , it was recommended I see Dr. Karkare. We set up a consultation and my wife and I left his office feeling totally confident and comfortable with moving ahead with the surgery. He explained everything to us, and the office staff set everything up for us and made the process easy. So about one month after our initial meeting I had the first knee done. I was up walking mere hours after the surgery, and on the workout machines the next morning. I went home two days after the surgery, and yes walked my daughter down the aisle at her wedding only one week after the surgery without even a cane! Three months later I had the other knee done and went home the very next day. Dr. Karkare put my fears to rest . I would highly recommend him. His expertise gave me my life back. Thank you Dr. Karkare.SincerelyVito Congro
Ethel Congo
23:58 12 Aug 20
Dr Rhodin really cares for his patients. When I see him he makes sure to review my progress in detail.
Micki Cahill
15:03 08 Feb 20
My mom had a total hip replacement by dr karkare. He is the BEST orthopedic doctor.Her incision is almost invisable.She is going back for her other hip next week. The office staff is the best, love Andrea.You wont find a better doctor.
21:06 13 Jul 18
There is no better Orthopedic doctor you will find. Broke my ankle three places on a Saturday. Called Dr. Karkare. He had is team ready at the hospital and operated on me within 6 hours after my injury. Now After 3 months of great care by him and his staff, I am walking to normalcy.
Spacecom Tel
04:13 23 Mar 18

I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.

Please take a look at my profile page and don't hesitate to come in and talk.