The Forgotten Lumbocostal Ligament: Anatomical Study with Application to Thoracolumbar Surgery

Abstract

Introduction: Most ligaments of the human body have been well studied. However, the lumbocostal ligament has received little attention in the extant medical literature and, to our knowledge, has not undergone anatomical study. Therefore, the present study was performed to better characterize this structure’s anatomy and relationships.Methods: In the prone position, 10 adult cadavers underwent dissection of their lumbocostal ligaments. All specimens were unembalmed and had no history of surgery to the spine. The lumbocostal ligament was dissected and measurements made using calipers and a ruler. This ligament’s attachments were determined as well as its relationships to surrounding fasciae, muscle, and nerves.Results: A lumbocostal ligament was identified on all sides. The ligament was posterior to the quadratus lumborum muscle on all sides. The mean length of the ligament was 3 cm. The overall shape of the ligaments ranged from short bands to large rhomboidal sheets. Inferiorly, the lumbocostal ligament blended with the middle layer of the thoracolumbar fascia on all sides. The ligament attached to the transverse processes of L1 on 25% of sides and onto the transverse processes of L1 and L2 on 75% of sides. The ligament became taut with rib elevation and was lax with rib depression.Conclusions: The lumbocostal ligament is a constant structure of the thoracolumbar junction. Appreciation of this ligament can help localize the transverse processes of L1 and L2 and adjacent nerves, such as the regional dorsal rami as they exit near its attachment onto the lumbar transverse processes.

The subcostal nerve as the target for nerve stimulator guided transverse abdominis plane blocks – A feasibility study

“…[10] In a recent study by Alonso et al ., the subcostal nerve was described as larger, covering a wider area with more branches (8 on average as opposed to 4 of the L1) and travels 5 cm below the 12 th rib in its initial course. [11] Beneath the rib, the nerve either travels anterior or inferior to the lumbocostal ligament[12] or even pierces it. [13] The nerve was also identifiable by ultrasound.…”

Piercing of the Lumbocostal Ligament by the Subcostal Nerve: A Previously Unreported Case

“…Furthermore, the subcostal nerve regularly runs around 2 cm below the 12th rib [ 7 ], exposing it to iatrogenic damage during surgical procedures [ 6 ]. In contrast, the first through 11th intercostal nerves tend to run along grooves in the corresponding ribs, mitigating the risk of partial or complete transection [ 8 ]. The lumbocostal ligament may have an important role to play in preventing damage to the subcostal nerve.…”

“…The lumbocostal ligament may have an important role to play in preventing damage to the subcostal nerve. As noted by Saker et al [ 8 ], due to its proximity, utilizing the lumbocostal ligament as a landmark during surgery may help surgeons to visualize and locate both the subcostal nerve and the adjacent dorsal rami as they exit below the 12th thoracic vertebra.…”

“…Saker et al [ 8 ] also discuss the two common paths taken by the subcostal nerve relative to the lumbocostal ligament. They found that the subcostal nerve usually passes either anterior (9/20) or inferior (11/20) to the lumbocostal ligament.…”

A plea for an extension of the anatomical nomenclature: The locomotor system

“…They are strengthened laterally and medially by ligamentous fibers termed ligamenta interchondralia, passing from one cartilage to the other. • Ligamentum lumbocostale ("ligamentum vertebrocostale" of Henle) is a thickened superior part of the lamina media fasciae thoracolumbalis as it attaches to the processus costalis of the first lumbar vertebra [L1] (25%) or L1 and L2 (75%), located dorsally to the musculus quadratus lumborum and ventrally to the musculi intertransversarii[22]. • Ligamentum iliolumbale (attached to the tip of processus costalis L5) is composed of two parts: the upper part inserts at the labium internum cristae iliacae and the lower (termed ligamentum lumbosacrale) at the ala ossis sacri, merging with the ligamentum sacroiliacum anterius.…”