The five lumbar vertebrae have the largest bodies of the spinal column (accepting the highest axial loads), kidney-shaped bodies, and sagittally-oriented facet joints that permit flexion-extension while restricting rotation. The pedicle dimensions are the largest in the spine, accommodating the widest pedicle screws for spinal instrumentation. The cauda equina occupies the lumbar spinal canal below the conus medullaris at L1-L2.
L4 is identified by palpation at the supracrestal line (the line connecting the highest points of the iliac crests) — lumbar puncture is performed at L3-L4 or L4-L5 to avoid the conus (which ends at L1-L2 in adults). Transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are the most common surgical techniques for lumbar fusion using pedicle screw fixation.
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