The lumbar multifidus attaches via short, stout tendinous slips to the spinous processes and laminae, the mammillary processes, and the posterior sacrum. Its deepest, shortest fibres run from the laminae to segments just below, giving the most segment-specific control. These tendons are the deepest structural stabilisers of each lumbar motion segment, providing intersegmental stiffness independent of the global erector spinae.
| Muscle | |
|---|---|
| Attachment | Spinous processes and laminae of the lumbar vertebrae, mammillary processes, and posterior sacrum |
Extends and stabilises individual lumbar segments
Multifidus atrophy and fatty infiltration ipsilateral to a symptomatic disc herniation is one of the most consistent MRI findings in chronic low back pain. Open posterior lumbar surgery strips the deep attachments from the laminae and can denervate the muscle, contributing to postoperative atrophy, which minimally invasive tubular techniques aim to reduce. Real-time ultrasound biofeedback targeting multifidus contraction is used in rehabilitation. Tendinous avulsions at the mammillary processes are rare but reported after severe spinal flexion injuries.
Degenerative changes at the multifidus insertion on the mammillary or spinous process producing deep unilateral lumbar pain, often associated with ipsilateral disc pathology and muscle atrophy.
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