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DESCRIPTION
anatomyTRANSCRIPT
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2BackandSpinalcord 1
atlasofHumananatomy
Topographicanatomyplate152
152 Back:SurfaceAnatomy
Bonesandligamentsplates153159
153 VertebralColumn
154 ThoracicVertebrae
155 LumbarVertebrae
156 Vertebrae:Radiology
157 SacrumandCoccyx
158 VertebralLigaments:LumbosacralRegion
159 VertebralLigaments:LumbarRegion
Spinalcordplates160170
160 SpinalCordandVentralRamiinSitu
161 RelationofSpinalNerveRootstoVertebrae
162 Dermatomes
163 SympatheticNervousSystem:Schema
164 ParasympatheticNervousSystem:Schema
165 SpinalMembranesandNerveRoots
166 SpinalNerveOrigin:CrossSections
167 ArteriesofSpinalCord:Schema
168 ArteriesofSpinalCord:IntrinsicDistribution
169 VeinsofSpinalCordandVertebralColumn
170 VeinsofVertebralColumn:VertebralVeins
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2BackandSpinalcord
2
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BackandSpinalcord
atlasofHumananatomy
Musclesandnervesplates171175
171 MusclesofBack:SuperficialLayers
172 MusclesofBack:IntermediateLayers
173 MusclesofBack:DeepLayers
174 NervesofBack
175 SuboccipitalTriangle
cross-Sectionalanatomyplates176177
176 LumbarRegionofBack:CrossSection
177 TypicalThoracicSpinalNerve:CrossSection
MuscleTables
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2Back:Surfaceanatomy
plate152Topographicanatomy
Trapezius muscle
Spine of scapula
Deltoid muscle
Triceps brachiimuscleLong headLateral headTendon
Infraspinatusmuscle
Teres major muscle
Latissimusdorsi muscle
Erector spinaemuscles
Iliac crest
Posterior superioriliac spine
Intergluteal (natal)cleft
Gluteal fold
Greater trochanterof femur
Gluteus maximusmuscle
Sacrum
Gluteus mediusmuscle
Spinous process ofT12 vertebra
Inferior angle ofscapula
Medial border ofscapula
Spine of scapula
Deltoid muscle
Spinous process ofC7 vertebra
Ligamentum nuchae
External occipital protuberance
Lumbar triangle (of Petit)
Triangle of auscultation
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plate153 Bonesandligaments
Anterior view Posterior viewLeft lateral view
Atlas (C1)
Axis (C2)
Cervicalvertebrae
Cervicallordosis
Thoracickyphosis
Lumbarlordosis
Sacralkyphosis
Thoracicvertebrae
C7
T1C7
T1
C7
T1
Atlas (C1)
Axis (C2)
Atlas (C1)
Axis (C2)
T12
L1
T12
L1
T12
L1
Lumbarvertebrae
L5
L5 L5
Sacrum(S15)Sacrum (S15)
Coccyx
Sacrum (S15)
Coccyx Coccyx
VertebralcolumnSeealsoPlates 21,183,243
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Bonesandligaments
2ThoracicVertebrae
plate154
Vertebral foramen
Superiorvertebral notch(forms lowermargin ofintervertebralforamen)
Superiorcostal facet
Superiorcostal facet
Superior articularprocess and facet
Transversecostal facet
Transverseprocess
Transversecostal facet
Superiorarticular facet
Superior articularprocess and facet
T6 vertebra:superior view
T6 vertebra:lateral view
T12 vertebra:lateral view
T7, T8, and T9 vertebrae:posterior view
Body
BodyPedicle
Lamina
Spinous process
Body
Costal facet
Vertebral canal
7th rib
Inferior articular processLamina
Spinous process
PedicleInferiorarticularprocess
Spinousprocess
Superior articularprocess and facet
Transverseprocess
Spinousprocess
Inferior articularprocess and facet
Inferiorvertebral notch
Inferiorcostal facet
Spinous process
Transverse process
T7
T8
T9
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Bonesandligaments
lumbarVertebrae
plate155
Vertebral body
Vertebral foramen
Pedicle
Transverse process
Superior articular process
Mammillary process
Lamina
Spinous process
Vertebral canal
Mammillary processVertebral body
Intervertebral disc
Vertebral body
Pedicle
Superior articular process
Mammillary process
Transverse process
Spinous process
Lamina
Anulus fibrosus
Accessory process
Intervertebral disc
Nucleuspulposus
Superiorarticular process
Transverseprocess
Inferiorvertebral notch
Intervertebral(neural) foramen
Accessoryprocess
Spinous processof L3 vertebra
Articular facetfor sacrumInferior
articular process
L2 vertebra:superior view
L3 and L4 vertebrae:posterior view
Lumbar vertebrae, articulated:left lateral view
Superiorvertebralnotch
Inferiorarticularprocess
L1
L2
L3
L4
L5
Lamina
Pars interarticularis
L3
L4
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Bonesandligaments
2Vertebrae:radiology
plate156
L3/L4 intervertebraldisc
Spinal cord
Conus medullaris
Lumbar cistern
Coccyx
S1 vertebraBody L5
Rectum
Heart
Body of cervical vertebra
Lung
12th rib
Transverse process L3
Lamina L4
Ilium
Sacrum
Air in stomach
Pedicle L2
Inferior articularprocess L2
Air in colon
Spinous process
Spinous process ofthoracic vertebra
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Bonesandligamentsplate157
Superiorarticular process
Base of sacrumSuperiorarticularprocess
Sacralcanal
Ala (wing)
Promontory
Sacral partof pelvic brim(linea terminalis)
Facets ofsuperior articularprocesses
Transverse sectionthrough S2 foramina
Anterior (pelvic)sacral foramina
Transverse processof coccyx
Posteriorsacral foramen
Intervertebralforamen
Anterior (pelvic)sacral foramen
Dorsal surface
Pelvic surface
Median sagittal section
Anterior inferiorview
Posterior superior view
Transverse processof coccyx
Coccygeal cornu(horn)
Sacral cornu(horn)
Sacral hiatus
Pelvic surface
Dorsal surface
Apex of sacrum
Transverseridges
Auricular surface
Median sacral crest
Sacral canal
Coccyx
Sacral tuberosity
Lateral sacral crest
Median sacral crest
Intermediate sacral crest
Sacral hiatus
Posteriorsacralforamina
SacrumandcoccyxSeealsoPlates 330,334
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Bonesandligaments
2Vertebralligaments:lumbosacralregion
plate158
Anteriorlongitudinalligament
Body ofL1 vertebra
Intervertebraldiscs
Ventral ramusof L2 spinalnerve
L4 spinalnerve
Body of L5 vertebra
Dorsal ramus ofL5 spinal nerve
Auricular surface of sacrum(for articulation with ilium)
Left lateral view
Posteriorsuperioriliac spine
Posteriorinferioriliac spine
Lateral,Posteriorsacro-coccygealligaments
Ischialtuberosity
Posterior view
Posterior sacro-iliac ligaments
Greater sciatic foramen
Ischial spine
Sacrospinous ligament
Lesser sciatic foramen
Sacrotuberous ligament
Superior articular processes;facet tropism (difference infacet axis) on right side
Posteriorlongitudinalligament
Pedicle (cut)
Superior articular process
Transverse process
Lamina
Inferior articular process
Pedicle
Intervertebral foramen
Spinous process
Interspinous ligament
Supraspinous ligament
Spinous process
Lamina
Transverse process
Inferior articular process
Ligamentum flavum
Iliolumbar ligament
Iliac crest
Sacrum
Coccyx
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Bonesandligaments
Vertebralligaments:lumbarregion
plate159
Posteriorlongitudinalligament
Nucleuspulposus
Anulusfibrosus
Cartilageend plate
Collagenlamellae ofanulus fibrosus
Anteriorlongitudinalligament
Intervertebral disc composed of central nuclear zone ofcollagen and hydrated proteoglycans surrounded byconcentric lamellae of collagen fibers
Left lateral view(partially sectionedin median plane)
Inferior articular process
Superior articular process
Transverse process
Spinous process
Ligamentum flavum
Interspinous ligament
Supraspinous ligament
Intervertebral foramen
Capsule of zygapophysial joint(partially opened)
Anteriorlongitudinal ligament
Anteriorlongitudinal ligament
Posteriorlongitudinal ligament
Lumbar vertebral body
Intervertebral disc
Pedicle (cut surface)
Ligamentum flavum
Lamina
Superior articularprocess
Posterior vertebral arches:anterior view
Transverse process
Inferior articular facet
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2SpinalcordandVentralramiinSitu
plate160Spinalcord
Occipital bone
C1 spinal nerve
C2 vertebra (axis)
C8 spinal nerve
T1 spinal nerve
1st rib
Intercostalnerves
T12 spinalnerve
12th rib
Subcostalnerve
Conus medullarisL1 spinal nerve
Cauda equina
L5 spinal nerve
S1 spinal nerve
Sacrum (cut away)
Filum terminale internum
Termination of dural sac
S5 spinal nerve
Coccygeal nerve
C1 vertebra (atlas)
Cervical plexus
C7 vertebra
T1 vertebra
Brachial plexus
Spinal dura mater
Lumbar plexus
Dorsal rootletsof spinal nerves(T7 and T8)
T12vertebra
L1vertebra
Iliohypogastricnerve
Ilio-inguinalnerve
L5 vertebra
Femoral nerve
Sacral plexus
Sciatic nerve
Superior and inferiorgluteal nerves
Posterior femoralcutaneous nerve
Pudendal nerve
Coccyx
Filum terminale externum(coccygeal ligament)
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Spinalcord
relationofSpinalnerverootstoVertebrae
plate161
C1 spinal nerve exitsabove C1 vertebra
Cervicalenlargement
Occipital bone
C8 spinal nerveexits belowC7 vertebra(there are 8 cervicalnerves but only7 cervical vertebrae)
Lumbar disc protrusion (dashed ovals) does not usuallyaffect nerve exiting above disc. Lateral protrusionat disc level L45 affects L5 spinal nerve, notL4 spinal nerve. Protrusion at disc level L5S1affects S1 spinal nerve, not L5 spinal nerve.
Lumbarenlargement
Conus medullaris(termination ofspinal cord)
Termination ofdural sac
Cauda equina
Coccygeal nerve
Coccyx Coccygeal nerve
Cervical nervesThoracic nervesLumbar nervesSacral and coccygeal nerves
Medial protrusion at disc level L45 (dashed oval)rarely affects L4 spinal nerve but may affect L5spinal nerve and sometimes S14 spinal nerves.
C1C2C3C4
C5C6C7
T1
T2
T3
T4
T5T6
T7
T8
T9
T10
T11
T12
L1
C1
C2C3C4
C5C6C7C8
T1
T2T3
T4T5T6
T7
T8
T9
T10
T11
T12
L1
L2L2
L3
L5
L3
L4L4
L5
Sacrum
S1S2
S3
S4S5
S2
L4
L4
L5
L5
S1
L4
L4
L5
L5
S1
S2
S3
S4
S5
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Spinalcord
2dermatomes
plate162
Levels of principal dermatomesC5 ClaviclesC5, 6 Lateral sides of upper limbsC8, T1 Medial sides of upper limbsC6 Digit I (thumb)C6, 7, 8 HandC8 Digits IV and V (ring and little fingers)T4 Level of nipples
T10 Level of umbilicusL1 Inguinal regionL1, 2, 3, 4 Anterior and inner surfaces of lower limbsL4, 5, S1 FootL4 Medial side digit I (great toe)L5, S1, 2 Lateral and posterior surfaces of lower limbsS1 Lateral margin of foot and digit V (little toe)S2, 3, 4 Perineum
Schematic demarcation of dermatomes(according to Keegan and Garrett)shown as distinct segments. There isactually considerable overlap betweenany two adjacent dermatomes. Analternative dermatome map is thatprovided by Foerster (see References).
C2
Trigeminal nerve (V)
C3C4C5
T1T2T3T4T5T6T7T8T9
T10
T11
T12
L1
L3
L4
L5
S1
L5
L4
C2
C3C4C5C6
C7C8 T1
T2T3T4T5T6T7T8T9T10T11T12L1
L3
L2
L1
S1 S2
L4
S1
L5
L4
S2
S1
L5
L2L3L4L5
S1S2
S3S4
S5
C6
T1
C5
C6
C8
C6
C7C7 C8
C7 C8
S2, 3L2
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Spinalcordplate163
Internal carotid nerve and plexus
External carotid nerve and plexus
Lacrimal gland
Eye
Parotid gland
Sublingual gland
Submandibular gland
Cardiac branches
Greater splanchnicnerve
Celiac ganglion
Lesser splanchnicnerve
Aorticorenalganglion
Least splanchnicnerveSuprarenal gland
SuperiormesentericganglionLumbarsplanchnicnerves
Inferiormesentericganglion
Inferiorhypogastricplexus
Sacralsplanchnicnerves
Preganglionic fibersPostganglionic fibers
First sacral ganglion
First lumbar ganglion
Superiorhypogastric plexus
Gray ramuscommunicans
White ramuscommunicans
First thoracic ganglion
Innervation to arrector pili muscles,vascular smooth muscle, and sweatglands of skin
Gray rami communicantes
Superior cervical ganglion
C1
C8
T1
T12
L1
L5
S1
S5
Larynx
BronchiTrachea
Lungs
Heart
Stomach
External genitalia
Prostate
Urinarybladder
Rectum
Sigmoid colon
Descendingcolon
Intestines
Kidneys
Pancreas
LiverGallbladderBile ducts
SympatheticnervousSystem:SchemaSeealsoPlates 206,317,319
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Spinalcord
2parasympatheticnervousSystem:Schema
plate164
Ciliary ganglion
Branch of oculomotor nerve (III)
Branch of facial nerve (VII)
Medulla oblongata
Branch of glossopharyngealnerve (IX)
Otic ganglion
Submandibular ganglion
S2
S3
S4
Celiac ganglion
Superiormesentericganglion
Pterygopalatine ganglion
Lacrimal glands
Eye
Parotid glands
Sublingual glands
Submandibular glands
Heart
Stomach
Liver
Gallbladder
Bile ducts
Pancreas
Kidneys
Descending colon
Sigmoid colon
Rectum
Urinary bladder
Prostate
Larynx
Trachea
Bronchi
Lungs
Intestines
External genitalia
Vagus nerve (X)
Preganglionic fibersPostganglionic fibers
Pelvic splanchnic nerves
Mucous glands ofnose, paranasalsinuses, palate
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Spinalcord
SpinalMembranesandnerveroots
plate165
Posterior view Ventral root of spinal nerveWithinmeningeal
sheath Dorsal root of spinal nerve
Dorsal root (spinal) ganglion
White and gray rami communicantesto and from sympathetic trunk
Ventral ramus of spinal nerve
Dorsal ramus of spinal nerve
Dura mater
Arachnoid mater
Pia mater overlying spinal cord
Rootlets of dorsal root
Denticulate ligament
Dura and arachnoid materremoved: anterior view(greatly magnified)
Gray matter
White matter Rootlets of dorsal root
Dorsal root of spinal nerve
Rootlets of ventral root
Dorsal root (spinal) ganglion
Dorsal ramus of spinal nerve
Ventral ramus of spinal nerve
Ventral root of spinal nerve
Spinal nerve
Gray and white ramicommunicantes
Lateral horn
Dorsal horn
Ventral horn
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Spinalcord
2Spinalnerveorigin:crossSections
plate166
Dura mater
Arachnoid mater
Ventral root
Spinal nerve
Ventral ramus (contributes to lumbar plexus)
Dorsal ramus
Dorsal root (spinal) ganglion
Dorsal root
Filum terminale internum *Leptomeninges
Dorsal and ventralroots of lumbar andsacral spinal nervesforming cauda equina
Gray ramuscommunicans
Fat inepiduralspace
Sympatheticganglion
Section through lumbar vertebra
Internal vertebral(epidural) venous plexus (of Batson)
Fat in epidural space
Sympathetic ganglion
Ventral root
White and gray ramicommunicantes
Spinal nerve
Ventral ramus(intercostal nerve)
Dorsal ramus
Aorta
Dura mater
Subarachnoid space
Arachnoid mater*
Pia mater*
Recurrent(meningeal)branches of spinalnerve
Pleurae
Lung
Dorsal root(spinal) ganglion
Dorsal root
Medial branch
Lateral branch
of dorsalramus ofspinal nerve
Lateral horn ofgray matter of spinal cord
Body of vertebra
Section through thoracic vertebra
Denticulate ligament
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Spinalcord
arteriesofSpinalcord:Schema
plate167
Posterior cerebral artery
Superior cerebellar artery
Basilar artery
Anterior inferiorcerebellar artery (AICA)
Posterior inferiorcerebellar artery (PICA)
Anterior spinal artery
Vertebral artery
Segmentalmedullary arteries
Ascending cervicalartery
Cervical v
ertebrae
Anterior view Posterior view
Deep cervical artery
Subclavian artery
Segmentalmedullary artery
Posterior intercostal artery
Thoracicvertebrae
Pial plexus
Posterior intercostal artery
Segmentalmedullary artery
Lumbar artery
Anastomotic loops toposterior spinal arteries
Lumbarvertebrae
Lateral sacralartery:spinal branches Sacrum
Posterior inferior cerebellar artery
Posterior spinal arteries
Vertebral artery
Segmentalmedullary arteries
Deep cervical artery
Ascending cervical artery
Subclavian artery
Segmentalmedullary arteries
Segmentalmedullary arteries
Posteriorintercostal arteries
Anastomotic loops toanterior spinal artery
Lumbar arteries
Lateral (or medial)sacral arteries
Note: All spinal nerve roots have associated radicular or segmental medullary arteries. Most roots have radicular arteries (see Plate 168). Both types of arteries run along roots, but radicular arteries end before reaching anterior or posterior spinal arteries; larger segmental medullary arteries continue on to supply a segment of these arteries.
Anterior radicular artery(great radicular artery of
Adamkiewicz)
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Spinalcord
2
plate168
Posterior spinal arteries
Anterior spinal artery
Segmentalmedullary artery
Posterior radicular artery
Branch to vertebral bodyand dura mater
Spinal branch
Dorsal branch of posteriorintercostal artery
Posterior intercostal artery
Paravertebral anastomoses
Prevertebral anastomoses
Thoracic (descending) aorta
Right posterior spinal artery
Peripheral branches from pial plexus
Sulcal (central) branches to left sideof spinal cord
Left posterior spinal artery
Posterior radicular artery
Segmental medullary artery
Pial arterial plexus
Section through thoracic level:anterosuperior view
Sulcal (central) branches toright side of spinal cord
Segmentalmedullary artery
Pial arterial plexus
Anterior and posteriorradicular arteries
Anterior spinal artery
Arterial distribution: schema
Posterior radicular artery
Anterior radicular artery
arteriesofSpinalcord:intrinsicdistributionSeealsoPlate 188
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Spinalcord
VeinsofSpinalcordandVertebralcolumn
plate169
Externalvertebral venousplexus
Internal vertebral(epidural) venous
plexus (Batsonsveins)
Basivertebral vein
Anterior spinal vein
Anterior sulcal(central) vein
Basivertebral vein
Internal vertebral(epidural) venous plexus
Intervertebral vein
Anterior segmental medullary/radicular vein
Posterior segmental medullary/radicular vein
Internal vertebral (epidural) venous plexus
Posterior spinal vein
Posterior sulcal (central) vein
Pial venous plexus
External vertebralvenous plexus
Internal vertebral(epidural) venous plexus
Intervertebralvein
Segmental medullary/radicular veins
Internal vertebral(epidural) venous plexus
Basivertebral vein
External vertebral venous plexus
External vertebral venous plexus
Internal vertebral (epidural) venous plexus
Intervertebral vein
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Spinalcord
2VeinsofVertebralcolumn:VertebralVeins
plate170
Superior bulb of right internal jugular vein Condylaremissaryvein
Mastoid emissary vein
Venous plexus around vertebral artery
Communicating veins
Right deep cervical vein
Accessory vertebral vein
Dorsal scapular artery
Costocervical trunk
Right thyrocervicaltrunk
Right subclavian vein
Right internal jugular vein (inferior bulb)
Right subclavian artery
Right brachiocephalic vein
Vertebral arteries
Dura mater
Anterior internal (epidural)vertebral venous plexus
Anterior externalvertebral venous plexus
Anterior vertebral veins
Left deep cervical vein
Left vertebral vein
Left vertebral artery
Left thyrocervical trunk
Left internal jugular vein(inferior bulb)
Left subclavianartery
Left common carotidartery
Left brachiocephalicvein
Right vertebral artery and vein
Right common carotid artery
Left subclavianvein
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plate171 Musclesandnerves
Superior nuchal line of skull
Spinous process of C2 vertebra
Sternocleidomastoid muscle
Posterior triangle of neck
Trapezius muscle
Spine of scapula
Deltoid muscle
Infraspinatusfascia
Teres minormuscle
Teres majormuscle
Latissimusdorsi muscle
Thoracolumbar fascia
Iliac crest
Externaloblique muscle
Internal obliquemuscle in lumbar triangle(of Petit)
Spinous processof T12 vertebra
Semispinalis capitis muscle
Splenius capitis muscle
Spinous process of C7 vertebra
Splenius cervicis muscle
Levator scapulae muscle
Rhomboid minor muscle (cut)
Supraspinatusmuscle
Serratusposteriorsuperior muscle
Rhomboidmajor muscle(cut)
Infraspinatusfascia (overinfraspinatusmuscle)
Teres minorand majormuscles
Latissimus dorsi muscle (cut)
Serratus anterior muscle
Serratus posterior inferiormuscle
Externaloblique muscle
Internaloblique muscle
12th rib
Erector spinae muscle
Gluteus maximus muscle
MusclesofBack:SuperficiallayersSeealsoPlates 29,250
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Musclesandnerves
2MusclesofBack:intermediatelayers
plate172
Erectorspinaemuscle
Iliocostalis muscle
Longissimus muscle
Spinalis muscle
Serratus posterior superior muscle
Splenius capitis andsplenius cervicis muscles
Superior nuchal line of skull
Posterior tubercle of atlas (C1)
Longissimus capitis muscle
Semispinalis capitis muscle
Serratus posteriorinferior muscle
Tendon of origin oftransversus abdominis muscle
Internal obliquemuscle
External obliquemuscle (cut)
Iliac crest
Thoracolumbar fascia(posterior layer) (cut)
Transversus abdominismuscle and tendonof origin
Spinous process of T12 vertebra
Iliocostalis lumborum muscle
Longissimus thoracis muscle
Spinalis thoracis muscle
Iliocostalis thoracis muscle
Hook
Iliocostalis cervicis muscle
Longissimus cervicis muscle
Spinous process of C7 vertebra
Spinalis cervicis muscle
Semispinalis capitis muscle (cut)
Longissimus capitis muscle
Obliquus capitis inferior muscle
Rectus capitis posterior major muscle
Obliquus capitis superior muscle
Rectus capitis posterior minor muscle
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Musclesandnerves
MusclesofBack:deeplayers
plate173
Superior nuchal line of skull
Mastoid process
Posterior tubercle of atlas(C1 vertebra)
Spinous process of axis(C2 vertebra)
Semispinalis capitis muscle
Semispinalis cervicis muscle
Spinous processof C7 vertebra
External intercostal muscles
Semispinalis thoracis muscle
Multifidus thoracis muscles
Thoracolumbar fascia(anterior layer)
Thoracolumbar fascia(posterior layer) (cut)
Transversus abdominis muscleand tendon of origin
Multifidus lumborum muscles
Erector spinae muscle (cut)Multifidus lumborummuscles (cut)
Iliac crest
Quadratus lumborum muscle
Intertransversarius lateraleslumborum muscle
Interspinalis lumborum muscle
Brevis
Longus
Levatorescostarum muscles
Longus
BrevisRotatoresthoracis muscles
Levator costarum muscle
Rectus capitis posterior minor muscle
Obliquus capitis superior muscle
Rectus capitis posterior major muscle
Transverse process of atlas (C1)
Obliquus capitis inferior muscle
Interspinalis cervicis muscle
Brevis
LongusRotatores cervicis muscles
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Musclesandnerves
2
plate174
Accessory nerve (XI)
Trapezius muscle (reflected)
Levator scapulae muscle
Superficial cervical artery
Supraspinatusmuscle
Spine ofscapula
Infraspinatusfascia
Rhomboidminor muscle
Rhomboidmajor muscle
Spinous process ofT12 vertebra
Gluteus maximusmuscle
Latissimus dorsi muscle
Thoracolumbar fascia
Iliac crest
External oblique muscle
Superior lateral brachialcutaneous nerve (fromaxillary nerve C5, 6)
Infraspinatus fascia
Lesser occipital nerve
Great auricular nerve
Trapezius muscle
Inferior clunial nerves fromposterior femoral cutaneousnerve (sacral plexus S1, 2, 3)
Iliohypogastric nerve(ventral ramus of T12, L1 spinal nerve)
Lateral cutaneous branches ofventral rami (intercostal nerves)
Posterior cutaneousbranches (from lateralbranches of dorsal ramiof T712 spinal nerves)
Teres minor andmajor muscles
Posterior cutaneous branches (from medialbranches of dorsal rami of C4T6 spinalnerves; C7, 8 are minimal)
Cervical plexus(ventral rami ofC2, 3 spinal nerves)
Third occipital nerve (dorsal ramus ofC3 spinal nerve)
Greater occipital nerve (dorsal ramus ofC2 spinal nerve)
Deltoid muscle
Superior clunial nerves(dorsal rami of L1, 2, 3 spinalnerves)
Middle clunial nerves(dorsal rami of S1, 2, 3 spinalnerves)
nervesofBackSeealsoPlates 409,481
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Musclesandnervesplate175
Epicranial aponeurosis
Occipital belly (occipitalis) ofoccipitofrontalis muscle
Greater occipital nerve(medial branch of dorsalramus of C2 spinal nerve)
Occipital artery
Posterior auricular artery
Great auricular nerve(cervical plexus C2, 3)
Lesser occipital nerve(cervical plexus C2, 3)
Sternocleidomastoid muscle
Trapezius muscle
Splenius capitis muscle (cut)
Semispinalis capitis muscle (cut)
Semispinalis cervicis muscle
Splenius cervicis muscle
Longissimus capitis muscle
Splenius capitis muscle(cut and reflected)
Greater occipitalnerve (dorsal ramusof C2 spinal nerve)
Obliquus capitisinferior muscle
Descendingbranch ofoccipital artery
Posterior arch ofatlas (C1 vertebra)
Suboccipital nerve(dorsal ramus of C1spinal nerve)
Obliquus capitissuperior muscle
Vertebral artery(horizontal segment)
Semispinalis capitis muscle(cut and reflected)
Rectus capitis posterior major muscle
Rectus capitis posterior minor muscle
Semispinalis capitis and Splenius capitis muscles in posterior triangle of neck
Posterior cutaneous branches of dorsal rami of C4, 5, 6spinal nerves
Third occipital nerve (dorsal ramus of C3spinal nerve)
Third occipital nerve(medial branch of dorsalramus of C3 spinal nerve)
SuboccipitalTriangleSeealsoPlates 29,32
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2lumbarregionofBack:crossSection
plate176cross-Sectionalanatomy
Abdominal aorta
Inferior vena cava
Pancreas
Anterior longitudinal ligament
Crura of diaphragm
Superior mesenteric artery and vein
Mesentery
Duodenojejunaljunction
Body ofL2 vertebra
Psoas majormuscleand fascia
Lumbarspinal nerve
Transverseprocess
Spinaldura mater
Caudaequina
Spinous processof L1 vertebra
Supraspinous ligament
Erector spinae and multifidus muscles
Thoracolumbar fascia (posterior layer)
Thoracolumbar fascia (middle layer)
Thoracolumbar fascia (anterior layerquadratus lumborum fascia)
Descending (2nd) part of duodenum
Kidney
Renal fascia (anterior and posterior layers)
Perirenal fat
Pararenal fat
Peritoneum
Extraperitoneal(subserous) fascia(areolar tissue)
Transversalisfascia
Externalobliquemuscle
Internaloblique muscle
Transversus abdominismuscle
Tendon of origin oftransversus abdominis andinternal oblique muscles
Serratus posterior inferior muscle
Latissimus dorsi muscle
Quadratus lumborum muscle
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cross-Sectionalanatomy
TypicalThoracicSpinalnerve:crossSection
plate177
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Anterior branch
Posterior branch
Lateral cutaneous branch
Anterior cutaneous branch
Lateral branchMedial branch
Sternum
Transversus thoracismuscle
Externalintercostal membrane
Intervertebralforamen
Ventral root
Dorsal root
Spinal nerve
Ventral ramus (intercostal nerve)
Dorsal root (spinal)ganglion
Sympathetic ganglion
Gray and white rami communicantes
Trapezius muscleDorsal ramus
Posterior cutaneous branch
Medial branch
Lateral branchRhomboid major muscle
Erector spinae muscle
Internal intercostal membrane
Infraspinatus muscle
Scapula
Teres major muscle
Subscapularis muscle
Latissimus dorsi muscle
Serratus anterior muscle
Note: In lower thoracic region, lateral branch of dorsal ramus is longer, motor, and cutaneous; medial branch is shorter and motor only.
SeealsoPlate 254
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2MuscleTables
Table2-1MuscleTables
MUSCLEPROXIMAL ATTACHMENT (ORIGIN)
DISTAL ATTACHMENT (INSERTION)
INNERVATION MAIN ACTIONS BLOOD SUPPLY MUSCLE GROUP
Erector spinae
Posterior sacrum, iliac crest, sacrospinous ligament, supraspinous ligament, spinous processes of lower lumbar and sacral vertebrae
Iliocostalis: angles of lower ribs, cervical transverse processes
Longissimus: between tubercles and angles of ribs, transverse processes of thoracic and cervical vertebrae, mastoid process
Spinalis: spinous processes of upper thoracic and midcervical vertebrae
Dorsal rami of each region
Extends and laterally bends vertebral column and head
Cervical portions: occipital, deep cervical, and vertebral arteries
Thoracic portions: dorsal branches of posterior intercostal, subcostal, and lumbar arteries
Sacral portions: dorsal branches of lateral sacral arteries
Sacrospinalis
Interspinales (cervical, thoracic, lumbar)
Spinous process Adjacent spinous processDorsal rami of
spinal nerves
Aid in extension of vertebral column
Cervical portions: occipital, deep cervical, and vertebral arteries
Thoracic portions: dorsal branches of posterior intercostal arteries
Lumbar portions: dorsal branches of lumbar arteries
Segmental
Intertransversarii (cervical, thoracic, lumbar)
Extend between adjacent transverse processes of vertebrae
Extend between adjacent transverse processes of vertebrae
Dorsal rami of spinal nerves
Assist in lateral flexion of vertebral column
Cervical portions: occipital, deep cervical, and vertebral arteries
Thoracic portions: dorsal branches of posterior intercostal, subcostal, and lumbar arteries
Lumbar portions: dorsal branches of lateral lumbar arteries
Segmental
Latissimus dorsi
Spinous processes of T7L5, thoracolumbar fascia, iliac crest, and last three ribs
Humerus (intertubercular sulcus)
Thoracodorsal nerve
Extends, adducts, and medially rotates humerus
Thoracodorsal artery, dorsal perforating branches of 9th, 10th, and 11th posterior intercostal, subcostal, and first three lumbar arteries
Superficial back
Levator scapulae
Posterior tubercles of transverse processes of C1C4
Medial border of scapula from superior angle to spine
Ventral rami of C3C4 and dorsal scapular nerve
Elevates scapula medially, inferiorly rotates glenoid cavity
Dorsal scapular artery, transverse cervical artery, ascending cervical artery
Superficial back
Multifidus
Sacrum, ilium, transverse processes of T1T12, and articular processes of C4C7
Spinous processes of vertebrae above, spanning two to four segments
Dorsal rami of each region Stabilizes spine
Cervical portions: occipital, deep cervical, and vertebral arteries
Thoracic portions: dorsal branches of posterior intercostal, subcostal, and lumbar arteries
Sacral portions: dorsal branches of lateral sacral arteries
Transversospinalis
Obliquus capitis inferior Spine of axis
Transverse process of atlas
Suboccipital nerve
Rotates atlas to turn face to same side
Vertebral artery, descending branch of occipital artery
Suboccipital
Obliquus capitis superior
Transverse process of atlas
Occipital bone Suboccipital nerve
Extends and bends head laterally
Vertebral artery, descending branch of occipital artery
Suboccipital
Rectus capitis posterior major
Spine of axis Inferior nuchal line Suboccipital nerve
Extends and rotates head to same side
Vertebral artery, descending branch of occipital artery
Suboccipital
Variations in spinal nerve contributions to the innervation of muscles, their arterial supply, their attachments, and their actions are common themes in human anatomy. Therefore, expect differences between texts and realize that anatomical variation is normal.
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MuscleTablesTable2-2
MuscleTables
MUSCLEPROXIMAL ATTACHMENT (ORIGIN)
DISTAL ATTACHMENT (INSERTION)
INNERVATION MAIN ACTIONS BLOOD SUPPLY MUSCLE GROUP
Rectus capitis posterior minor
Tubercle of posterior arch of atlas
Median inferior nuchal line Suboccipital nerve Extends head
Vertebral artery, descending branch of occipital artery
Suboccipital
Rhomboid majorSpinous processes
of T2T5 vertebrae
Medial border of scapula below base of spine of scapula
Dorsal scapular nerve
Fixes scapula to thoracic wall and retracts and rotates it to depress glenoid cavity
Dorsal scapular artery OR deep branch of transverse cervical artery, dorsal perforating branches of the upper five or six posterior intercostal arteries
Superficial back
Rhomboid minor
Ligamentum nuchae, spines of C7 and T1 vertebrae
Medial border of scapula at spine of scapula
Dorsal scapular nerve
Fixes scapula to thoracic wall and retracts and rotates it to depress glenoid cavity
Dorsal scapular artery OR deep branch of transverse cervical artery, dorsal perforating branches of the upper five or six posterior intercostal arteries
Superficial back
Rotatores
Transverse processes of cervical, thoracic, and lumbar regions
Lamina and transverse process of spine above, spanning one or two segments
Dorsal rami of spinal nerves
Stabilizes, extends, and rotates spine
Dorsal branches of segmental arteries Transversospinalis
SemispinalisTransverse
processes of C4T12
Spinous processes of cervical and thoracic regions
Dorsal rami of spinal nerves
Extends head, neck, and thorax and rotates them to opposite side
Cervical portions: occipital, deep cervical, and vertebral arteries
Thoracic portions: dorsal branches of posterior intercostal arteries
Transversospinalis
Serratus posterior inferior
Spinous processes of T11L2
Inferior aspect of ribs 912
Ventral rami of lower thoracic nerves
Depresses ribs Posterior intercostal arteries Intermediate back
Serratus posterior superior
Ligamentum nuchae, spinous processes of C7T3
Superior aspect of ribs 24
Ventral rami of upper thoracic nerves Elevates ribs
Posterior intercostal arteries Intermediate back
Splenius capitis
Nuchal ligament, spinous process of C7T3
Mastoid process of temporal bone, lateral third of superior nuchal line
Dorsal rami of middle cervical nerves
Bilaterally: extend head
Unilaterally: laterally bends (flexes) and rotates face to same side
Descending branch of occipital artery, deep cervical artery
Spinotransverse
Splenius cervicis Spinous process of T3T6
Transverse processes (C1C3)
Dorsal rami of lower cervical nerves
Bilaterally: extend neck
Unilaterally: laterally bends (flexes) and rotates neck toward same side
Descending branch of occipital artery, deep cervical artery
Spinotransverse
Trapezius
Superior nuchal line, external occipital protuberance, nuchal ligament, spinous processes of C7T12
Lateral third of clavicle, acromion, spine of scapula
Accessory nerve (CN XI)
Elevates, retracts, and rotates scapula; lower fibers depress scapula
Transverse cervical artery, dorsal perforating branches of posterior intercostal arteries
Superficial back