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1 _CH01redo.qxd 9/24/07 3:07 PM Page 1 [Half-Title to come]
2 _CH01redo.qxd 9/24/07 3:07 PM Page 2 THE BACK Lippincott Williams & Wilkins atlas of ANATOMY CHAPTER 1 Plate 1-01 Palpable Structures of the Back Plate 1-02 Vertebral Column, Lateral View Plate 1-03 Cervical Vertebrae Plate 1-04 Articulated Cervical Vertebrae Plate 1-05 Thoracic and Lumbar Vertebrae Plate 1-06 Articulated Thoracic Vertebrae Plate 1-07 Articulated Lumbar Vertebrae Plate 1-08 and Coccyx Plate 1-09 Ligaments of the Cervical Vertebrae Plate 1-10 Ligaments of the Thoracic Vertebrae Plate 1-11 Ligaments of the Lumbar Vertebrae and Plate 1-12 Cutaneous Innervation of the Back Plate 1-13 Superficial Muscles of the Back Plate 1-14 Deep Back Muscles, Superficial Dissection Plate 1-15 Deep Back Muscles, Deeper Dissection Plate 1-16 Suboccipital Region Plate 1-17 Pattern of a Typical Spinal Nerve Plate 1-18 Spinal Cord, Posterior View Plate 1-19 Portion of the Spinal Cord Plate 1-20 Inferior Portion of the Spinal Cord Plate 1-21 Blood Supply of the Spinal Cord, Anterior View Plate 1-22 Venous Drainage of the Vertebral Column and Spinal Cord Plate 1-23 Dermatomes
3 _CH01redo.qxd 9/24/07 3:07 PM Page 4 Palpable Structures of the Back PLATE 1-01 Palpable bony structures nuchal line External occipital protuberance border of trapezius muscle Vertebra prominens () Clavicle Acromioclavicular joint Greater tubercle of humerus Acromion of scapula Spine of scapula Posterior axillary fold es of vertebrae in vertebral furrow Inferior angle of scapula Rib Iliac crest Bulge of erector spinae muscles Posterior superior iliac spine Hip bone Greater trochanter of femur Coccyx Ischial tuberosity PAGE 5
4 _CH01redo.qxd 9/24/07 3:07 PM Page 6 PLATE 1-02 Vertebral Column, Lateral View Cervical Vertebrae PLATE 1-03 Vertebral Column, Lateral View A. Atlas (C1), superior view B. Atlas (C1), inferior view Anterior arch Anterior tubercle Articular facet for dens Posterior arch Anterior a rch Posterior tubercle Vertebral Atlas (C1) Cervical curvature Axis (C2) Vertebral articular facet for occipital condyle Groove for vertebral artery and C1 ventral ramus Posterior tubercle Posterior arch Inferior articular facet for axis Anterior arch Anterior tubercle Articular facet for dens C. Axis (C2), superior view Anterior arch Dens Anterior articular facet for arch of atlas Thoracic curvature articular facet Inferior articular 2 Posterior articular facet for transverse of atlas Lumbar curvature D. Cervical vertebra (C4), superior view Body E. Cervical vertebra (C4), lateral view Sacral curvature : Anterior tubercle Posterior tubercle Vertebral Uncinate articular facet articular facet and Uncinate Inferior articular Body : Anterior tubercle Posterior tubercle Coccyx PAGE 6 PAGE 7
5 _CH01redo.qxd 9/24/07 3:07 PM Page 8 PLATE 1-04 Articulated Cervical Vertebrae Thoracic and Lumbar Vertebrae PLATE 1-05 A. Lateral view B. Radiograph of cervical vertebrae, lateral view A. Thoracic vertebra (T6), superior view Body B. Thoracic vertebra (T6), lateral view C1 C2 C3 C4 C5 Occipital bone Anterior arch of atlas (C1) Posterior arch of atlas (C1) Intervertebral disc Zygapophyseal joint Intervertebral C1 C2 C3 C4 C5 Vertebral vertebral notch articular facet costal facet costal facet costal facet Inferior articular articular facet and vertebral notch costal facet Inferior vertebral notch Inferior costal facet Body of C. Intervertebral disc, superior view Anulus fibrosus Nucleus pulposus C. Posterior view D. Radiograph of cervical vertebrae, posterior view C1 C2 C3 C4 C5 Mandible of C4 es of of C3 C4 C5 D. Lumbar vertebra (L3), superior view articular and facet Mammillary Body Vertebral E. Lumbar vertebra (L3), lateral view Inferior articular articular Inferior articular facet vertebral notch Inferior vertebral notch Body PAGE 8 PAGE 9
6 _CH01redo.qxd 9/24/07 3:07 PM Page 10 PLATE 1-06 Articulated Thoracic Vertebrae Articulated Lumbar Vertebrae PLATE 1-07 A. Lateral view B. Posterior view A. Lateral view B. Radiograph of lumbar vertebrae, lateral view 2 Inferior articular 2 articular Intervertebral disc es L2 L2 costal facets Intervertebral foramina L3 Inferior vertebral notch Intervertebral L3 vertebral notch Inferior costal facets of e Body costal facets es C. Posterior view D. Radiograph of lumbar vertebrae, posterior view 2 2 s Intervertebral discs L2 Zygapophyseal joint Inferior articular articular L2 L3 L3 2 PAGE 10 PAGE 11
7 _CH01redo.qxd 9/24/07 3:07 PM Page 12 PLATE 1-08 and Coccyx Ligaments of the Cervical Vertebrae PLATE 1-09 A. Anterior view Base of sacrum A. Lateral view Anterior atlanto-occipital membrane Ala (lateral part) articular Posterior atlanto-occipital membrane Capsule of atlanto-occipital joint Anterior arch of atlas (C1) Lumbosacral articular surface Promontory Body of axis (C2) Vertebral artery ridges Anterior (pelvic) sacral foramina Ligamenta flava Ligamentum nuchae Capsules of zygapophyseal joints (C3 C4 and C4 C5) Anterior longitudinal Coccyx Apex of sacrum Interspinous of vertebra (vertebra prominens) Intervertebral discs (C4 C5 and ) B. Posterior view B. Posterior view Occipital bone articular facet Auricular surface Capsule of atlanto-occipital joint Capsule of lateral atlantoaxial joint Posterior atlanto-occipital membrane of atlas (C1) Atlas (C1) Axis (C2) Median sacral crest Lateral sacral crest Posterior sacral foramina Ligamenta flava Ligamentum nuchae Capsules of zygapophyseal joints Vertebral artery Sacral hiatus Coccyx Supraspinous PAGE 12 PAGE 13
8 _CH01redo.qxd 9/24/07 3:07 PM Page 14 PLATE 1-10 Ligaments of the Thoracic Vertebrae Ligaments of the Lumbar Vertebrae and PLATE 1-11 A. Lateral view Body of 2 Supraspinous A. Lateral view Ligamenta flava Intervertebral Body of Posterior longitudinal Anulus fibrosus Nucleus pulposus Tip of conus medullaris (cut) surrounded by nerve roots Interspinous Intervertebral Intertransverse s costotransverse s Posterior longitudinal Anterior longitudinal B. Posterior view Zygapophyseal joint capsules Supraspinous Interspinous L2 spinal nerve Anterior longitudinal Intervertebral disc Radiate s Ribs costotransverse Supraspinous Intervertebral discs Ribs Lateral costotransverse Dorsal rami: Ventral rami: B. Posterior view Intertransverse Posterior longitudinal (cut) 2 Anterior longitudinal Intertransverse Ligamenta flava Zygopophyseal joint capsule Iliolumbar Supraspinous 2 Posterior sacroiliac PAGE 14 PAGE 15
9 _CH01redo.qxd 9/24/07 3:07 PM Page 16 PLATE 1-12 Cutaneous Innervation of the Back Superficial Muscles of the Back PLATE 1-13 nuchal line Greater occipital nerve (dorsal ramus of C2) Third occipital nerve (dorsal ramus of C3) Sternocleidomastoid muscle of Splenius capitis muscle Accessory nerve (CN XI) Splenius cervicis muscle cervical artery Trapezius muscle Levator scapulae muscle Skin Trapezius muscle Rhomboid minor muscle Spine of scapula Rhomboid major muscle Posterior cutaneous branches (dorsal rami of C4 T6) Deltoid muscle Trapezius muscle Deltoid muscle Infraspinatus fascia Teres major muscle Infraspinatus fascia Teres major muscle Thoracodorsal artery and nerve Latissimus dorsi muscle Posterior cutaneous branches (dorsal rami of T7 2) Triangle of auscultation Superficial fascia External abdominal oblique muscle Erector spinae muscles (deep to thoracolumbar fascia) Latissimus dorsi muscle Latissimus dorsi muscle (cut) Lateral cutaneous branches of ventral rami (intercostal nerves) External abdominal oblique muscle of 2 Lumbar triangle Serratus anterior muscle Serratus posterior inferior muscle cluneal nerves (dorsal rami of L3) Iliac crest 12th rib Thoracolumbar fascia Iliac crest Middle cluneal nerves (dorsal rami of S1 S3) PAGE 16 PAGE 17
10 _CH01redo.qxd 9/24/07 3:07 PM Page 18 PLATE 1-14 Deep Back Muscles, Superficial Dissection Deep Back Muscles, Deeper Dissection PLATE 1-15 External occipital protuberance nuchal line External occipital protuberance Rectus capitis posterior muscles: Minor Major of nuchal line Posterior tubercle of atlas Semispinalis capitis muscle Splenius capitis and cervicis muscles Longissimus cervicis muscle Iliocostalis cervicis muscle Posterior tubercle of atlas (C1) of axis (C2) Semispinalis muscles: Capitis Thoracis Obliquus capitis superior muscle of altas (C1) Obliquus capitis inferior muscle Interspinalis cervicis muscle Rotatores cervicis muscles: Longus Brevis Iliocostalis thoracis muscle (retracted) of Serratus posterior superior muscle Rotatores thoracis muscles: Longus Brevis External intercostal muscles Erector spinae muscle: Iliocostalis muscle Longissimus muscle Spinalis muscle Spinalis thoracis muscle Longissimus thoracis muscle Multifidus muscles Interspinalis thoracis muscle Levatores costarum muscles: Longus Brevis Iliocostalis lumborum muscle Serratus posterior inferior muscle Interspinalis lumborum muscle External abdominal oblique muscle Internal abdominal oblique muscle Lateral intertransversarius muscle Iliac crest Iliac crest PAGE 18 PAGE 19
11 _CH01redo.qxd 9/24/07 3:07 PM Page 20 PLATE 1-16 Suboccipital Region Pattern of a Typical Spinal Nerve PLATE 1-17 A. Orientation B. Oblique section Anterior cutaneous branch of 6th intercostal nerve: Medial branch Lateral branch Trapezius muscles (cut) Occipital artery Greater occipital nerve Parietal pleura Superficial fascia Rectus capitis posterior minor muscle Skin Rectus capitis posterior major muscle Sternum Vertebral artery Obliquus capitis superior muscle External intercostal muscle Internal intercostal muscle External intercostal membrane Transversus thoracis muscle Sternocleidomastoid muscle (cut) Innermost intercostal muscle Sternocleidomastoid muscle (cut) Suboccipital nerve (dorsal ramus of C1 spinal nerve) Obliquus capitis inferior muscle Lateral cutaneous branch of 6th intercostal nerve: Anterior branch Posterior branch Body of 6th thoracic vertebra Lesser occipital nerve Splenius capitis muscle (cut and reflected) Sympathetic ganglion Semispinalis capitis muscle Splenius capitis muscle Greater occipital nerve (dorsal ramus of C2 spinal nerve) White and gray rami communicantes Ventral root Trapezius muscle (cut) 3rd occipital nerve (dorsal ramus of C3 spinal nerve) Spinal cord Dorsal root Dorsal root ganglion Longissimus capitis muscle Scapula 6th thoracic spinal nerve Ventral ramus (intercostal nerve) Dorsal ramus Posterior cutaneous branch of dorsal ramus of 6th thoracic spinal nerve: Lateral branch Medial branch Deep back muscles PAGE 20 PAGE 21
12 _CH01redo.qxd 9/24/07 3:07 PM Page 22 PLATE 1-18 Spinal Cord, Posterior View Portion of the Spinal Cord PLATE 1-19 Occipital bone A. Orientation C1 vertebra (atlas, cut) C2 vertebra (axis, cut) Denticulate C1 spinal nerve Splenius capitis and splenius cervicis muscles (cut and reflected) B. Dissection Serratus posterior superior muscle (cut and reflected) vertebra (cut) vertebra (cut) Dorsal root ganglion spinal nerve C5 pedicle (cut) Dura mater Dura and arachnoid mater (cut and reflected) Arachnoid mater Pia mater on surface of spinal cord Erector spinae muscle: Iliocostalis muscle Longissimus muscle (spinalis muscle removed) Roots of spinal nerves T2 1 Ventral ramus Dorsal median sulcus Serratus posterior inferior muscle (cut and reflected) Conus medullaris Dorsal ramus Dorsal rootlets 2 vertebra (cut) vertebra (cut) spinal nerve Termination of spinal cord at intervertebral disc /L2 Cauda equina Dorsal root of spinal nerve Denticulate Posterior radicular artery vertebra (cut) Filum terminale internum spinal nerve Posterior spinal arteries Ventral root of spinal nerve (cut) Hip bone S1 spinal nerve Termination of dural sac at S2 vertebral level Spinal branches of posterior intercostal artery Dorsal root ganglion S5 spinal nerve T3 pedicle (cut) Filum terminale externum Coccygeal nerve Coccyx PAGE 22 PAGE 23
13 _CH01redo.qxd 9/24/07 3:08 PM Page 24 PLATE 1-20 Inferior Portion of the Spinal Cord Blood Supply of the Spinal Cord, Anterior View PLATE 1-21 A. Orientation B. Dissection Thoracic vertebrae Anterior spinal artery Posterior spinal arteries Spinal cord Arachnoid mater Dura mater Dura and arachnoid mater (cut and reflected) Conus medullaris Radicular arteries Lumbar vertebrae Spinal branch Denticulate (cut) Branch to vertebral body and dura mater Arachnoid mater Posterior radicular artery Anterior radicular artery Posterior intercostal artery Cauda equina s (cut) Filum terminale internum Dorsal root ganglia Filum terminale externum C. MRI (T2 weighted), sagittal view Basivertebral veins Conus medullaris Dorsal branch of posterior intercostal artery Intercostal nerves Accessory hemiazygos vein Vertebral bodies (L2 and L3) Cerebrospinal fluid in lumbar cistern Sympathetic trunk and ganglion Posterior intercostal arteries Descending thoracic aorta Thoracic duct Intervertebral disc Cauda equina Accessory hemiazygos vein Azygos vein PAGE 24 PAGE 25
14 _CH01redo.qxd 9/24/07 3:08 PM Page 26 PLATE 1-22 Venous Drainage of the Vertebral Column and Spinal Cord Dermatomes PLATE 1-23 A. Sagittal view A. Anterior view B. Posterior view CN V Internal vertebral venous plexus Cutaway sections of: Epidural fat Dura mater Arachnoid mater Spinal cord Posterior external vertebral venous plexus Anterior external vertebral venous plexus Basivertebral vein vertebral body C8 C5 S2 S3 C2 L2 C3 C4 T2 T3 T4 T5 T6 T7 T8 T C2 C3 C4 C5 C8 T2 T3 T4 T5 T6 T7 T8 T L2 L3 S1 S2 S3 S4 S5 C8 L3 B. view External vertebral venous plexus S1 Basivertebral vein Internal vertebral venous plexus Intervertebral vein Anterior median spinal vein Anterior lateral spinal vein Anterior radicular vein Posterior radicular vein S2 Epidural fat External vertebral venous plexus Posterior lateral spinal vein Posterior median spinal vein S1 PAGE 26 PAGE 27
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