Back - Netter 6th Edition

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

Sec

tio

n

2BackandSpinalcord

2

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

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

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

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


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


Transverseprocess

Spinousprocess

Inferior articularprocess and facet

Inferiorvertebral notch

Inferiorcostal facet

Spinous process

Transverse process

T7

T8

T9

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


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

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

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

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)


Transverse process

Lamina

Inferior articular process

Pedicle

Intervertebral foramen

Spinous process

Interspinous ligament

Supraspinous ligament

Spinous process

Lamina

Transverse process


Ligamentum flavum

Iliolumbar ligament

Iliac crest

Sacrum

Coccyx

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)



Transverse process

Spinous process

Ligamentum flavum

Interspinous 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

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)

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

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

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

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

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 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

Spinalcord

2Spinalnerveorigin:crossSections

plate166

Dura mater

Arachnoid mater

Ventral root

Spinal nerve

Ventral ramus (contributes to lumbar plexus)

Dorsal ramus


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

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



Lumbar artery

Anastomotic loops toposterior spinal arteries

Lumbarvertebrae

Lateral sacralartery:spinal branches Sacrum

Posterior inferior cerebellar artery

Posterior spinal arteries

Vertebral artery


Deep cervical artery

Ascending cervical artery

Subclavian artery



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)

Spinalcord

2

plate168

Posterior spinal arteries



Posterior radicular artery

Branch to vertebral bodyand dura mater

Spinal branch

Dorsal branch of posteriorintercostal 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


Segmental medullary artery

Pial arterial plexus

Section through thoracic level:anterosuperior view

Sulcal (central) branches toright side of spinal cord


Pial arterial plexus

Anterior and posteriorradicular arteries


Arterial distribution: schema


Anterior radicular artery

arteriesofSpinalcord:intrinsicdistributionSeealsoPlate 188

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


Intervertebralvein

Segmental medullary/radicular veins


Basivertebral vein

External vertebral venous plexus

External vertebral venous plexus

Internal vertebral (epidural) venous plexus

Intervertebral vein

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

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


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

Musclesandnerves

2MusclesofBack:intermediatelayers

plate172

Erectorspinaemuscle

Iliocostalis muscle

Longissimus muscle

Spinalis muscle

Serratus posterior superior muscle

Splenius capitis andsplenius cervicis muscles


Posterior tubercle of atlas (C1)

Longissimus 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


Spinalis cervicis muscle

Semispinalis capitis muscle (cut)


Obliquus capitis inferior muscle

Rectus capitis posterior major muscle

Obliquus capitis superior muscle

Rectus capitis posterior minor muscle

Musclesandnerves

MusclesofBack:deeplayers

plate173


Mastoid process

Posterior tubercle of atlas(C1 vertebra)

Spinous process of axis(C2 vertebra)


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


Obliquus capitis superior muscle


Transverse process of atlas (C1)

Obliquus capitis inferior muscle

Interspinalis cervicis muscle

Brevis

LongusRotatores cervicis muscles

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

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


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)



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

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


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


Quadratus lumborum muscle

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


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

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


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



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



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


Suboccipital

Rectus capitis posterior major

Spine of axis Inferior nuchal line Suboccipital nerve

Extends and rotates head to same side


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.

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


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


Stabilizes, extends, and rotates spine

Dorsal branches of segmental arteries Transversospinalis

SemispinalisTransverse

processes of C4T12

Spinous processes of cervical and thoracic regions


Extends head, neck, and thorax and rotates them to opposite side


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

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