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10752-01_CH01redo.qxd 9/24/07 3:07 PM Page 1
CHAPTER 1ANATOMY
atlas ofL i p p i n c o t t W i l l i a m s & W i l k i n s
Plate 1-01 Palpable Structures of the Back . . . . . . . . . . . . . . . . 5
Plate 1-02 Vertebral Column, Lateral View . . . . . . . . . . . . . . . 6
Plate 1-03 Cervical Vertebrae . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Plate 1-04 Articulated Cervical Vertebrae . . . . . . . . . . . . . . . . 8
Plate 1-05 Thoracic and Lumbar Vertebrae . . . . . . . . . . . . . . . 9
Plate 1-06 Articulated Thoracic Vertebrae . . . . . . . . . . . . . . . 10
Plate 1-07 Articulated Lumbar Vertebrae . . . . . . . . . . . . . . . 11
Plate 1-08 Sacrum and Coccyx . . . . . . . . . . . . . . . . . . . . . . . . 12
Plate 1-09 Ligaments of the Cervical Vertebrae . . . . . . . . . . . 13
Plate 1-10 Ligaments of the Thoracic Vertebrae . . . . . . . . . . 14
Plate 1-11 Ligaments of the Lumbar Vertebrae and Sacrum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Plate 1-12 Cutaneous Innervation of the Back . . . . . . . . . . . . 16
Plate 1-13 Superficial Muscles of the Back . . . . . . . . . . . . . . . 17
Plate 1-14 Deep Back Muscles, Superficial Dissection . . . . . . 18
Plate 1-15 Deep Back Muscles, Deeper Dissection . . . . . . . . 19
Plate 1-16 Suboccipital Region. . . . . . . . . . . . . . . . . . . . . . . . . 20
Plate 1-17 Pattern of a Typical Spinal Nerve . . . . . . . . . . . . . 21
Plate 1-18 Spinal Cord, Posterior View . . . . . . . . . . . . . . . . . 22
Plate 1-19 Superior Portion of the Spinal Cord . . . . . . . . . . . 23
Plate 1-20 Inferior Portion of the Spinal Cord . . . . . . . . . . . . 24
Plate 1-21 Blood Supply of the Spinal Cord, Anterior View. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Plate 1-22 Venous Drainage of the Vertebral Column and Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Plate 1-23 Dermatomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
THE BACK
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PLATE 1-01
PAGE 5
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Palpable Structures of the Back
Superior nuchal line
Superior borderof trapezius muscle
Vertebra prominens (C7)
Acromioclavicularjoint
Greater tubercleof humerus
Spinous processesof vertebrae invertebral furrow
Rib
Iliac crest
Posterior superior iliac spine
Greater trochanterof femur
External occipital protuberance
Clavicle
Acromion of scapula
Spine of scapula
Inferior angle of scapula
Posterior axillaryfold
Bulge of erector spinae muscles
Hip bone
Sacrum
Coccyx
Ischial tuberosity
Palpable bony structures
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PLATE 1-03
PAGE 7
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Cervical Vertebrae
PAGE 6
Chapter 1
PLATE 1-02
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Vertebral Column, Lateral View
A. Atlas (C1), superior view
Articular facet for densTransverse
process
Transverseforamen
Superior articular facet for occipitalcondyle
Anterior tubercle
Groove for vertebral arteryand C1 ventral ramus
Vertebralforamen
Posterior arch
Posteriortubercle
Anterior arch
Anterior arch
Articular facetfor dens
Transverse process
Transverseforamen
Inferior articularfacet for axis
Anterior tubercle
Vertebral foramenPosterior arch
Posterior tubercle
Anterior arch
B. Atlas (C1), inferior view
Anterior arch
Posterior articular facet fortransverse ligament of atlas
Transverseprocess
Spinousprocess
Dens
Superior articularfacet
Inferior articularprocess
Anterior articular facetfor arch of atlas
Lamina
Anterior tubercle
Lamina
Transverseforamen
Spinousprocess
Pedicle
Superiorarticularfacet
Posteriortubercle
Transverse process:
BodyD. Cervical vertebra (C4), superior view
Uncinateprocess
Spinousprocess
Superior articularfacet and process
BodyInferiorarticular process
E. Cervical vertebra (C4), lateral view
Uncinateprocess
Vertebral foramen
C. Axis (C2), superior view
Anterior tubercle
Transverse foramen Posterior tubercle
Transverse process:
Atlas (C1)
Axis (C2)
C7
T1
T12
L1
L5
Sacrum
Coccyx
Cervical curvature
Thoracic curvature
Lumbar curvature
Sacral curvature
Vertebral Column, Lateral View
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PLATE 1-05
PAGE 9
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Thoracic and Lumbar Vertebrae
PAGE 8
Chapter 1
PLATE 1-04
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Articulated Cervical Vertebrae
A. Lateral view
C3
C4
C5
C6
C7
C2
Occipital bone
Anterior archof atlas (C1)
Posterior archof atlas (C1)
Zygapophyseal joint
Intervertebral foramen
Intervertebral disc
Spinous process of C6
Transverse process
C1 C1
C3
C4
C5
C6
C7
T1
C2
B. Radiograph of cervical vertebrae, lateral view
C1
C3
C4
C5
C6
C7
C6
C5
C4
C3
C2
C7
T1
Spinous processof C7
Transverseprocess of C4
Lamina of C6
Spinous processes
Mandible
C. Posterior view D. Radiograph of cervical vertebrae, posterior view
Vertebralforamen
Body
Superiorcostal facet
Pedicle
Transversecostal facet
Lamina
Spinous process
Superiorarticularfacet
Superior vertebralnotch
Transverseprocess
A. Thoracic vertebra (T6), superior view
Anulus fibrosus
C. Intervertebral disc, superior view
Superior articularfacet and process
BodySuperiorcostal facet
Pedicle
Inferiorcostal facet
Inferiorvertebralnotch
Transverseprocess
Inferiorarticularprocess
Superiorvertebral notch
B. Thoracic vertebra (T6), lateral view
Spinousprocess
Transversecostal facet
Pedicle
Transverseprocess
Superiorarticularprocessand facet
Mammillaryprocess
Lamina
Spinousprocess
D. Lumbar vertebra (L3), superior view
Body
Body
Inferior articular facet
Pedicle
Superiorarticularprocess
Superior vertebral notch
Inferior vertebralnotch Inferior
articularprocess
Spinousprocess
Transverseprocess
E. Lumbar vertebra (L3), lateral view
Vertebralforamen
Nucleus pulposus
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PLATE 1-07
PAGE 11
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Articulated Lumbar Vertebrae
PAGE 10
Chapter 1
PLATE 1-06
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Articulated Thoracic Vertebrae
Transversecostal facets
Pedicles
A. Lateral view B. Posterior view
Spinous processes
Laminae
T12
L1
Intervertebral foramina
Superior costal facetsTransverse processes
C7
T1
Intervertebral discs
Inferior costal facets
A. Lateral view B. Radiograph of lumbar vertebrae, lateral view
Superior articularprocess
Inferior articularprocess
Superior vertebralnotch
Inferior vertebralnotch
L1L1
L2 L2
L3 L3
L4L4
L5L5
T12 T12
Sacrum
Pedicle
Spinous process
Body
Intervertebral disc
Intervertebralforamen
Transverseprocess of L4
Lamina
Superior articular process
Inferior articular process
L1
L1
L2L2
L3L3
L4L4
L5 L5
T12
T12
Sacrum
Pedicle
Zygapophysealjoint
Transverse process
Spinous process
D. Radiograph of lumbar vertebrae, posterior viewC. Posterior view
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PLATE 1-09
PAGE 13
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Ligaments of the Cervical Vertebrae
PAGE 12
Chapter 1
PLATE 1-08
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Sacrum and Coccyx
Base of sacrum
Ala (lateral part)
Promontory
Transverseridges
Apex of sacrum
Coccyx
Anterior (pelvic)sacral foramina
Lumbosacralarticular surface
Superior articular process
B. Posterior view
A. Anterior view
Auricular surface
Superior articular facet
Median sacral crest
Sacral hiatus
Posterior sacral foraminaLateral sacral crest
Coccyx
Anterior longitudinal ligament
Anterior arch of atlas (C1)
Body of axis (C2)
Intervertebral discs(C4–C5 and C6–C7)
Capsules of zygapophyseal joints(C3–C4 and C4–C5)
Vertebral artery
Capsule of atlanto-occipital jointPosterior atlanto-occipital membrane
Ligamenta flava
Ligamentum nuchae
Spinous process of C7 vertebra(vertebra prominens)
T1
Anterior atlanto-occipital membrane
Interspinous ligament
A. Lateral view
T1
Supraspinous ligament
Occipital bone
atlanto-occipital joint Posterior atlanto-occipital membrane
Transverse process of atlas (C1)
Vertebral artery
Capsule of
atlantoaxial jointCapsule of lateral
Ligamenta flava
Capsules of zygapophyseal joints
Ligamentum nuchae
Axis (C2)
Atlas (C1)
B. Posterior view
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PLATE 1-11
PAGE 15
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Ligaments of the Lumbar Vertebrae and Sacrum
PAGE 14
Chapter 1
PLATE 1-10
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Ligaments of the Thoracic Vertebrae
C7
Intervertebral foramen
Supraspinousligament
Interspinousligament
Intertransverseligaments
T1
Ribs
L1
T12
Intervertebraldiscs
Radiateligaments
Anteriorlongitudinalligament
Superiorcostotransverseligaments
A. Lateral view
B. Posterior view
C7
T1
Superiorcostotransverse ligament
Supraspinousligament
Intertransverseligament
Lamina
T12
L1
Transverseprocess
Ribs
Lateralcostotransverse ligament
Posterior longitudinalligament
Anterior longitudinalligament
Ligamentaflava
Supraspinousligament
Spinous process
Interspinousligament Pedicle
Sacrum
Anterior longitudinal ligament
Intervertebral disc
Zygapophysealjoint capsules
Body of L1
Tip of conus medullaris (cut) surrounded by nerve roots
Ventral rami: L4 L5
Intervertebralforamen
Body of T12
Posterior longitudinal ligament
Anulus fibrosusNucleus pulposus
L2 spinal nerve
Dorsal rami: L4 L5
A. Lateral view
Lamina
Ligamenta flava
Pedicle(cut)
Posteriorlongitudinal ligament
Spinous process
Lamina
Transverse process
Intertransverse ligament
Zygopophyseal joint capsule
Supraspinous ligament
Posterior sacroiliac ligament
Iliolumbar ligament
B. Posterior view
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PLATE 1-13
PAGE 17
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Superficial Muscles of the Back
PAGE 16
Chapter 1
PLATE 1-12
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Cutaneous Innervation of the Back
Posterior cutaneous branches(dorsal rami of C4–T6)
Superficialfascia
Teres major muscle
Infraspinatus fascia
Posterior cutaneous branches (dorsal rami of T7–T12)
Lateral cutaneous branches of ventral rami (intercostal nerves)
External abdominal oblique muscle
Latissimus dorsi muscle
Trapezius muscle
Deltoid muscle
Skin
Superior cluneal nerves(dorsal rami of L1–L3)
Middle cluneal nerves(dorsal rami of S1–S3)
Iliac crest
Greater occipital nerve(dorsal ramus of C2)
Third occipital nerve(dorsal ramus of C3)
Spinous process of C7
Levator scapulae muscle
Rhomboid minor muscle
Rhomboid major muscle
Trapezius muscle
Spine of scapula
Teres majormuscle
Latissimus dorsimuscle (cut)
Thoracodorsalartery and nerve
Serratus anterior muscle
Latissimus dorsi muscle
Spinous process of T12
Trapezius muscle
Deltoid muscle
Infraspinatusfascia
Triangle ofauscultation
Lumbar triangle
Superior nuchal line
Sternocleidomastoid muscle
Iliac crest
External abdominal oblique muscle
Erector spinae muscles(deep to thoracolumbar fascia)
12th rib
Serratus posterior inferior muscle
Splenius capitis muscle
Splenius cervicis muscle
Accessory nerve (CN XI)
Transverse cervical artery
Thoracolumbar fascia
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PLATE 1-15
PAGE 19
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Deep Back Muscles, Deeper Dissection
PAGE 18
Chapter 1
PLATE 1-14
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Deep Back Muscles, Superficial Dissection
Spinous process of C7 Iliocostalis cervicis muscle
Iliocostalis thoracis muscle(retracted)
Spinalis thoracis muscle
Iliocostalis lumborum muscle
Longissimus thoracis muscle
Longissimus cervicis muscle
External occipital protuberance
Superior nuchal line
Posterior tubercle of atlas
Semispinalis capitis muscle
Serratus posteriorsuperior muscle
Erector spinae muscle:
Serratus posteriorinferior muscle
External abdominaloblique muscle
Internal abdominaloblique muscle
Iliac crest
Splenius capitis andcervicis muscles
Iliocostalis muscle Longissimus muscle Spinalis muscle
Obliquus capitis superior muscle
Spinous process of C7
Interspinalis cervicis muscle
Obliquus capitis inferior muscle
Transverse process of altas (C1)
Rectus capitis posterior muscles:
Rotatores thoracis muscles:
Rotatores cervicis muscles:
Interspinalis lumborum muscle
Interspinalis thoracis muscle
Levatores costarum muscles:
External occipital protuberance
Superior nuchal line
Posterior tubercle of atlas (C1)
Spinous process of axis (C2)
Semispinalis muscles:
External intercostalmuscles
Lateralintertransversarius muscle
Multifidus muscles
Iliac crest
Minor Major
LongusBrevis
LongusBrevis
LongusBrevis
Capitis Thoracis
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PLATE 1-17
PAGE 21
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Pattern of a Typical Spinal Nerve
PAGE 20
Chapter 1
PLATE 1-16
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Suboccipital Region
Rectus capitis posteriorminor muscle
Rectus capitis posteriormajor muscle
Vertebral artery
Obliquus capitissuperior muscle
Obliquus capitisinferior muscle
Suboccipital nerve(dorsal ramus of C1 spinal nerve)
Splenius capitis muscle(cut and reflected)
Greater occipital nerve(dorsal ramus of C2spinal nerve)
3rd occipital nerve(dorsal ramus of C3spinal nerve)
Longissimus capitis muscle
Greater occipital nerve
Splenius capitis muscle
Semispinalis capitis muscle
Sternocleidomastoidmuscle (cut)
Sternocleidomastoidmuscle (cut)
Trapezius muscle (cut)
Lesser occipital nerve
Occipital arteryTrapezius muscles (cut)
Anterior cutaneous branch of 6th intercostal nerve: Medial branch Lateral branch
Sternum
External intercostal membrane
Transversus thoracis muscle
Parietal pleura
External intercostal muscle
Innermost intercostal muscle
Scapula
Deep back muscles
Posterior cutaneous branchof dorsal ramus of 6th thoracicspinal nerve: Lateral branch Medial branch
Body of 6th thoracic vertebra
Spinal cord
Internal intercostal muscle
Lateral cutaneous branch of 6th intercostal nerve: Anterior branch Posterior branch
Sympathetic ganglion
White and gray rami communicantes
Ventral root
Dorsal root
Dorsal root ganglion
6th thoracic spinal nerve
Ventral ramus (intercostal nerve)
Dorsal ramus
Skin
Superficial fascia
A. Orientation
B. Oblique section
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PLATE 1-19
PAGE 23
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Superior Portion of the Spinal Cord
PAGE 22
Chapter 1
PLATE 1-18
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Spinal Cord, Posterior View
Occipital bone
C1 spinal nerve
C2 vertebra (axis, cut)
Dorsal root ganglion
T1 spinal nerve
Roots of spinal nerves T2–T11
Conus medullaris
L1 spinal nerve
Cauda equina
L5 spinal nerve
S1 spinal nerveSacrum (cut)
Termination of dural sacat S2 vertebral level
S5 spinal nerve
Coccygeal nerve
Coccyx
L5 vertebra(cut)
L1 vertebra(cut)
T12 vertebra(cut)
T1 vertebra(cut)
C7 vertebra(cut)
C1 vertebra (atlas, cut)
Serratus posteriorsuperior muscle (cut and reflected)
Erector spinae muscle: Iliocostalis muscle Longissimus muscle (spinalis muscle removed)
Serratus posteriorinferior muscle (cut and reflected)
Hip bone
Splenius capitis and splenius cervicis muscles(cut and reflected)
Dura and arachnoid mater(cut and reflected)
Denticulate ligament
Termination of spinal cordat intervertebral disc L1/L2
Filum terminale internum
Filum terminale externum
Dorsal root of spinal nerve
Dorsal root ganglion
Ventral ramus
Dorsal ramus
Posterior spinal arteries
Denticulate ligament
Dorsal rootlets
Dura mater
Arachnoid mater
Dorsal median sulcus
Posterior radicular artery
C5 pedicle (cut)
T3 pedicle (cut)
Pia mater on surfaceof spinal cord
Spinal branchesof posterior intercostal artery
Ventral root of spinal nerve
A. Orientation
B. Dissection
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PLATE 1-21
PAGE 25
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Blood Supply of the Spinal Cord, Anterior View
PAGE 24
Chapter 1
PLATE 1-20
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Inferior Portion of the Spinal Cord
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Radicular arteries
Dura and arachnoid mater(cut and reflected)
Conus medullaris
Cauda equina
Pedicles (cut)
Filum terminale internum
Dorsal root ganglia
Filum terminale externum
Arachnoid mater
Cerebrospinal fluid in lumbar cistern
Basivertebralveins
Intervertebral disc
Sacrum
Cauda equina
Conus medullaris
C. MRI (T2 weighted), sagittal view
Spinous process
Vertebral bodies(L2 and L3)
A. Orientation B. Dissection
Azygos vein
Anterior radicular artery
Anterior spinal artery
Spinal cord
Intercostalnerves
Sympathetic trunk and ganglion
Posterior intercostal arteries
Thoracic duct
Descending thoracic aorta
Posteriorintercostalartery
Spinal branch
Dorsal branchof posteriorintercostal artery
Branch to vertebral body and dura mater
Posterior spinal arteries
Posterior radicular artery
Denticulate ligament (cut)
Dura mater
Accessory hemiazygos vein
Accessory hemiazygos vein
Arachnoid mater
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PLATE 1-23
PAGE 27
Chapter 1
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Dermatomes
PAGE 26
Chapter 1
PLATE 1-22
L i p p i n c o t t W i l l i a m s & W i l k i n s A t l a s o f A n a t o m y
Venous Drainage of the Vertebral Column and Spinal Cord
Posterior externalvertebral venous plexus
Anterior externalvertebral venous plexus
Basivertebral vein
L1 vertebral body
Internal vertebralvenous plexus
Cutaway sections of: Epidural fat Dura mater Arachnoid mater Spinal cord
Basivertebral vein
Internal vertebralvenous plexus
Intervertebral vein
Epidural fat
External vertebral venous plexus
External vertebralvenous plexus
Anterior lateral spinal vein
Posterior radicular vein
Posterior lateralspinal vein
Anterior radicular vein
Anterior median spinal vein
Posterior medianspinal vein
B. Superior view
A. Sagittal view
C3
C4
CN V
C6T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L4
L5
S2–S3C8C7
C6
L3
S1
C5
T1
C2C3
C2
C4
C5
C6
C7C8T1T2T3T4T5T6T7T8T9T10T11T12L1L2L3
L4L5
S1S2S3
C7
C8
C6
S2
S1
S4
S5
L5
B. Posterior viewA. Anterior view
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