[Half-Title to come]

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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

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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

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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

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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

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Thoracic and Lumbar Vertebrae

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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

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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

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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

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Ligaments of the Cervical Vertebrae

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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

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Ligaments of the Lumbar Vertebrae and Sacrum

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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

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Superficial Muscles of the Back

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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

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Deep Back Muscles, Deeper Dissection

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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

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Pattern of a Typical Spinal Nerve

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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

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Superior Portion of the Spinal Cord

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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

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Blood Supply of the Spinal Cord, Anterior View

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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

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Dermatomes

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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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