Atlas of ANATOMY

11071-01_CH01.qxd 3/28/08 10:05 AM Page 1

Lippincott Williams & Wilkins atlas of ANATOMY

Latin Edition 11071-01_CH01.qxd 3/28/08 10:05 AM Page 2

Lippincott Williams & Wilkins atlas of ANATOMY THE BACK CHAPTER 1

Plate 1-01 Palpable Features 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 11071-01_CH01.qxd 3/28/08 10:05 AM Page 4

Palpable Features of the Back PLATE 1-01

Palpable bony structures

Linea nuchalis superior

Protuberantia occipitalis externa

Margo superior musculi trapezius

Vertebra prominens (C7) Clavicula

Articulatio Acromion acromioclaviculare Spina scapulae

Tuberculum majus Plica axillaris posterior

Angulus inferior Processus spinosus

Costa

Musculus erector spinae Crista iliaca

Os coxae Spina iliaca posterior superior

Os sacrum

Trochanter major Os coccygis

Tuber ischiadicum

Chapter 1 Lippincott Williams & Wilkins Atlas of Anatomy PAGE 5 11071-01_CH01.qxd 3/31/08 1:43 PM Page 6

PLATE 1-02 Vertebral Column, Lateral View Cervical Vertebrae PLATE 1-03

A. Atlas (C1), superior view B. Atlas (C1), inferior view Tuberculum Arcus anterior atlantis Tuberculum anterius posterius Arcus posterior Foramen atlantis vertebrale Processus Fovea dentis transversus Processus transversus

Atlas (C1)

Axis (C2) Foramen transversarium Foramen Foramen Curvatura cervicalis vertebrale transversarium

Facies articularis Arcus posterior Facies articularis superior atlantis inferior C7 Fovea dentis T1 Tuberculum posterius Arcus anterior Sulcus arteriae vertebralis atlantis Tuberculum anterius

C. Axis (C2), superior view

Facies articularis Dens axis anterior

Curvatura thoracica Facies articularis superior Processus transversus Processus articularis inferior T12 Facies articularis posterior L1 Lamina arcus vertebrae Processus spinosus

Curvatura lumbalis D. Cervical vertebra (C4), superior view E. Cervical vertebra (C4), lateral view Corpus vertebrae Processus transversus: Processus Processus Processus et facies L5 Tuberculum uncinatus uncinatus anterius articularis superior Foramen Pediculus transversarium arcus vertebrae Processus transversus: Curvatura sacralis Tuberculum Tuberculum Os sacrum posterius anterius Foramen transversarium Facies Tuberculum articularis posterius superior Foramen Processus Processus Corpus vertebrale spinosus articularis inferior vertebrae Lamina arcus vertebrae Processus spinosus Os coccygis

Chapter 1 Chapter 1 PAGE 6 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 7 11071-01_CH01.qxd 3/28/08 10:05 AM 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 B. Thoracic vertebra (T6), lateral view Corpus vertebrae

Incisura Facies et processus vertebralis superior Os occipitale articularis superior Foramen Fovea Corpus vertebrale Fovea costalis superior Pediculus arcus costalis vertebrae Arcus anterior vertebrae superior atlantis C1 C1 Incisura Pediculus arcus Fovea costalis processus Arcus posterior vertebralis vertebrae superior transversus atlantis (C1) Fovea costalis C2 C2 processus transversus Processus Discus transversus C3 intervertebralis C3 Processus articularis C4 Facies Lamina arcus inferior Incisura C4 Fovea costalis Articulatio Processus articularis vertebrae vertebralis inferior zygapophysialis superior inferior transversus Processus Processus C5 C5 spinosus spinosus Foramen intervertebrale

Processus spinosus (C6) C6 C6 C. Intervertebral disc, superior view Processus transversus Anulus C7 C7 fibrosus

T1 Nucleus pulposus

C. Posterior view D. Radiograph of cervical vertebrae, posterior view

D. Lumbar vertebra (L3), superior view E. Lumbar vertebra (L3), lateral view Mandibula C1 Corpus vertebrae Processus articularis C2 superior Incisura vertebralis superior Pediculus arcus C3 vertebrae C3 Processus transversus Processus C4 Pediculus arcus C4 transversus (C4) vertebrae Processus Processus spinosus C5 Foramen C5 Processus vertebrale spinosus transversus C6 C6 Lamina arcus vertebrae (C6) Incisura Processus vertebralis et facies C7 C7 inferior Corpus articularis Processus vertebrae Processus superior Lamina arcus articularis Processus vertebrae Facies spinosus (C7) inferior T1 mammillaris articularis Processus inferior spinosus

Chapter 1 Chapter 1 PAGE 8 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 9 11071-01_CH01.qxd 3/28/08 10:05 AM 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

Processus articularis T12 inferior T12 Processus articularis C7 superior Pediculus arcus L1 T1 L1 vertebrae Discus intervertebralis Processes spinoses L2 L2 Processus spinosus

Incisura vertebralis Foramina intervertebrales inferior Fovea costalis L3 L3 processus Foramen transversus intervertebrale

L4 Incisura vertebralis superior L4 Foveae costales inferior Processus transversus (L4) Laminae arcus vertebrae L5 Corpus vertebrae L5

Os sacrum

Foveae costales superior Processus transversus

C. Posterior view D. Radiograph of lumbar vertebrae, posterior view

T12 T12 Pediculi arci vertebrae Processus transversus L1 L1 Articulationes zygapophysiales L2 Discus intervertebralis Processus articularis L2 inferior Processus articularis superior L3 Pediculus arcus L3 vertebrae Processus spinosus L4 L4 T12 Lamina arcus vertebrae

L1 L5 L5

Os sacrum

Chapter 1 Chapter 1 PAGE 10 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 11 11071-01_CH01.qxd 3/28/08 10:05 AM Page 12

PLATE 1-08 Sacrum and Coccyx Ligaments of the Cervical Vertebrae PLATE 1-09

Basis ossis sacri A. Anterior view A. Lateral view

Membrana atlantooccipitalis anterior Capsula articulatio atlantooccipitalis Ala ossis sacri Membrana atlantooccipitalis posterior (pars lateralis) Processus articularis superior Arcus anterior atlantis (C1)

Facies articularis Corpus vertebrae axis (C2) superior

Promontorium Arteria vertebralis

Foramina sacralia Capsulae articulationibus anteriora Ligamenta flava zygapophysiales Lineae transversae Ligamentum longitudinale anterius Ligamentum nuchae

Apex ossis sacralis Ligamenta interspinalia Disci intervertebrales (C4–C5, C6–C7) Os coccygis

Vertebra prominens (C7)

B. Posterior view B. Posterior view

Os occipitale

Processus articularis Capsula articulationis Membrana atlantooccipitalis posterior superior atlantooccipitalis lateralis Processus transversus Capsula articulationis Facies auricularis atlantoaxialis lateralis Atlas (C1) Axis (C2) Crista sacralis mediana Foramina sacralis Ligamenta flava Crista sacralis lateralis posteriora Ligamentum nuchae

Arteria vertebralis Capsula articulationis Hiatus sacralis zygapophysialis

Os coccygis

T1 Ligamentum supraspinale

Chapter 1 Chapter 1 PAGE 12 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 13 11071-01_CH01.qxd 3/28/08 10:05 AM Page 14

PLATE 1-10 Ligaments of the Thoracic Vertebrae Ligaments of the Lumbar Vertebrae and Sacrum PLATE 1-11

A. Lateral view Corpus vertebrae (T12)

Ligamenta Corpus vertebrae (L1) flava Ligamentum longitudinale posterius A. Lateral view Anulus fibrosus Nucleus pulposus Foramen Ligamentum Tip of conus medullaris intervertebrale surrounded by radiculi nervi supraspinale C7

Ligamenta Nervus spinalis (L2) interspinalia T1 Articulationes zygapophysiales Foramen Ligamentum longitudinale intervertebrale Ligamentum anterius Ligamentum longitudinale B. Posterior view supraspinale posterius Ligamenta Discus intervertebralis intertransversaria Ligamentum C7 Ligamentum longitudinale interspinalis anterius Pediculus arcus vertebrae Ligamentum costotransversarium T1 Processus superius Processus spinosus transversus Rami dorsales: Ligamenta Rami ventrales: L4 L4 capitis costae L5 radiatum L5 Costae B. Posterior view Ligamentum costotransversarium superius Lamina Costae Ligamentum arcus vertebrae supraspinale Sacrum Ligamentum Disci costotransversarium intervertebrales laterale Pediculus Ligamenta Ligamentum arcus intertransversaria longitudinale vertebrae posterius

Processus spinosus

Lamina arcus vertebrae

T12 Processus transversus Lamina arcus vertebrae Ligamenta intertransversaria Ligamenta flava L1 Capsula articulationis zygapophysiales Ligamentum iliolumbale

Ligamentum supraspinale

T12 Ligamentum sacroiliacum posterius L1

Chapter 1 Chapter 1 PAGE 14 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 15 11071-01_CH01.qxd 3/28/08 10:05 AM Page 16

PLATE 1-12 Cutaneous Innervation of the Back Superficial Muscles of the Back PLATE 1-13

Linea nuchalis superior

Nervus occipitalis major Musculus sternocleiodomastoideus Musculus splenius capitis Nervus accessorius (XI) Nervus occipitalis tertius Processus spinosus vertebra (C7) Musculus splenius cervicis

Arteria transversa cervicis Musculus trapezius Musculus levator scapulae Cutis Musculus trapezius Musculus rhombiodeus minor Spina scapulae Musculus rhomboideus major Rami cutanei posteriores (rami dorsales C4–T6)

Musculus Musculus trapezius deltoideus Musculus deltoideus Fascia infraspinata Musculus teres major Fascia infraspinata

Arteria et nervus Musculus thoracodorsalis teres major Musculus latissimus dorsi

Rami cutanei posteriores Trigonum (rami dorsales T7–T12) auscultationis

Musculus obliquus externus abdominis Tela subcutanea Musculi erector spinae

Musculus Musculus latissimus dorsi latissimus dorsi Rami cutanei laterales, rami ventrales (nervi intercostales) Musculus obliquus externus abdominis Musculus serratus anterior Processus spinosus vertebra (T12) Musculus serratus Trigonum lumbale posterior inferior Costa 12 Nervi clunium superiores Crista iliaca (rami dorsales L1–L3) Fascia thoracolumbalis Crista iliaca

Nervi clunium medii (rami dorsales S1–S3)

Chapter 1 Chapter 1 PAGE 16 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 17 11071-01_CH01.qxd 3/28/08 10:05 AM Page 18

PLATE 1-14 Deep Back Muscles, Superficial Dissection Deep Back Muscles, Deeper Dissection PLATE 1-15

Linea nuchalis superior Protuberantia occipitalis externa Musculi rectus capitis posterior: Protuberantia occipitalis externa Minus Majus

Linea nuchalis superior Musculus obliquus capitis superior Processus transversus (C1) Tuberculum posterius atlantis (C1) Tuberculum posterius atlantis Musculus obliquus capitis inferior Processus spinosus (C2) Musculi splenius Musculi interspinales cervicis Musculus semispinalis capitis capitis et cervicis Musculi semispinales: Capitis Musculi rotatores cervicis: Musculus longissimus cervicis Thoracis Longus Brevis Processus spinosus vertebra (C7) Musculus iliocostalis cervicis

Musculus iliocostalis Processus spinosus (C7) thoracis

Musculus serratus posterior superior

Musculi rotatores thoracis: Longus Brevis

Musculi intercostales externi

Musculus interspinalis thoracis Musculus erector spinae: Musculus spinalis thoracis Musculus iliocostalis Musculus longissimus Musculi levatores costarum: Musculus spinalis Musculus longissimus thoracis Longus Musculi multifidi Brevis

Musculus iliocostalis lumborum

Musculus serratus posterior inferior Musculus interspinalis lumborum

Musculus obliquus Musculus obliquus Musculus intertransversarius externus abdominis internus abdominis lateralis lumborum

Crista iliaca Crista iliaca

Chapter 1 Chapter 1 PAGE 18 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 19 11071-01_CH01.qxd 3/28/08 10:05 AM Page 20

PLATE 1-16 Suboccipital Region Pattern of a Typical Spinal Nerve PLATE 1-17

A. Orientation

B. Oblique section

Nervus intercostalis (6), ramus cutaneus anterior: Ramus medialis Ramus lateralis

Pleura parietalis Musculus trapezius Arteria occipitalis Nervus occipitalis major Tela subcutanea

Musculus rectus capitis Cutis posterior minor

Musculus rectus capitis posterior major Sternum

Membrana intercostalis externa Arteria vertebralis Musculus intercostalis externus Musculus transversus thoracis Musculus obliquus Musculus intercostalis internus capitis superior Musculus intercostalis intimus Musculus sternocleiodomastoideus

Nervus suboccipitalis Nervus intercostalis (6), Musculus ramus cutaneus lateralis: sternocleiodomastoideus Ramus anterior Ramus posterior Musculus obliquus capitis inferior Corpus vertebrae (T6)

Nervus occipitalis minor Musculus splenius capitis Ganglion sympathicum Rami communicantes Musculus semispinalis capitis Nervus occipitalis major albus et griseus (ramus posterior, nervus spinalis C2) Radix anterior Musculus splenius capitis

Musculus trapezius Nervus occipitalis tertius Medulla spinalis (ramus posterior, nervus spinalis C3) Radix posterior Ganglion sensorium nervi spinalis Musculus longissimus capitis Nervus spinalis (T6) Scapula Ramus anterior (nervus intercostalis) Ramus posterior Nervus spinalis (T6), ramus posterior, ramus cutaneus posterior Ramus lateralis Ramus medialis

Musculi dorsi proprii

Chapter 1 Chapter 1 PAGE 20 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 21 11071-01_CH01.qxd 3/31/08 1:43 PM Page 22

PLATE 1-18 Spinal Cord, Posterior View Superior Portion of the Spinal Cord PLATE 1-19

Os occipitale A. Orientation

Vertebra (C1) Nervus spinalis (C1) B. Dissection Vertebra (C2) Musculi splenius capitis et cervicis Ligamentum denticulatum Vertebra (C7) Ganglion sensorium nervi spinalis Vertebra (T1)

Pediculus arcus vertebrae (C5) Musculus serratus posterior superior Nervus spinalis (T1)

Dura mater

Dura mater spinalis et Arachnoidea mater arachnoidea mater

Spatium subarachnoideum Musculus erector spinae: Musculus iliocostalis Fila radicularia, nervi spinales Musculus longissimus (T2–T11) (musculus spinalis removed) Ramus anterior Pia mater on surface of Ramus posterior medulla spinalis Musculus serratus posterior inferior Sulcus medianus posterior Fila radicularia posterior Conus medullaris

Nervus spinalis (L1) Vertebra (T12) Nervus spinalis, Arteria radicularis posterior Termination of medulla spinalis radix posterior Vertebra (L1) at discus intervertebralis L1/L2 Ligamentum denticulatum Cauda equina

Arteriae spinales posteriores Filum terminale internum Nervus spinalis, radix anterior Vertebra (L5) Nervus spinalis (L5) Os sacrum Ganglion sensorium nervi Nervus spinalis (S1) spinalis Os coxae Termination of dural sac Arteria intercostales at S2 vertebral level posteriores, rami spinales

Pediculus arcus Nervus spinalis (S5) vertebrae T3 Filum terminale externum Nervus coccygeus Os coccygis

Chapter 1 Chapter 1 PAGE 22 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 23 11071-01_CH01.qxd 3/28/08 10:06 AM 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

Arteriae spinales posterior

Vertebrae Arteria spinalis anterior Medulla spinalis thoracicae Dura mater Arachnoidea mater Dura mater et arachnoidea Ligamentum denticulatum Arachnoidea mater mater Arteria radicularis posterior Arteria intercostalis posterior, Arteria intercostalis Conus medullaris ramus corpus vertebrae Arteria radicularis anterior Arteria intercostalis et dura mater posterior posterior, ramus spinalis Arteriae radicularis Vertebrae lumbales

Cauda equina

Pediculus arcus vertebrae

Filum terminale internum

Ganglia sensoria nervi spinales Os sacrum

Filum terminale externum

C. MRI (T2 weighted), sagittal view Nervi intercostales Arteria intercostalis Venae posterior, ramus Vena hemiazygos basivertebrales dorsalis accessoria Conus medullaris Pars descendens Corpora vertebrae Truncus sympathicus thoracica aortae (L2, L3) et ganglion Processus spinosus Ductus thoracicus Liquor cerebrospinalis, cisterna lumbalis Arteriae intercostales posterior Discus intervertebralis Cauda equina Vena hemiazygos accessoria

Vena azygos

Os sacrum

Chapter 1 Chapter 1 PAGE 24 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 25 11071-01_CH01.qxd 3/28/08 10:06 AM 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 C2

Plexus venosus C3 vertebralis externus C2 anterior C4 C5 C3 C6 Vena basivertebralis C7 Plexus venosus C4 C8 vertebralis internus T1 T1 T2 C6 T2 T3 T4 C5 T3 T5 T4 T6 Cutaway sections of: T7 T5 Textus adiposus Corpus vertebrae (L1) T8 epidurale T6 T9 Dura mater T10 T1 Arachnoidea mater T7 T11 Medulla spinalis T12 T8 L1 C6 T9 L2 L3 T10 L4 C8 L1 T11 L5 Plexus venosus S1 vertebralis externus posterior T12 L2 S2 S3 S4 C6 S2–S3 S5 C7 C7 C8

L4 B. Superior view Plexus venosus vertebralis externus S1

Vena spinalis mediana Vena anterior basivertebralis Vena spinalis lateralis Plexus venosus anterior vertebralis internus Vena radicularis anterior Vena L5 intervertebralis Vena radicularis posterior S2

Textus adiposus epidurale Vena spinalis lateralis posterior Plexus venosus vertebralis externus Vena spinalis mediana posterior S1 L5

Chapter 1 Chapter 1 PAGE 26 Lippincott Williams & Wilkins Atlas of Anatomy Lippincott Williams & Wilkins Atlas of Anatomy PAGE 27