Back and Spinal Cord
Topographic Anatomy | Back
Trapezius Muscle
Spine of scapula
Deltoid muscle
Infraspinatus muscle
Long head
Lateral head
Tendon
Teres major muscle
Latissimus dorsi muscle
Lumbar (triangle of Petit)
Iliac crest
Erector spinae muscle
Posterior superior iliac spine
Intergluteal (natal) cleft
External occipital protuberance
Ligamentum nuchae
Spinous process of C7 vertebra
Deltoid muscle
Spine of scapula
Triangle of auscultation
Medial border of scapula
Inferior angle of scapula
Spinous process of T12 vertebra
Gluteus medius muscle
Sacrum
Gluteus maximus muscle
Greater trochanter of femur
Gluteal fold
Bones and Ligaments | Vertebral Column
Anterior view
Atlas (C1)
Axis (C2)
C7
T1
T12
L1
L5
Sacrum (S1-5)
Coccyx
Left lateral view
Atlas (C1)
Axis (C2)
Cervical curvature
C7
Thoracic curvature
T1
T12
L1
Lumbar curvature
L5
Sacral curvature
Sacrum (S1-5)
Coccyx
Posterior view
Cervical Vertebrae
Atlas (C1)
Axis (C2)
C7
Thoracic Vertebrae
T1
T12
Lumbar Vertebrae
L1
L5
Sacrum (S1-5)
Coccyx
Bones and Ligaments | Thoracic Vertebrae
T6 vertebra: superior view
Body
Superior costal facet
Pedicle
Transverse costal facet
Lamina
Spinous process
Superior articular facet
Superior vertebral notch (forms lower margin of intervertebral foramen)
Vertebral foramen
T6 vertebra: lateral view
Body
Superior costal facet
Superior articular process and facet
Pedicle
Transverse costal facet
Transverse process
Inferior articular process
Spinous process
Inferior vertebral notch
Inferior costal facet
T7, T8, and T9 vertebrae: posterior view
7th rib
Vertebral canal
Superior articular process and facet
T7
Spinous process of T7 vertebra
T8
T9
Transverse process of T9 vertebra
Lamina
Inferior articular process (T9)
Spinous process (T9)
T12 vertebra: lateral view
Body
Superior articular process and facet
Transverse process
Spinous process
Inferior articular process and facet
Costal facet
Bones and Ligaments | Lumbar Vertebrae
L2 vertebra: superior view
Vertebral body
Vertebral foramen
Pedicle
Transverse process
Superior articular process
Mammillary process
Lamina
Spinous process
Accessory process
Intervertebral disc
Anulus fibrosus
Nucleus pulposus
L3 and L4 vertebrae: posterior view
Vertebral body
Vertebral canal
Superior articular process
Mammillary process
Transverse process
Pars interarticularis
Accessory process
L3
Spinous process of L3 vertebra
L4
Lamina
Inferior articular process
Lumbar vertebrae, assembled: left lateral view
Vertebral Body
Intervertebral disc
Pedicle
Superior articular process
Mammillary process
Transverse process
Spinous process
Inferior articular process
Inferior vertebral notch
Intervertebral (neural) foramen
Superior vertebral notch
Lamina
Articular facet for sacrum
L1
L2
L3
L4
L5
Bones and Ligaments | Lumbar Vertebrae: Radiographs
Anteroposterior radiograph
SA, Superior articular process of L1 vertebra
IA, Inferior articular process of L1 vertebra
T, Transverse process of L3 vertebra
P, Pedicle of L3 vertebra
B, Body of L3 vertebra
L, Lamina of L4 vertebra
S, Spinous process of L4 vertebra
SF, Sacral foramen
Lateral radiograph
T12, 12th Thoracic vertebra
L1, 1st Lumbar vertebra
L2, 2nd Lumbar vertebra
IN, Inferior vertebral notch of L2 vertebra
D, Intervertebral disc space
SN, Superior vertebral notch of L3 vertebra
P, Pedicle of L3 vertebra
L3, 3rd Lumbar vertebra
I, Intervertebral foramen
IA, Inferior articular process of L3 vertebra
SA, Superior articular process of L4 vertebra
L4, 4th Lumbar vertebra
S, Spinous process of L3 vertebra
L5, 5th Lumbar vertebra
S1, 1st Sacral vertebra
S2, 2nd Sacral vertebra
Bones and Ligaments | Sacrum and Coccyx
Anterior inferior view
Base of sacrum
Lumbosacral articular surface
Superior articular process
Ala (wing)
Promontory
Transverse ridges
Sacral part of pelvic brim (linear terminalis)
Anterior (pelvic) sacral foramina
Apex of sacrum
Transverse process of coccyx
Coccyx
Pelvic surface
Median sagittal section
Superior articular process
Sacral canal
Dorsal surface
Pelvic surface
Sacral hiatus
Posterior superior view
Facets of superior articular processes
Auricular surface
Sacral tuberosity
Lateral sacral crest
Median sacral crest
Intermediate sacral crest
Sacral hiatus
Posterior sacral foramina
Sacral cornu (horn)
Coccygeal cornu (horn)
Transverse process of coccyx
Dorsal surface
Coronal section through S2 foramina
Median sacral crest
Sacral canal
Intervertebral foramen
Posterior sacral foramen
Anterior (pelvic) sacral foramen
Bones and Ligaments | Vertebral Ligaments: Lumbar Region
Left lateral view (partially sectioned in median plane)
Anterior longitudinal ligament
Lumbar vertebral body
Intervertebral body
Anterior longitudinal ligament
Posterior longitudinal ligament
Inferior articular process
Capsule of zygapophyseal joint (partially opened)
Superior articular process
Transverse process
Spinous process
Ligamentum flavum
Interspinous ligament
Supraspinous ligament
Intervertebral foramen
Anterior vertebral segments: posterior view (pedicles sectioned)
Pedicle (cut surface)
Posterior surface of vertebral bodies
Posterior longitudinal ligament
Intervertebral disc
Posterior vertebral segments: anterior view
Pedicle (cut surface)
Ligamentum flavum
Lamina
Superior articular process
Transverse process
Inferior articular facet
Bones and Ligaments | Vertebral Ligaments: Lumbosacral Region
Left lateral view
Anterior longitudinal ligament
Body of L1 vertebra
Intervertebral discs
L2 spinal nerve
Body of L5 vertebra
L5 spinal nerve
Auricular surface of sacrum (for articulation with ilium)
Sacrum
Coccyx
Superior articular process
Transverse process
Lamina
Inferior articular process
Pedicle
Intervertebral foramen
Spinous process
Interspinous ligament
Supraspinous ligament
Posterior view
Posterior longitudinal ligament
Pedicle (cut)
Superior articular processes; facet tropism (difference in facet axis) on right side
Spinous process
Lamina
Transverse process
Inferior articular process
Ligamentum flavum
Iliolumbar ligament
Iliac crest
Posterior superior iliac spine
Posterior inferior iliac spine
Posterior sacroiliac ligaments
Greater sciatic foramen
Spine of ischium
Sacrospinous ligament
Lesser sciatic foramen
Sacrotuberous ligament
Ischial tuberosity
Lateral sacrococcygeal ligament
Posterior sacrococcygeal ligament
Spinal Cord | Spinal Cord and Ventral Rami in Situ
Base of skull
C1 spinal nerve
C2 vertebra (axis)
C8 spinal nerve
T1 spinal nerve
1st rib
Intercostal nerves
T12 spinal nerve
12th rib
Subcostal nerve
L1 spinal nerve
Conus medullaris
Cauda equina
L5 spinal nerve
S1 spinal nerve
Sacrum (cut away)
Filum terminale internum
Termination of dural sac
Filum terminale externum (coccygeal ligament)
S5 spinal nerve
Coccygeal nerve
C1 vertebra (atlas)
Cervical plexus
C7 vertebra
T1 vertebra
Brachial plexus
Spinal dura mater
Filaments of spinal nerve roots (T7 and T8)
T12 vertebra
L1 vertebra
Iliohypogastric nerve
Ilioinguinal nerve
Lumbar plexus
L5 plexus
L5 vertebra
Femoral nerve
Sacral plexus
Superior and inferior gluteal nerves
Posterior femoral cutaneous nerve
Pudendal nerve
Coccyx
Spinal Cord | Relation of Spinal Nerve Roots to Vertebrae
Base of skull
Cervical enlargement
Lumbar enlargement
Filum terminale internum
Filum terminale externum (coccygeal ligament)
C1, 1st Cervical spinal nerve
C1 spinal nerve exits above the C1 vertebra
C1, 1st Cervical vertebra
C2, 2nd Cervical spinal nerve
C2 spinal nerve exits above the C1 vertebra
C2, 2nd Cervical vertebra
C3, 3rd Cervical spinal nerve
C3, 3rd Cervical vertebra
C4, 4th Cervical spinal nerve
C4, 4th Cervical vertebra
C5, 5th Cervical spinal nerve
C5, 5th Cervical vertebra
C6, 6th Cervical spinal nerve
C6, 6th Cervical vertebra
C7, 7th Cervical spinal nerve
C7, 7th Cervical vertebra
C8, 8th Cervical spinal nerve exits below C7 vertebra (there are 8 cervical nerves but only 7 cervical vertebrae)
T1, 1st Thoracic vertebra
T1, 1st Thoracic spinal nerve
T2, 2nd Thoracic vertebra
T2, 2nd Thoracic spinal nerve
T3, 3rd Thoracic vertebra
T3, 3rd Thoracic spinal nerve
T4, 4th Thoracic vertebra
T4, 4th Thoracic spinal nerve
T5, 5th Thoracic vertebra
T5, 5th Thoracic spinal nerve
T6, 6th Thoracic vertebra
T6, 6th Thoracic spinal nerve
T7, 7th Thoracic vertebra
T7, 7th Thoracic spinal nerve
T8, 8th Thoracic vertebra
T8, 8th Thoracic spinal nerve
T9, 9th Thoracic vertebra
T9, 9th Thoracic spinal nerve
T10, 10th Thoracic vertebra
T10, 10th Thoracic spinal nerve
T11, 11th Thoracic vertebra
T11, 11th Thoracic spinal nerve
T12, 12th Thoracic vertebra
T12, 12th Thoracic spinal nerve
L1, 1st Lumbar vertebra
Conus medullaris (termination of spinal cord)
L1, 1st Lumbar spinal nerve
L2, 2nd Lumbar vertebra
L2, 2nd Lumbar spinal nerve
L3, 3rd Lumbar vertebra
L3, 3rd Lumbar spinal nerve
Cauda equina
L4, 4th Lumbar vertebra
L4, 4th Lumbar spinal nerve
L5, 5th Lumbar vertebra
L5, 5th Lumbar spinal nerve
Sacrum
S1, 1st Sacral spinal nerve
S2, 2nd Sacral spinal nerve
Termination of dural sac
S3, 3rd Sacral spinal nerve
S4, 4th Sacral spinal nerve
S5, 5th Sacral spinal nerve
Coccygeal nerve
Coccyx
Lumbar disc protrusion does not usually affect nerve exiting above disc. Lateral protrusion at disc level L4-5 affects L5 spinal nerve, not L4 spinal nerve. Protrusion at disc level L5-S1 affects S1 spinal nerve, not L5 spinal nerve.
L4
L4
L5
L5
S1
S2
Medial protrusion at disc level L4-5 rarely affects L4 spinal nerve but may affect L5 spinal nerve and sometimes S1-4 spinal nerves.
L4, 4th Lumbar vertebra
L4, 4th Lumbar spinal nerve
L5, 5th Lumbar vertebra
L5, 5th Lumbar spinal nerve
S1, 1st Sacral spinal nerve
S2, 2nd Sacral spinal nerve
S3, 3rd Sacral spinal nerve
S4, 4th Sacral spinal nerve
S5, 5th Sacral spinal nerve
Coccygeal nerve
Spinal Cord | Lumbar Disc Herniation: Clinical Manifestations
Schematic cross section showing compression of nerve root
Characteristic posture in left-sided lower lumbar disc herniation
Surgical exposure of lower lumbar disc
Nucleus pulposus
Nerve root
Dura
Clinical features of herniated lumbar nucleus pulposus
Spinal Cord | Lumbar Puncture and Epidural Anesthesia
Lumbar puncture
Cauda equina
Subarachnoid space
Needle entering subarachnoid space
Arrows show locations of insertion of needles
Iliac crest
Epidural anesthesia
Dural sac
Epidural space
Spinous process of L4
Ligamentum flavum
Needle entering epidural space
Epidural anesthesia and lumbar puncture are performed by inserting a needle above or below the L4 vertebral spine, which lies at the level of the iliac crest. For epidural anesthesia, the needle passes into the epidural space, and anesthetic agent bathes the nerve roots in proximity. Lumbar puncture, on the other hand, is performed in order to collect a sample of cerebrospinal fluid (CSF) or to introduce an anesthetic agent into the CSF (spinal anesthesia), so therefore the needle penetrates the dural sac to enter the subarachnoid space.
Spinal Cord | Dermatomes
Schematic demarcation of dermatomes (according to Keegan and Garrett) shown as distinct segments. There is actually considerable overlap between any two adjacent dermatomes. An alternative dermatome map is that provided by Foerster (see References).
Anterior view of full body
C2
C3
C4
C5
C5
C6
C6
C7
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L4
L5
L5
S1
S2
S3
Posterior view of full body
C2
C3
C4
C5
C6
C6
C6
C7
C7
C7
C8
C8
C8
T1
T2
T3
T4
T5
T6
T7
T8
T9
T10
T11
T12
L1
L2
L3
L4
L5
L5
L1
L2
L3
L4
L5
L4
Levels of principal dermatomes
C5 Clavicles
C5, 6, 7 Lateral parts of upper limbs
C8, T1 Medial sides of upper limbs
C6 Thumb
C6, 7, 8 Hand
C8 Ring and little fingers
T4 Level of nipples
T10 Level of umbilicus
L1 Inguinal or groin regions
L1, 2, 3, 4 Anterior and inner surfaces of lower limbs
L4, 5, S1 Foot
L4 Medial side of great toe
S1, 2, L5 Posterior and outer surfaces of lower limbs
S1 Lateral margin of foot and little toe
S2, 3, 4 Perineum
Spinal Cord | Sympathetic Nervous System: General Topography
Internal carotid plexus
Internal carotid nerve
Superior cervical ganglion
Gray rami communicantes
Cervical sympathetic trunk
Middle cervical ganglion
Cervicothoracic (stellate) ganglion
Thoracic visceral nerves
Pulmonary plexus
White and gray rami communicantes
Esophageal plexus
Greater thoracic splanchnic nerve
Lesser thoracic splanchnic nerve
Aorticorenal ganglion
Lumbar splanchnic nerves
Sacral splanchnic nerves
External carotid nerve
Cervical cardiac nerves
Cardiac plexus
Celiac plexus
Celiac ganglion
Superior mesenteric ganglion
Superior mesenteric plexus
Inferior mesenteric ganglion
Inferior mesenteric plexus
Hypogastric nerve
Inferior hypogastric plexus
Spinal Cord | Parasympathetic Nervous System: General Topography
Oculomotor nerve (CN III)
Facial nerve (CN VII)
Glossopharyngeal nerve (CN IX)
Vagus nerve (CN X)
Pulmonary plexus
Esophageal plexus
Pelvic splanchnic nerves (from S2-4)
Inferior hypogastric plexus
Lacrimal gland
Ciliary ganglion
Pterygopalatine ganglion
Parotid gland
Submandibular ganglion
Sublingual and submandibular glands
Cervical cardiac branch
Cardiac plexus
Anterior and posterior vagal trunks
Celiac plexus
Superior mesenteric plexus
Cavernous nerves
Spinal Cord | Sympathetic Nervous System: Schema
Superior cervical ganglion
Gray rami communicantes
First thoracic ganglion
Innervation to arrector pili muscles, vascular smooth muscle, and sweat glands of skin
White ramus communicans
Gray ramus communicans
First lumbar ganglion
First sacral ganglion
Sacral splanchnic nerves
Internal carotid nerve and plexus
External carotid nerve and plexus
Lacrimal gland
Eye
Parotid gland
Sublingual gland
Submandibular gland
Larynx
Trachea
Bronchi
Lungs
Cardiac branches
Greater thoracic splanchnic nerve
Heart
Celiac ganglion
Lesser thoracic splanchnic nerve
Stomach
Aorticorenal ganglion
Liver
Gallbladder
Bile ducts
Pancreas
Least thoracic splanchnic
Superior mesenteric ganglion
Kidneys
Intestines
Lumbar splanchnic nerves
Descending colon
Inferior mesenteric ganglion
Sigmoid colon
Rectum
Urinary bladder
Inferior hypogastric plexus
Prostate
External genitalia
Preganglionic fibers
Postganglionic fibers
Spinal Cord | Parasympathetic Nervous System: Schema
Branch of oculomotor nerve (III)
Branch of facial nerve (VII)
Medulla oblongata
Branch of glossopharyngeal nerve (IX)
Otic ganglion
Submandibular ganglion
Ciliary ganglion
Pterygopalatine ganglion
Lacrimal glands
Eye
Parotid glands
Sublingual glands
Submandibular glands
Vagus nerve (X)
Larynx
Trachea
Bronchi
Lungs
Pulmonary plexus
Heart
Stomach
Celiac ganglion
Superior mesenteric ganglion
Liver
Gallbladder
Bile ducts
Pancreas
Kidneys
Intestines
Descending colon
Sigmoid colon
Rectum
Inferior hypogastric plexus
Urinary bladder
Prostate
Pelvic splanchnic nerves
External genitalia
Preganglionic fibers
Postganglionic fibers
Spinal Cord | Spinal Membranes and Nerve Roots
Posterior view
Ventral root of spinal nerve
Dorsal root of spinal nerve
Dorsal root (spinal) ganglion
White and gray rami communicantes to and from sympathetic trunk
Ventral ramus of spinal nerve
Dorsal ramus of spinal nerve
Dura mater
Arachnoid mater
Mesothelial septum in dorsal median sulcus
Pia mater overlying spinal cord
Filaments of dorsal root
Denticulate ligament
Membranes removed: anterior view (greatly magnified)
White matter
Gray matter
Lateral horn
Dorsal horn
Ventral horn
Filaments of dorsal root
Dorsal root of spinal nerve
Filaments of ventral root
Dorsal root (spinal) ganglion
Dorsal ramus of spinal nerve
Ventral ramus of spinal nerve
Ventral root of spinal nerve
Spinal nerve
Gray and white rami communicantes
Spinal Cord | Spinal Nerve Origin: Cross Sections
Section through thoracic vertebra
Body of vertebra
Dura mater
Arachnoid mater
Subarachnoid space
Pia mater
Recurrent meningeal branches of spinal nerve
Pleura
Lung
Aorta
Fat in epidural space
Sympathetic ganglion
Denticulate ligament
Ventral root
White and gray rami communicantes
Spinal nerve
Ventral ramus (intercostal nerve)
Dorsal ramus
Dorsal root (spinal) ganglion
Dorsal root
Lateral horn of gray matter of spinal cord
Internal vertebral (epidural) venous plexus (of Batson)
Medial branch of dorsal ramus of spinal nerve
Lateral branch of dorsal ramus of spinal nerve
Section through lumbar vertebra
Sympathetic ganglion
Gray ramus communicans
Fat in epidural space
Dorsal and ventral roots of lumbar and sacral spinal nerves forming cauda equina
Dura mater
Arachnoid mater
Ventral root
Spinal nerve
Ventral ramus (contributes to lumbar plexus)
Dorsal ramus
Dorsal root (spinal) ganglion
Dorsal root
Conus medullaris
Spinal Cord | Arteries of Spinal Cord: Schema
Anterior view
Posterior cerebral artery
Superior cerebral artery
Basilar artery
Anterior inferior cerebellar artery (AICA)
Posterior inferior cerebellar artery (PICA)
Anterior spinal artery
Vertebral artery
Anterior segmental medullary arteries
Ascending cervical artery
Deep cervical artery
Subclavian artery
Anterior segmental medullary artery
Posterior intercostal artery
Pial plexus
Major anterior segmental medullary artery (great radicular artery of Adamkiewicz)
Posterior intercostal artery
Anterior segmental medullary artery
Lumbar
Anastomotic loops to posterior spinal arteries
Cauda equina arteries
Lateral (or medial) sacral arteries
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Posterior view
Posterior inferior cerebellar artery
Posterior spinal arteries
Vertebral artery
Posterior segmental medullary arteries
Deep cervical artery
Ascending cervical artery
Subclavian artery
Posterior segmental medullary arteries
Posterior intercostal arteries
Posterior segmental medullary arteries
Anastomotic loops to anterior spinal artery
Lumbar arteries
Lateral (or medial) sacral arteries
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Note: All spinal nerve roots have associated radicular or segmental medullary arteries. Most roots have radicular arteries (see Plate 172). 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.
Spinal Cord | Arteries of Spinal Cord: Intrinsic Distribution
Section through thoracic level: anterosuperior view
Posterior spinal arteries
Anterior spinal artery
Anterior segmental medullary artery
Anterior radicular artery
Posterior radicular artery
Branch to vertebral body and dura mater
Spinal branch
Dorsal branch of posterior intercostal artery
Posterior intercostal artery
Paravertebral anastomoses
Prevertebral anastomoses
Prevertebral anastomoses
Thoracic (descending) aorta
Arterial distribution schema
Sulcal (central) branches to right side of spinal cord
Posterior radicular artery
Anterior segmental medullary artery
Pial arterial plexus
Anterior and posterior radicular arteries
Anterior spinal artery
Right posterior spinal artery
Peripheral branches from pial plexus
Sulcal (central) branches to left side of spinal cord
Left posterior spinal artery
Posterior radicular artery
Anterior segmental medullary artery
Pial arterial plexus
Note: All spinal nerve roots have associated radicular or segmental medullary arteries. Most roots have radicular arteries. 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.
Spinal Cord | Veins of Spinal Cord and Vertebral Column
External vertebral venous plexus
Internal vertebral (epidural) venous plexus (Batson’s veins)
Internal vertebral (epidural) venous plexus
Intervertebral vein
External vertebral venous plexus
External vertebral venous plexus
Basivertebral vein
Internal vertebral (epidural) venous plexus
Segmented medullary/radicular veins
Intervertebral vein
Internal vertebral (epidural) venous plexus
External vertebral venous plexus
Anterior sulcal (central) vein
Anterior spinal vein
Basivertebral vein
Internal vertebral (epidural) venous plexus (Batson’s veins)
Intervertebral vein
Anterior segmental medullary/radicular vein
Posterior segmental medullary/radicular vein
Pial venous plexus
Posterior sulcal (central) vein
Posterior spinal vein
Internal vertebral (epidural) venous plexus
Muscles and Nerves | Muscles of Back: Superficial Layers
Gluteus maximus muscle
Gluteal aponeurosis (over gluteus medius muscle)
Iliac crest
Internal oblique muscle in lumbar triangle (of Petit)
External oblique muscle
Thoracolumbar fascia
Spinous process of T12 vertebra
Latissimus dorsi muscle
Teres major muscle
Teres minor muscle
Infraspinatus fascia
Deltoid muscle
Spine of scapula
Trapezius muscle
Posterior triangle of neck
Sternocleidomastoid muscle
Spinous process of C2 vertebra
Superior nuchal line of skull
Semispinalis capitis muscle
Splenius capitis muscle
Spinous process of C7 vertebra
Splenius cervicis muscle
Levator scapulae muscle
Rhomboid minor muscle (cut)
Supraspinatus muscle
Serratus posterior superior muscle
Rhomboid major muscle (cut)
Infraspinatus fascia (over infraspinatus muscle)
Teres minor and major muscles
Latissimus dorsi muscle (cut)
Serratus anterior muscle
Serratus posterior inferior muscle
12th rib
Erector spinae muscle
External oblique muscle
Internal oblique muscle
Muscles and Nerves | Muscles of Back: Intermediate Layers
Superior nuchal line of skull
Posterior tubercle of atlas (C1)
Longissimus capitis
Semispinalis capitis muscle
Splenius capitis and splenius cervicis muscles
Iliocostalis muscle of Erector spinae muscle
Longissimus muscle of Erector spinae muscle
Spinalis muscle of Erector spinae muscle
Serratus posterior inferior muscle
Tendon of origin of transversus abdominis muscle
Internal oblique muscle
External oblique muscle (cut)
Iliac crest
Rectus capitis posterior minor muscle
Obliquus capitis superior muscle
Rectus capitis posterior major muscle
Obliquus capitis inferior muscle
Longissimus capitis muscle
Semispinalis capitis muscle (cut)
Spinalis cervicis muscle
Spinous process of C7 vertebra
Longissimus cervicis muscle
Iliocostalis cervicis muscle
Iliocostalis thoracis muscle
Hook
Spinalis thoracis muscle
Longissimus thoracis muscle
Iliocostalis lumborum muscle
Spinous process of T12 vertebra
Transversus abdominis muscle and tendon of origin
Thoracolumbar fascia (posterior layer) (cut)
Muscles and Nerves | Muscles of Back: Deep Layers
Superior nuchal line of skull
Mastoid process
Posterior tubercle of atlas (C1 vertebra)
Spinous process of axis (C2 vertebra)
Semispinalis capitis muscle
Spinous process of C7 vertebra
External intercostal muscles
Semispinalis thoracis muscles
Multifidus muscles
Thoracolumbar fascia (anterior layer)
Thoracolumbar fascia (posterior layer) (cut)
Transversus abdominis muscle and tendon of origin
Multifidus muscles
Erector spinae muscle (cut)
Rectus capitis posterior minor muscle
Obliquus capitis superior muscle
Rectus capitis posterior major muscle
Transverse process of atlas (C1)
Obliquus capitis inferior muscle
Longus of Rotatores cervicis muscles
Brevis of Rotatores cervicis muscles
Interspinalis cervicis muscle
Levator costae muscle
Longus of Rotatores thoracis muscles
Brevis of Rotatores thoracis muscles
Brevis of Levatores costarum muscles
Longus of Levatores costarum muscles
Interspinalis lumborum muscle
Intertransversarius muscle
Quadratus lumborum muscle
Iliac crest
Multifidus muscles (cut)
Muscles and Nerves | Nerves of Back
Accessory nerve (XI)
Trapezius muscle (reflected)
Levator scapulae muscle
Transverse cervical artery and vein
Subtrapezial plexus
Supraspinatus
Spine of scapula
Infraspinatus fascia
Rhomboid minor muscle
Rhomboid major muscle
Latissimus dorsi muscle
Spinous process of T12 vertebra
Thoracolumbar fascia
Gluteus maximus muscle
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
3rd occipital nerve (dorsal ramus of C3 spinal nerve)
Lesser occipital nerve of Cervical plexus (ventral rami of C2, 3 spinal nerves)
Great auricular nerve of Cervical plexus (ventral rami of C2, 3 spinal nerves)
Trapezius muscle
Posterior cutaneous branches (from medial branches of dorsal rami of C4-T6 spinal nerves; C7, 8 are minimal)
Deltoid muscle
Infraspinatus fascia
Teres minor and major muscles
Superior lateral brachial cutaneous nerve (from axillary nerve C5, 6)
Posterior cutaneous branches (from lateral branches of dorsal rami of T7-12 spinal nerves)
Lateral cutaneous branches of ventral rami (intercostal nerves)
External oblique muscle
Iliac crest
Iliohypogastric nerve (ventral ramus of L1 spinal nerve)
Superior clunial nerves (dorsal rami of L1, 2, 3 spinal nerves)
Medial clunial nerves (dorsal rami of S1, 2, 3 spinal nerves)
Inferior clunial nerves from posterior femoral cutaneous nerve (sacral plexus S1, 2, 3)
Muscles and Nerves | Suboccipital Triangle
Epicranial aponeurosis (galea aponeurotica)
Occipital belly (occipitalis) of occipitofrontalis muscle
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
Occipital artery
Third occipital nerve (dorsal ramus of C3 spinal nerve)
Semispinalis capitis and splenius capitis muscles in posterior triangle of neck
Posterior auricular artery
Great auricular nerve (cervical plexus C2, 3)
Lesser occipital nerve (cervical plexus C2)
Sternocleidomastoid muscle
Trapezius muscle
Posterior cutaneous branches of dorsal rami of C4, 5, 6 spinal nerves
Rectus capitis posterior minor muscle
Rectus capitis posterior major muscle
Semispinalis capitis muscle (cut and reflected)
Vertebral artery (atlantic part)
Obliquus capitis superior muscle
Suboccipital nerve (dorsal ramus of C1 spinal nerve)
Posterior arch of atlas (C1 vertebra)
Occipital artery
Obliquus capitis inferior muscle
Greater occipital nerve (dorsal ramus of C2 spinal nerve)
Splenius capitis muscle (cut and reflected)
Third occipital nerve (dorsal ramus of C3 spinal nerve)
Longissimus capitis muscle
Splenius cervicis muscle
Semispinalis cervicis muscle
Semispinalis capitis muscle (cut)
Splenius capitis muscle (cut)
Muscles and Nerves | Lumbar Region of Back: Cross Section
Quadratus lumborum muscle
Latissimus dorsi muscle
Serratus posterior inferior muscle
Tendon of origin of transversus abdominis and internal oblique muscles
Transversus abdominis muscle
Internal oblique muscle
External oblique muscle
Transversalis fascia
Extraperitoneal (subserous) fascia (areolar tissue)
Peritoneum
Pararenal fat
Perirenal fat
Renal (Gerota’s) fascia (anterior and posterior layers
Kidney
Descending (2nd) part of duodenum
Inferior vena cava
Pancreas
Anterior longitudinal ligament
Crura of diaphragm
Superior mesenteric artery and vein
Mesentery
Abdominal aorta
Duodenojejunal
Body of L2 vertebra
Psoas major muscle and fascia
Lumbar spinal nerve
Transverse process
Spinal dura mater
Cauda equina
Spinous process of L1 vertebra
Supraspinous ligament
Erector spinae muscle
Thoracolumbar fascia (posterior layer)
Thoracolumbar fascia (middle layer)
Thoracolumbar fascia (anterior layer-quadratus lumborum fascia)
Muscles and Nerves | Typical Thoracic Spinal Nerve
Anterior cutaneous branch
Lateral cutaneous branch
Posterior cutaneous branch
Dorsal ramus
Ventral ramus (intercostal nerve)
Spinal nerve
Dorsal root
Ventral root
Sternum
External intercostal membrane
Medial branch
Transversus thoracis muscle
Lateral branch
External intercostal muscle
Internal intercostal muscle
Innermost intercostal muscle
Anterior branch
Posterior branch
Serratus anterior muscle
Latissimus dorsi muscle
Subscapularis muscle
Teres major muscle
Scapula
Infraspinatus muscle
Trapezius muscle
Rhomboid major muscle
Erector spinae muscle
Internal intercostal membrane
Lateral branch
Medial branch
Intervertebral foramen
Dorsal root (spinal) ganglion
Sympathetic ganglion
Gray and white rami communicantes
Note: In lower thoracic region, lateral branch of dorsal ramus is longer, motor, and cutaneous; medial branch is shorter and motor only.
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