awinml/medqa-textbooks-chunked · Datasets at Hugging Face

id stringlengths 14 28	file_name stringclasses 18 values	content stringlengths 1 722k
Anatomy_Gray_700	Anatomy_Gray.txt	Fig. 2.16 Radiograph of thoracic region of vertebral column. A. Anteroposterior view. B. Lateral view.
Anatomy_Gray_701	Anatomy_Gray.txt	RibPedicleLocation of intervertebral discSpinous processTransverse processVertebral bodyA
Anatomy_Gray_702	Anatomy_Gray.txt	BIntervertebral foramenVertebral bodyLocation of intervertebral disc
Anatomy_Gray_703	Anatomy_Gray.txt	Fig. 2.17 Radiograph of lumbar region of vertebral column. A. Anteroposterior view. B. Lateral view.
Anatomy_Gray_704	Anatomy_Gray.txt	RibTransverse processPedicleSpinous process of LIVA
Anatomy_Gray_705	Anatomy_Gray.txt	Location ofintervertebral discVertebral body of LIIIIntervertebral foramenB
Anatomy_Gray_706	Anatomy_Gray.txt	Fig. 2.18 Development of the vertebrae.
Anatomy_Gray_707	Anatomy_Gray.txt	Fig. 2.19 Typical vertebra.
Anatomy_Gray_708	Anatomy_Gray.txt	Fig. 2.20 Regional vertebrae. A. Typical cervical vertebra.
Anatomy_Gray_709	Anatomy_Gray.txt	B. Atlas and axis. C. Typical thoracic vertebra. D. Typical lumbar vertebra.
Anatomy_Gray_710	Anatomy_Gray.txt	E. Sacrum. F. Coccyx.
Anatomy_Gray_711	Anatomy_Gray.txt	Transverse processDensDensForamen transversariumSuperior viewSuperior viewSuperior viewPosterior viewPosterosuperior viewBAnterior tuberclePosterior tubercleAnterior archLateral massPosterior archFacet for densFacet for occipital condyleImpressionsfor alarligamentsAlarligamentsTectorial membrane (upper partof posterior longitudinal ligament)PosteriorlongitudinalligamentFacets forattachment ofalar ligamentsAtlas (CI vertebra)Atlas (CI vertebra) and Axis (CII vertebra)Atlas (CIvertebra)and Axis(CII vertebra)and baseof skullAxis (CII vertebra)Transverse ligament of atlasTransverse ligament of atlasVertebral bodyTransverse processTransverseprocessSpinousprocessMammillaryprocessSpinousprocessSuperior viewLateral viewSuperior viewFacet for articulationwith tubercle ofits own ribDemifacet for articulationwith head of rib belowDemifacet for articulationwith head of its own ribCDApical ligamentof densInferior longitudinalband of cruciformligament
Anatomy_Gray_712	Anatomy_Gray.txt	Anterior viewDorsolateral viewPosterior viewFacet for articulation with pelvic boneEFAnterior sacral foraminaPosterior sacral foraminaCoccygeal cornuIncomplete sacral canal
Anatomy_Gray_713	Anatomy_Gray.txt	Fig. 2.21 Radiograph showing CI (atlas) and CII (axis) vertebrae. Open mouth, anteroposterior (odontoid peg) view.
Anatomy_Gray_714	Anatomy_Gray.txt	Superior articularfacet of CIIDensInferior articular faceton lateral mass of CI
Anatomy_Gray_715	Anatomy_Gray.txt	Fig. 2.22 Intervertebral foramen.
Anatomy_Gray_716	Anatomy_Gray.txt	Fig. 2.23 Spaces between adjacent vertebral arches in the lumbar region.
Anatomy_Gray_717	Anatomy_Gray.txt	Fig. 2.24 T1-weighted MR image in the sagittal plane demonstrating a lumbosacral myelomeningocele. There is an absence of laminae and spinous processes in the lumbosacral region.
Anatomy_Gray_718	Anatomy_Gray.txt	Fig. 2.25 Radiograph of the lumbar region of the vertebral column demonstrating a wedge fracture of the L1 vertebra. This condition is typically seen in patients with osteoporosis.
Anatomy_Gray_719	Anatomy_Gray.txt	Fig. 2.26 Radiograph of the lumbar region of the vertebral column demonstrating three intrapedicular needles, all of which have been placed into the middle of the vertebral bodies. The high-density material is radiopaque bone cement, which has been injected as a liquid that will harden.
Anatomy_Gray_720	Anatomy_Gray.txt	Fig. 2.27 Severe scoliosis. A. Radiograph, anteroposterior view. B. Volume-rendered CT, anterior view.
Anatomy_Gray_721	Anatomy_Gray.txt	Fig. 2.28 Sagittal CT showing kyphosis.
Anatomy_Gray_722	Anatomy_Gray.txt	Fig. 2.29 Variations in vertebral number. A. Fused vertebral bodies of cervical vertebrae. B. Hemivertebra. C. Axial slice MRI through the LV vertebra. The iliolumbar ligament runs from the tip of the LV vertebra transverse process to the iliac crest.
Anatomy_Gray_723	Anatomy_Gray.txt	Fused bodies of cervical vertebraeA
Anatomy_Gray_724	Anatomy_Gray.txt	HemivertebraPartial lumbarization of first sacral vertebraB
Anatomy_Gray_725	Anatomy_Gray.txt	Fig. 2.30 A. MRI of a spine with multiple collapsed vertebrae due to diffuse metastatic myeloma infiltration. B1, B2. Positron emission tomography CT (PETCT) study detecting cancer cells in the spine that have high glucose metabolism.
Anatomy_Gray_726	Anatomy_Gray.txt	Fig. 2.31 Intervertebral joints.
Anatomy_Gray_727	Anatomy_Gray.txt	Anulus fibrosusNucleus pulposusLayer of hyalinecartilage
Anatomy_Gray_728	Anatomy_Gray.txt	Fig. 2.32 Zygapophysial joints.
Anatomy_Gray_729	Anatomy_Gray.txt	Fig. 2.33 Uncovertebral joint.
Anatomy_Gray_730	Anatomy_Gray.txt	Fig. 2.34 Disc protrusion. T2-weighted magnetic resonance images of the lumbar region of the vertebral column. A. Sagittal plane.
Anatomy_Gray_731	Anatomy_Gray.txt	B. Axial plane.
Anatomy_Gray_732	Anatomy_Gray.txt	Fig. 2.35 Anterior and posterior longitudinal ligaments of vertebral column.
Anatomy_Gray_733	Anatomy_Gray.txt	Fig. 2.36 Ligamenta flava.
Anatomy_Gray_734	Anatomy_Gray.txt	Fig. 2.37 Supraspinous ligament and ligamentum nuchae.
Anatomy_Gray_735	Anatomy_Gray.txt	Fig. 2.38 Interspinous ligaments.
Anatomy_Gray_736	Anatomy_Gray.txt	Fig. 2.39 Axial slice MRI through the lumbar spine demonstrating bilateral hypertrophy of the ligamentum flavum.
Anatomy_Gray_737	Anatomy_Gray.txt	Fig. 2.40 Radiograph of lumbar region of vertebral column, oblique view (“Scottie dog”). A. Normal radiograph of lumbar region of vertebral column, oblique view. In this view, the transverse process (nose), pedicle (eye), superior articular process (ear), inferior articular process (front leg), and pars interarticularis (neck) resemble a dog. A fracture of the pars interarticularis is visible as a break in the neck of the dog, or the appearance of a collar. B. Fracture of pars interarticularis. C. CT of lumbar spine shows fracture of the LV pars interarticularis.
Anatomy_Gray_738	Anatomy_Gray.txt	Fig. 2.41 A. Anterior lumbar interbody fusion (ALIF). B. Posterior lumbar interbody fusion (PLIF).
Anatomy_Gray_739	Anatomy_Gray.txt	Fig. 2.42 Superficial group of back muscles—trapezius and latissimus dorsi.
Anatomy_Gray_740	Anatomy_Gray.txt	Spinous process of CVIIAcromionSpine of scapulaIliac crestGreater occipital nerve(posterior ramus of C2)Third occipital nerve(posterior ramus of C3)Medial branches of posterior ramiLateral branches of posterior ramiTrapeziusLatissimus dorsiThoracolumbar fascia
Anatomy_Gray_741	Anatomy_Gray.txt	Fig. 2.43 Superficial group of back muscles—trapezius and latissimus dorsi, with rhomboid major, rhomboid minor, and levator scapulae located deep to trapezius in the superior part of the back.
Anatomy_Gray_742	Anatomy_Gray.txt	Fig. 2.44 Innervation and blood supply of trapezius.
Anatomy_Gray_743	Anatomy_Gray.txt	TrapeziusLatissimus dorsiRhomboid minorRhomboid majorLevator scapulaeAccessory nerve [XI]Superficial branch of transverse cervical artery
Anatomy_Gray_744	Anatomy_Gray.txt	Fig. 2.45 Rhomboid muscles and levator scapulae.
Anatomy_Gray_745	Anatomy_Gray.txt	Fig. 2.46 Innervation and blood supply of the rhomboid muscles.
Anatomy_Gray_746	Anatomy_Gray.txt	Dorsal scapular nerveTrapeziusLatissimus dorsiRhomboid minorRhomboid majorLevator scapulaeSuperficial branch of transverse cervical arteryDeep branch of transverse cervical artery
Anatomy_Gray_747	Anatomy_Gray.txt	Fig. 2.47 Intermediate group of back muscles—serratus posterior muscles.
Anatomy_Gray_748	Anatomy_Gray.txt	Fig. 2.48 Thoracolumbar fascia and the deep back muscles (transverse section).
Anatomy_Gray_749	Anatomy_Gray.txt	Fig. 2.49 Deep group of back muscles—spinotransversales muscles (splenius capitis and splenius cervicis).
Anatomy_Gray_750	Anatomy_Gray.txt	Fig. 2.50 Deep group of back muscles—erector spinae muscles.
Anatomy_Gray_751	Anatomy_Gray.txt	Spinous process of CVIIIliac crestSplenius capitisLongissimus capitis Ligamentum nuchaeLongissimus thoracisLongissimus cervicisSpinalis thoracisSpinalisIliocostalis lumborum Iliocostalis thoracisIliocostalis cervicisIliocostalisLongissimus
Anatomy_Gray_752	Anatomy_Gray.txt	Fig. 2.51 Deep group of back muscles—transversospinales and segmental muscles.
Anatomy_Gray_753	Anatomy_Gray.txt	Spinous process of CVIIObliquus capitis inferiorObliquus capitis superiorRectus capitis posterior minorRectus capitis posterior majorSemispinalis thoracisIntertransversariusErector spinaeRotatores thoracis(short, long)Levatores costarum(short, long)Semispinalis capitisMultifidus
Anatomy_Gray_754	Anatomy_Gray.txt	Fig. 2.52 Deep group of back muscles—suboccipital muscles. This also shows the borders of the suboccipital triangle.
Anatomy_Gray_755	Anatomy_Gray.txt	Spinous process of CIIPosterior ramus of C1Obliquus capitis superior Rectus capitis posterior minorObliquus capitis inferiorRectus capitis posterior majorSplenius capitisSplenius capitisLongissimus capitisSemispinalis cervicisSemispinalis capitisSemispinalis capitisVertebral artery
Anatomy_Gray_756	Anatomy_Gray.txt	Fig. 2.53 Spinal cord.
Anatomy_Gray_757	Anatomy_Gray.txt	End of spinalcord LI–LIIConus medullarisInferior part ofarachnoid materEnd of subarachnoidspace SIICervicalenlargement(of spinal cord)Lumbosacralenlargement(of spinal cord)FilumterminalePial partDural partPedicles ofvertebrae
Anatomy_Gray_758	Anatomy_Gray.txt	Fig. 2.54 Features of the spinal cord.
Anatomy_Gray_759	Anatomy_Gray.txt	Fig. 2.55 Arteries that supply the spinal cord. A. Anterior view of spinal cord (not all segmental spinal arteries are shown).
Anatomy_Gray_760	Anatomy_Gray.txt	B. Segmental supply of spinal cord.
Anatomy_Gray_761	Anatomy_Gray.txt	Posterior spinal arteryADeep cervical arteryCostocervical trunkThyrocervical trunkSubclavian arteryPosterior intercostalarterySegmentalspinal arteryArtery of Adamkiewicz(branch fromsegmentalspinal artery)Ascending cervicalarteryVertebral arterySegmental medullaryarteriesAnterior spinal arterySegmental medullaryarteries (branch fromsegmental spinalartery)Lateral sacral arterySegmentalspinal artery
Anatomy_Gray_762	Anatomy_Gray.txt	Fig. 2.56 Veins that drain the spinal cord.
Anatomy_Gray_763	Anatomy_Gray.txt	Fig. 2.57 MRI of the spine. There is discitis of the T10-T11 intervertebral disc with destruction of the adjacent endplates. There is also a prevertebral abscess and an epidural abscess, which impinges the cord.
Anatomy_Gray_764	Anatomy_Gray.txt	Fig. 2.58 CT at the level of CI demonstrates two breaks in the closed ring of the atlas following an axial-loading injury.
Anatomy_Gray_765	Anatomy_Gray.txt	Fig. 2.59 Meninges.
Anatomy_Gray_766	Anatomy_Gray.txt	Fig. 2.60 Arrangement of structures in the vertebral canal and the back (lumbar region).
Anatomy_Gray_767	Anatomy_Gray.txt	Crura of diaphragmAortaPsoasDuraQuadratus lumborumInternal vertebral plexus of veinsin extradural spaceErector spinae musclesLigamenta flavaSupraspinous ligamentInterspinous ligamentLumbar arteryVeinCauda equinaSkinVertebraIntervertebral discIntervertebral foramenLaminaPediclePosterior longitudinal ligament
Anatomy_Gray_768	Anatomy_Gray.txt	Fig. 2.61 Basic organization of a spinal nerve.
Anatomy_Gray_769	Anatomy_Gray.txt	Fig. 2.62 Course of spinal nerves in the vertebral canal.
Anatomy_Gray_770	Anatomy_Gray.txt	1121110112233445595678412345678123C8T1T2T3T4T5T6T7T8T9T10T11T12L1L2L3L4L5S1S2S3S4S5CoC7C6C5C4Cervical enlargement(of spinal cord)C2C3C1Lumbosacral enlargement(of spinal cord)Cauda equinaPedicles of vertebraeSpinal ganglion
Anatomy_Gray_771	Anatomy_Gray.txt	Fig. 2.63 Nomenclature of the spinal nerves.
Anatomy_Gray_772	Anatomy_Gray.txt	Nerve C1 emerges betweenskull and CI vertebraNerve C8 emerges inferior topedicle of CVII vertebraNerves C2 to C7 emergesuperior to pediclesNerves T1 to Co emergeinferior to pedicles oftheir respective vertebraeC2C1C3C4C5C6C7C8T1CICVIITIPedicleTransition innomenclatureof nervesT2
Anatomy_Gray_773	Anatomy_Gray.txt	Fig. 2.64 Normal appearance of the back. A. In women. B. In men.
Anatomy_Gray_774	Anatomy_Gray.txt	Fig. 2.65 Normal curvatures of the vertebral column.
Anatomy_Gray_775	Anatomy_Gray.txt	Fig. 2.66 Back of a woman with major palpable bony landmarks indicated.
Anatomy_Gray_776	Anatomy_Gray.txt	Spine of scapulaInferior angle of scapulaMedial border of scapulaPosition of externaloccipital protuberancePosterior superior iliac spineIliac crest
Anatomy_Gray_777	Anatomy_Gray.txt	Fig. 2.67 The back with the positions of vertebral spinous processes and associated structures indicated. A. In a man. B. In a woman with neck flexed. The prominent CVII and TI vertebral spinous processes are labeled. C. In a woman with neck flexed to accentuate the ligamentum nuchae.
Anatomy_Gray_778	Anatomy_Gray.txt	Tip of coccyxSII vertebral spinous processTXII vertebral spinous processTVII vertebral spinous processTIII vertebral spinous processTI vertebral spinous processRoot of spine of scapulaInferior angle of scapulaHighest point of iliac crestIliac crestSacral dimpleCVII vertebral spinous processCII vertebral spinous processPosition of externaloccipital protuberanceLIV vertebral spinous processA
Anatomy_Gray_779	Anatomy_Gray.txt	Fig. 2.68 Back with the ends of the spinal cord and subarachnoid space indicated. A. In a man.
Anatomy_Gray_780	Anatomy_Gray.txt	Back with the ends of the spinal cord and subarachnoid space indicated. B. In a woman lying on her side in a fetal position, which accentuates the lumbar vertebral spinous processes and opens the spaces between adjacent vertebral arches. Cerebrospinal fluid can be withdrawn from the subarachnoid space in lower lumbar regions without endangering the spinal cord.
Anatomy_Gray_781	Anatomy_Gray.txt	Tip of coccyxSII vertebral spinous processTXII vertebral spinous processInferior end of spinal cord(normally betweenLI and LII vertebra)Inferior end ofsubarachnoid spaceALIV vertebral spinous process
Anatomy_Gray_782	Anatomy_Gray.txt	LIV vertebral spinous processNeedleLV vertebral spinous processTip of coccyxB
Anatomy_Gray_783	Anatomy_Gray.txt	Fig. 2.69 Back muscles. A. In a man with latissimus dorsi, trapezius, and erector spinae muscles outlined.
Anatomy_Gray_784	Anatomy_Gray.txt	Back muscles. B. In a man with arms abducted to accentuate the lateral margins of the latissimus dorsi muscles. C. In a woman with scapulae externally rotated and forcibly retracted to accentuate the rhomboid muscles.
Anatomy_Gray_785	Anatomy_Gray.txt	Fig. 2.70 MRI of the lumbar spine reveals posterior herniation of the L2-3 disc resulting in compression of the cauda equina filaments.
Anatomy_Gray_786	Anatomy_Gray.txt	Table 2.1 Superficial (appendicular) group of back muscles
Anatomy_Gray_787	Anatomy_Gray.txt	Table 2.2 Intermediate (respiratory) group of back muscles
Anatomy_Gray_788	Anatomy_Gray.txt	Table 2.3 Spinotransversales muscles
Anatomy_Gray_789	Anatomy_Gray.txt	Table 2.4 Erector spinae group of back muscles
Anatomy_Gray_790	Anatomy_Gray.txt	Table 2.5 Transversospinales group of back muscles
Anatomy_Gray_791	Anatomy_Gray.txt	Table 2.6 Segmental back muscles
Anatomy_Gray_792	Anatomy_Gray.txt	Table 2.7 Suboccipital group of back muscles
Anatomy_Gray_793	Anatomy_Gray.txt	In the clinic
Anatomy_Gray_794	Anatomy_Gray.txt	Spina bifida is a disorder in which the two sides of vertebral arches, usually in lower vertebrae, fail to fuse during development, resulting in an “open” vertebral canal (Fig. 2.24). There are two types of spina bifida.
Anatomy_Gray_795	Anatomy_Gray.txt	The commonest type is spina bifida occulta, in which there is a defect in the vertebral arch of LV or SI. This defect occurs in as many as 10% of individuals and results in failure of the posterior arch to fuse in the midline. Clinically, the patient is asymptomatic, although physical examination may reveal a tuft of hair over the spinous processes.
Anatomy_Gray_796	Anatomy_Gray.txt	The more severe form of spina bifida involves complete failure of fusion of the posterior arch at the lumbosacral junction, with a large outpouching of the meninges. This may contain cerebrospinal fluid (a meningocele) or a portion of the spinal cord (a myelomeningocele). These abnormalities may result in a variety of neurological deficits, including problems with walking and bladder function.
Anatomy_Gray_797	Anatomy_Gray.txt	In the clinic
Anatomy_Gray_798	Anatomy_Gray.txt	Vertebroplasty is a relatively new technique in which the body of a vertebra can be filled with bone cement (typically methyl methacrylate). The indications for the technique include vertebral body collapse and pain from the vertebral body, which may be secondary to tumor infiltration. The procedure is most commonly performed for osteoporotic wedge fractures, which are a considerable cause of morbidity and pain in older patients.
Anatomy_Gray_799	Anatomy_Gray.txt	Osteoporotic wedge fractures (Fig. 2.25) typically occur in the thoracolumbar region, and the approach to performing vertebroplasty is novel and relatively straightforward. The procedure is performed under sedation or light general anesthetic. Using X-ray guidance the pedicle is identified on the anteroposterior image. A metal cannula is placed through the pedicle into the vertebral body. Liquid bone cement is injected via the cannula into the vertebral body (Fig. 2.26). The function of the bone cement is two-fold. First, it increases the strength of the vertebral body and prevents further loss of height. Furthermore, as the bone cement sets, there is a degree of heat generated that is believed to disrupt pain nerve endings. Kyphoplasty is a similar technique that aims to restore some or all of the lost vertebral body height from the wedge fracture by injecting liquid bone cement into the vertebral body.

Anatomy_Gray_700

Anatomy_Gray.txt

Fig. 2.16 Radiograph of thoracic region of vertebral column. A. Anteroposterior view. B. Lateral view.

Anatomy_Gray_701

Anatomy_Gray.txt

RibPedicleLocation of intervertebral discSpinous processTransverse processVertebral bodyA

Anatomy_Gray_702

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BIntervertebral foramenVertebral bodyLocation of intervertebral disc

Anatomy_Gray_703

Anatomy_Gray.txt

Fig. 2.17 Radiograph of lumbar region of vertebral column. A. Anteroposterior view. B. Lateral view.

Anatomy_Gray_704

Anatomy_Gray.txt

RibTransverse processPedicleSpinous process of LIVA

Anatomy_Gray_705

Anatomy_Gray.txt

Location ofintervertebral discVertebral body of LIIIIntervertebral foramenB

Anatomy_Gray_706

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Fig. 2.18 Development of the vertebrae.

Anatomy_Gray_707

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Fig. 2.19 Typical vertebra.

Anatomy_Gray_708

Anatomy_Gray.txt

Fig. 2.20 Regional vertebrae. A. Typical cervical vertebra.

Anatomy_Gray_709

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B. Atlas and axis. C. Typical thoracic vertebra. D. Typical lumbar vertebra.

Anatomy_Gray_710

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E. Sacrum. F. Coccyx.

Anatomy_Gray_711

Anatomy_Gray.txt

Transverse processDensDensForamen transversariumSuperior viewSuperior viewSuperior viewPosterior viewPosterosuperior viewBAnterior tuberclePosterior tubercleAnterior archLateral massPosterior archFacet for densFacet for occipital condyleImpressionsfor alarligamentsAlarligamentsTectorial membrane (upper partof posterior longitudinal ligament)PosteriorlongitudinalligamentFacets forattachment ofalar ligamentsAtlas (CI vertebra)Atlas (CI vertebra) and Axis (CII vertebra)Atlas (CIvertebra)and Axis(CII vertebra)and baseof skullAxis (CII vertebra)Transverse ligament of atlasTransverse ligament of atlasVertebral bodyTransverse processTransverseprocessSpinousprocessMammillaryprocessSpinousprocessSuperior viewLateral viewSuperior viewFacet for articulationwith tubercle ofits own ribDemifacet for articulationwith head of rib belowDemifacet for articulationwith head of its own ribCDApical ligamentof densInferior longitudinalband of cruciformligament

Anatomy_Gray_712

Anatomy_Gray.txt

Anterior viewDorsolateral viewPosterior viewFacet for articulation with pelvic boneEFAnterior sacral foraminaPosterior sacral foraminaCoccygeal cornuIncomplete sacral canal

Anatomy_Gray_713

Anatomy_Gray.txt

Fig. 2.21 Radiograph showing CI (atlas) and CII (axis) vertebrae. Open mouth, anteroposterior (odontoid peg) view.

Anatomy_Gray_714

Anatomy_Gray.txt

Superior articularfacet of CIIDensInferior articular faceton lateral mass of CI

Anatomy_Gray_715

Anatomy_Gray.txt

Fig. 2.22 Intervertebral foramen.

Anatomy_Gray_716

Anatomy_Gray.txt

Fig. 2.23 Spaces between adjacent vertebral arches in the lumbar region.

Anatomy_Gray_717

Anatomy_Gray.txt

Fig. 2.24 T1-weighted MR image in the sagittal plane demonstrating a lumbosacral myelomeningocele. There is an absence of laminae and spinous processes in the lumbosacral region.

Anatomy_Gray_718

Anatomy_Gray.txt

Fig. 2.25 Radiograph of the lumbar region of the vertebral column demonstrating a wedge fracture of the L1 vertebra. This condition is typically seen in patients with osteoporosis.

Anatomy_Gray_719

Anatomy_Gray.txt

Fig. 2.26 Radiograph of the lumbar region of the vertebral column demonstrating three intrapedicular needles, all of which have been placed into the middle of the vertebral bodies. The high-density material is radiopaque bone cement, which has been injected as a liquid that will harden.

Anatomy_Gray_720

Anatomy_Gray.txt

Fig. 2.27 Severe scoliosis. A. Radiograph, anteroposterior view. B. Volume-rendered CT, anterior view.

Anatomy_Gray_721

Anatomy_Gray.txt

Fig. 2.28 Sagittal CT showing kyphosis.

Anatomy_Gray_722

Anatomy_Gray.txt

Fig. 2.29 Variations in vertebral number. A. Fused vertebral bodies of cervical vertebrae. B. Hemivertebra. C. Axial slice MRI through the LV vertebra. The iliolumbar ligament runs from the tip of the LV vertebra transverse process to the iliac crest.

Anatomy_Gray_723

Anatomy_Gray.txt

Fused bodies of cervical vertebraeA

Anatomy_Gray_724

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HemivertebraPartial lumbarization of first sacral vertebraB

Anatomy_Gray_725

Anatomy_Gray.txt

Fig. 2.30 A. MRI of a spine with multiple collapsed vertebrae due to diffuse metastatic myeloma infiltration. B1, B2. Positron emission tomography CT (PETCT) study detecting cancer cells in the spine that have high glucose metabolism.

Anatomy_Gray_726

Anatomy_Gray.txt

Fig. 2.31 Intervertebral joints.

Anatomy_Gray_727

Anatomy_Gray.txt

Anulus fibrosusNucleus pulposusLayer of hyalinecartilage

Anatomy_Gray_728

Anatomy_Gray.txt

Fig. 2.32 Zygapophysial joints.

Anatomy_Gray_729

Anatomy_Gray.txt

Fig. 2.33 Uncovertebral joint.

Anatomy_Gray_730

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Fig. 2.34 Disc protrusion. T2-weighted magnetic resonance images of the lumbar region of the vertebral column. A. Sagittal plane.

Anatomy_Gray_731

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B. Axial plane.

Anatomy_Gray_732

Anatomy_Gray.txt

Fig. 2.35 Anterior and posterior longitudinal ligaments of vertebral column.

Anatomy_Gray_733

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Fig. 2.36 Ligamenta flava.

Anatomy_Gray_734

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Fig. 2.37 Supraspinous ligament and ligamentum nuchae.

Anatomy_Gray_735

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Fig. 2.38 Interspinous ligaments.

Anatomy_Gray_736

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Fig. 2.39 Axial slice MRI through the lumbar spine demonstrating bilateral hypertrophy of the ligamentum flavum.

Anatomy_Gray_737

Anatomy_Gray.txt

Fig. 2.40 Radiograph of lumbar region of vertebral column, oblique view (“Scottie dog”). A. Normal radiograph of lumbar region of vertebral column, oblique view. In this view, the transverse process (nose), pedicle (eye), superior articular process (ear), inferior articular process (front leg), and pars interarticularis (neck) resemble a dog. A fracture of the pars interarticularis is visible as a break in the neck of the dog, or the appearance of a collar. B. Fracture of pars interarticularis. C. CT of lumbar spine shows fracture of the LV pars interarticularis.

Anatomy_Gray_738

Anatomy_Gray.txt

Fig. 2.41 A. Anterior lumbar interbody fusion (ALIF). B. Posterior lumbar interbody fusion (PLIF).

Anatomy_Gray_739

Anatomy_Gray.txt

Fig. 2.42 Superficial group of back muscles—trapezius and latissimus dorsi.

Anatomy_Gray_740

Anatomy_Gray.txt

Spinous process of CVIIAcromionSpine of scapulaIliac crestGreater occipital nerve(posterior ramus of C2)Third occipital nerve(posterior ramus of C3)Medial branches of posterior ramiLateral branches of posterior ramiTrapeziusLatissimus dorsiThoracolumbar fascia

Anatomy_Gray_741

Anatomy_Gray.txt

Fig. 2.43 Superficial group of back muscles—trapezius and latissimus dorsi, with rhomboid major, rhomboid minor, and levator scapulae located deep to trapezius in the superior part of the back.

Anatomy_Gray_742

Anatomy_Gray.txt

Fig. 2.44 Innervation and blood supply of trapezius.

Anatomy_Gray_743

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TrapeziusLatissimus dorsiRhomboid minorRhomboid majorLevator scapulaeAccessory nerve [XI]Superficial branch of transverse cervical artery

Anatomy_Gray_744

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Fig. 2.45 Rhomboid muscles and levator scapulae.

Anatomy_Gray_745

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Fig. 2.46 Innervation and blood supply of the rhomboid muscles.

Anatomy_Gray_746

Anatomy_Gray.txt

Dorsal scapular nerveTrapeziusLatissimus dorsiRhomboid minorRhomboid majorLevator scapulaeSuperficial branch of transverse cervical arteryDeep branch of transverse cervical artery

Anatomy_Gray_747

Anatomy_Gray.txt

Fig. 2.47 Intermediate group of back muscles—serratus posterior muscles.

Anatomy_Gray_748

Anatomy_Gray.txt

Fig. 2.48 Thoracolumbar fascia and the deep back muscles (transverse section).

Anatomy_Gray_749

Anatomy_Gray.txt

Fig. 2.49 Deep group of back muscles—spinotransversales muscles (splenius capitis and splenius cervicis).

Anatomy_Gray_750

Anatomy_Gray.txt

Fig. 2.50 Deep group of back muscles—erector spinae muscles.

Anatomy_Gray_751

Anatomy_Gray.txt

Spinous process of CVIIIliac crestSplenius capitisLongissimus capitis Ligamentum nuchaeLongissimus thoracisLongissimus cervicisSpinalis thoracisSpinalisIliocostalis lumborum Iliocostalis thoracisIliocostalis cervicisIliocostalisLongissimus

Anatomy_Gray_752

Anatomy_Gray.txt

Fig. 2.51 Deep group of back muscles—transversospinales and segmental muscles.

Anatomy_Gray_753

Anatomy_Gray.txt

Spinous process of CVIIObliquus capitis inferiorObliquus capitis superiorRectus capitis posterior minorRectus capitis posterior majorSemispinalis thoracisIntertransversariusErector spinaeRotatores thoracis(short, long)Levatores costarum(short, long)Semispinalis capitisMultifidus

Anatomy_Gray_754

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Fig. 2.52 Deep group of back muscles—suboccipital muscles. This also shows the borders of the suboccipital triangle.

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Spinous process of CIIPosterior ramus of C1Obliquus capitis superior Rectus capitis posterior minorObliquus capitis inferiorRectus capitis posterior majorSplenius capitisSplenius capitisLongissimus capitisSemispinalis cervicisSemispinalis capitisSemispinalis capitisVertebral artery

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Fig. 2.53 Spinal cord.

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End of spinalcord LI–LIIConus medullarisInferior part ofarachnoid materEnd of subarachnoidspace SIICervicalenlargement(of spinal cord)Lumbosacralenlargement(of spinal cord)FilumterminalePial partDural partPedicles ofvertebrae

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Fig. 2.54 Features of the spinal cord.

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Fig. 2.55 Arteries that supply the spinal cord. A. Anterior view of spinal cord (not all segmental spinal arteries are shown).

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B. Segmental supply of spinal cord.

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Posterior spinal arteryADeep cervical arteryCostocervical trunkThyrocervical trunkSubclavian arteryPosterior intercostalarterySegmentalspinal arteryArtery of Adamkiewicz(branch fromsegmentalspinal artery)Ascending cervicalarteryVertebral arterySegmental medullaryarteriesAnterior spinal arterySegmental medullaryarteries (branch fromsegmental spinalartery)Lateral sacral arterySegmentalspinal artery

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Fig. 2.56 Veins that drain the spinal cord.

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Fig. 2.57 MRI of the spine. There is discitis of the T10-T11 intervertebral disc with destruction of the adjacent endplates. There is also a prevertebral abscess and an epidural abscess, which impinges the cord.

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Fig. 2.58 CT at the level of CI demonstrates two breaks in the closed ring of the atlas following an axial-loading injury.

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Fig. 2.59 Meninges.

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Fig. 2.60 Arrangement of structures in the vertebral canal and the back (lumbar region).

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Crura of diaphragmAortaPsoasDuraQuadratus lumborumInternal vertebral plexus of veinsin extradural spaceErector spinae musclesLigamenta flavaSupraspinous ligamentInterspinous ligamentLumbar arteryVeinCauda equinaSkinVertebraIntervertebral discIntervertebral foramenLaminaPediclePosterior longitudinal ligament

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Fig. 2.61 Basic organization of a spinal nerve.

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Fig. 2.62 Course of spinal nerves in the vertebral canal.

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1121110112233445595678412345678123C8T1T2T3T4T5T6T7T8T9T10T11T12L1L2L3L4L5S1S2S3S4S5CoC7C6C5C4Cervical enlargement(of spinal cord)C2C3C1Lumbosacral enlargement(of spinal cord)Cauda equinaPedicles of vertebraeSpinal ganglion

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Fig. 2.63 Nomenclature of the spinal nerves.

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Nerve C1 emerges betweenskull and CI vertebraNerve C8 emerges inferior topedicle of CVII vertebraNerves C2 to C7 emergesuperior to pediclesNerves T1 to Co emergeinferior to pedicles oftheir respective vertebraeC2C1C3C4C5C6C7C8T1CICVIITIPedicleTransition innomenclatureof nervesT2

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Fig. 2.64 Normal appearance of the back. A. In women. B. In men.

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Fig. 2.65 Normal curvatures of the vertebral column.

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Fig. 2.66 Back of a woman with major palpable bony landmarks indicated.

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Spine of scapulaInferior angle of scapulaMedial border of scapulaPosition of externaloccipital protuberancePosterior superior iliac spineIliac crest

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Fig. 2.67 The back with the positions of vertebral spinous processes and associated structures indicated. A. In a man. B. In a woman with neck flexed. The prominent CVII and TI vertebral spinous processes are labeled. C. In a woman with neck flexed to accentuate the ligamentum nuchae.

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Tip of coccyxSII vertebral spinous processTXII vertebral spinous processTVII vertebral spinous processTIII vertebral spinous processTI vertebral spinous processRoot of spine of scapulaInferior angle of scapulaHighest point of iliac crestIliac crestSacral dimpleCVII vertebral spinous processCII vertebral spinous processPosition of externaloccipital protuberanceLIV vertebral spinous processA

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Fig. 2.68 Back with the ends of the spinal cord and subarachnoid space indicated. A. In a man.

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Back with the ends of the spinal cord and subarachnoid space indicated. B. In a woman lying on her side in a fetal position, which accentuates the lumbar vertebral spinous processes and opens the spaces between adjacent vertebral arches. Cerebrospinal fluid can be withdrawn from the subarachnoid space in lower lumbar regions without endangering the spinal cord.

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Tip of coccyxSII vertebral spinous processTXII vertebral spinous processInferior end of spinal cord(normally betweenLI and LII vertebra)Inferior end ofsubarachnoid spaceALIV vertebral spinous process

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LIV vertebral spinous processNeedleLV vertebral spinous processTip of coccyxB

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Fig. 2.69 Back muscles. A. In a man with latissimus dorsi, trapezius, and erector spinae muscles outlined.

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Back muscles. B. In a man with arms abducted to accentuate the lateral margins of the latissimus dorsi muscles. C. In a woman with scapulae externally rotated and forcibly retracted to accentuate the rhomboid muscles.

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Fig. 2.70 MRI of the lumbar spine reveals posterior herniation of the L2-3 disc resulting in compression of the cauda equina filaments.

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Table 2.1 Superficial (appendicular) group of back muscles

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Table 2.2 Intermediate (respiratory) group of back muscles

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Table 2.3 Spinotransversales muscles

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Table 2.4 Erector spinae group of back muscles

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Table 2.5 Transversospinales group of back muscles

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Table 2.6 Segmental back muscles

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Table 2.7 Suboccipital group of back muscles

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In the clinic

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Spina bifida is a disorder in which the two sides of vertebral arches, usually in lower vertebrae, fail to fuse during development, resulting in an “open” vertebral canal (Fig. 2.24). There are two types of spina bifida.

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The commonest type is spina bifida occulta, in which there is a defect in the vertebral arch of LV or SI. This defect occurs in as many as 10% of individuals and results in failure of the posterior arch to fuse in the midline. Clinically, the patient is asymptomatic, although physical examination may reveal a tuft of hair over the spinous processes.

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The more severe form of spina bifida involves complete failure of fusion of the posterior arch at the lumbosacral junction, with a large outpouching of the meninges. This may contain cerebrospinal fluid (a meningocele) or a portion of the spinal cord (a myelomeningocele). These abnormalities may result in a variety of neurological deficits, including problems with walking and bladder function.

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In the clinic

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Vertebroplasty is a relatively new technique in which the body of a vertebra can be filled with bone cement (typically methyl methacrylate). The indications for the technique include vertebral body collapse and pain from the vertebral body, which may be secondary to tumor infiltration. The procedure is most commonly performed for osteoporotic wedge fractures, which are a considerable cause of morbidity and pain in older patients.

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Osteoporotic wedge fractures (Fig. 2.25) typically occur in the thoracolumbar region, and the approach to performing vertebroplasty is novel and relatively straightforward. The procedure is performed under sedation or light general anesthetic. Using X-ray guidance the pedicle is identified on the anteroposterior image. A metal cannula is placed through the pedicle into the vertebral body. Liquid bone cement is injected via the cannula into the vertebral body (Fig. 2.26). The function of the bone cement is two-fold. First, it increases the strength of the vertebral body and prevents further loss of height. Furthermore, as the bone cement sets, there is a degree of heat generated that is believed to disrupt pain nerve endings. Kyphoplasty is a similar technique that aims to restore some or all of the lost vertebral body height from the wedge fracture by injecting liquid bone cement into the vertebral body.