Human Anatomy Synopsis Spine PDF

GERARD GORNIAK &

WILLIAM CONRAD
HUMAN ANATOMY
SYNOPSIS: SPINE
AND NECK
Download free eBooks at bookboon.com

2
Human Anatomy Synopsis: Spine and Neck
1st edition
© 2018 Gerard Gorniak & William Conrad & bookboon.com
ISBN 978-87-403-2040-4
Peer reviewers:
Dr. Ed Kane, the University of St Augustine San Diego
Dr. Hilmir Augustsson, University of St Augustine Miami

3
HUMAN ANATOMY SYNOPSIS:
SPINE AND NECK Contents
CONTENTS
Preface 6
1 Osteology 7
1.1 Spinal column 7
1.2 Characteristics of vertebrae 8
1.3 Differences among vertebrae 11
2 Vertebral joints and ligaments 16

2.1 Vertebral joints 16
2.2 Vertebral ligaments 22
3 Vertebral blood supply 29

Click on the ad to read more
4
SPINE AND NECK Contents
4 Spinal Nerves 32
4.1 Nerve composition 32
4.2 Spinal nerve configuration 34
4.3 Dermatomes 36
4.4 Spinal nerve injuries 36
4.5 Facet joint and disc innervation 38
4.6 Autonomic nervous system 42
5 Muscles of the back 48

5.1 Superficial subdivision 48
5.2 Intermediate subdivision 52
5.3 Deep subdivision 53
5.4 Transversospinalis group 59
6 The neck 71
6.1 Superficial anterior neck 72
6.2 Deep anterior neck 89
7 Study question answers 100
References 109

5
SPINE AND NECK PREFACE
PREFACE
This is one of a series of 4 Human Anatomy Synopses that are based on over 40 years of
Anatomy course notes used in the graduate education of health care professions. This series
started as a detailed content outline for a course developed for medical students back in
1983. Since that time, it has undergone many revisions and additions. In 2008 and 2014,
text and illustrations were reviewed and revised, and study sections were added throughout
the text. In 2017, the 4 Synopses were developed, and the text and illustrations formatted
to be used by students as a supplement to anatomy courses.
The 4 Human Anatomy Synopses in this series are: Spine and Neck, Axilla and Upper
Limb, Pelvic Girdle and Lower Limb, and Thorax, abdomen, and Pelvis. There are numerous
illustrations and Tables. Many of the Tables have clinical relevance. This SPINE AND NECK
SYNOPSIS contains the osteology and ligaments of the vertebral column, spinal nerves,
vertebral blood flow and nerve innervation, muscles of the spine, and the major striations in
the anterior and posterior lateral neck. In this Synopsis, major structures are CAPTILIZED.
This feature allows students to make a study outline by linking together these words under
each title or subtitle. After each content area, there are short answer Study Questions to
help students relate and apply the anatomy. The answers to these questions are included at
the end of the Notes.
These Synopses are only possible because of the works of the many anatomists and other
basic scientists as well as numerous clinicians who have contributed to our knowledge and
understanding of the human body. I am most grateful to them for sharing what they learned.
I am also grateful to the many students who over the years, have made comments and
suggestions about the content of this work. I am also grateful to Drs. Hilmir Augustsson,
Jeff Rot, Ed Kane, Sue Curfman, Jim Viti, and Mrs. Jackie Nelson and to the University
of St Augustine for Health Sciences for help with this publication.
This book is dedicated to all those people who have so generously donated their body to
science so that we may learn. Thank you for the unselfish gift of yourself to others. May
God bless you for your contribution to mankind.
Unless otherwise indicated, all materials on these pages are copyrighted. All rights reserved.
No part of these pages, either text or image may be used for any purpose other than personal
use. Therefore, reproduction, modification, storage in a retrieval system or retransmission,
in any form or by any means, electronic, mechanical or otherwise, for reasons other than
personal use, is strictly prohibited without prior written permission.

6
SPINE AND NECK OSTEOLOGY
1 OSTEOLOGY
1.1 SPINAL COLUMN

The spine or vertebral column consists of 7 cervical vertebrae in the neck, 12 thoracic
vertebrae in the chest region onto which the 12 pairs of ribs attach, 5 lumbar vertebrae in
the abdominal region, and the sacrum and coccyx in the pelvic region (Fig. 1-1).
The vertical alignment of these vertebrae produces the four main anterior-posterior curves
of the vertebral column.
1) In the neck, the cervical vertebral column is convex anteriorly. This curve is called
the CERVICAL LORDOSIS.
2) In the abdominal region, the lumbar part of the vertebral column is also convex
anteriorly forming the LUMBAR LORDOSIS.
3) In the chest region, the thoracic portion of the vertebral column is convex posteriorly.
This curve is called a KYPHOSIS.
4) In the pelvis, the sacrococcygeal component of the spine is convex posteriorly.

7
Fig. 1-1. Back: 1. Cervical spine. 2. Thoracic spine. 3. Lumbar spine.

4. Sacrum. 5. Coccyx. 6. Posterior arch of Atlas. 7. Spinous process of
C2. 8. Vertebra spinal prominence (C7). 9. Vertebral foramen.
10. Spinous processes. 11. Vertebral bodies. 12. Laminae. 13. Superior
articular processes. 14. Transverse processes. 15. Sacral ala. 16. Body
of sacrum (Modified from Gray, 1918).
1.2 CHARACTERISTICS OF VERTEBRAE

Each vertebra from the second cervical vertebra to the fifth lumbar may be divided into
anterior and posterior parts.
The ANTERIOR PART is ventral to the spinal cord and consists of the body of the vertebra.
The POSTERIOR PART is lateral and dorsal to the spinal cord and forms the vertebral arch.

8
The vertebral arch contains: 1) one SPINOUS PROCESS, 2) a right and left TRANSVERSE
PROCESS, 3) right and left LAMINAE between the spinous process and each transverse
process, 4) a right and left PEDICLE between the body and each transverse process, 5) two
SUPERIOR and two INFERIOR ARTICULAR PROCESSES, and 6) the SUPERIOR
and INFERIOR VERTEBRAL NOTCHES (Fig. 1-2).
The region between the superior and inferior articular processes is called the PARS
INTERARTICULARIS (Fig. 1-2). The pars interarticularis is the weakest part of the vertebral
arch and is a site commonly associated with a defect known as SPONDYLOLYSIS. This defect
is most common at L5 and can result in the L5 vertebra slipping anteriorly on the sacrum.
This forward slippage of a vertebra on the one below it is called SPONDYLOLISTHESIS.
Fig. 1-2. Back: TOP Drawing of A) superior view and BOTTOM lateral view to show
structures that are common to vertebrae from C3 to L5. (Modified from Gray, 1918).
The first cervical vertebra or the ATLAS has a posterior arch, a lateral mass bilaterally and
an anterior arch (Fig. 1-3). It does not have a body or a spinous process.
The POSTERIOR ARCH has a small POSTERIOR TUBERCLE rather than a spinous
process and a groove on its superior surface for the vertebral artery.
The LATERAL MASS lies between the posterior and anterior arches. Each lateral mass
contains a TRANSVERSE PROCESS, a TRANSVERSE FORAMEN, a TUBERCLE for
the intertransverse ligament, and SUPERIOR and INFERIOR ARTICUALR PROCESSES.

9
The short ANTERIOR ARCH has an ARTICULATION for the DENS of the axis (C2)
and an ANTERIOR TUBERCLE.
Fig. 1-3. Back – Image showing: The structural parts of the atlas in superior (A) and inferior
(B) view. The structural part of the axis in superior (C) and anterior (D) view. Radiograph (E)
with the mouth open showing a frontal view of the dens, atlas, axis and atlantoaxial joint. The
numbers relating to the atlas: 1. Anterior arch. 2. Anterior tubercle. 3. Vertebral foramen.
4. Posterior arch. 5. Transverse processes. 6. Superior articular facet. 7. Posterior tubercle.
8. Inferior articular facet. 9. Transverse foramen. The numbers relating to the axis: 10. Dens.
11. Body. 12. Superior articular facets. 13. Spinous process. 14. Inferior articular facets.
15. Transverse processes (Modified from Gray 1918).
The second cervical vertebra is called the AXIS.
It has a BODY, SPINOUS and TRANSVERSE PROCESSES, TRANSVERSE FORAMEN,

and SUPERIOR and INFERIOR ARTICULAR PROCESSES.

10
The body of the axis has a superior extension called the DENS or ODONTOID PROCESS
that articulates with the anterior arch of the atlas.
1.3 DIFFERENCES AMONG VERTEBRAE

Cervical, thoracic and lumbar vertebrae have distinct structural features that can be used
to differentiate them.
CERVICAL VERTEBRAE are characterized by a TRANSVERSE FORAMEN for the

VERTEBRAL ARTERY in each transverse process from C1-C6. This artery is a major
blood supply to the brain.
Fig. 1-4. Back: Image showing the structural parts of a cervical vertebra in superior (A)
and lateral (B) views (Modified from Gray, 1918). Radiographs of the cervical spine in
lateral (C) and frontal (D) view. The numbers indicate: 1. Vertebral body. 2. Transverse
processes. 3. Vertebral foramen. 4. Spinous process. 5. Anterior tubercle of transverse
process. 6. Posterior tubercle. 7. Superior articular facets. 8. Inferior articular facets.
9. Transverse foramen. 10. Inferior vertebral notch. 11. Pedicle. 12. Lamina. 13. Clavicle.
14. First rib.

11
THORACIC VERTEBRAE are distinguished by the COSTAL FACETS for the ribs
on the vertebral bodies and transverse processes for the COSTOVERTEBRAL and
COSTOTRANSVERSE JOINTS respectively (Fig. 1-5). Compared to the cervical and
lumbar vertebrae, thoracic vertebrae have long and narrow spinous processes.
�e Graduate Programme
I joined MITAS because for Engineers and Geoscientists
I wanted real responsibili� www.discovermitas.com
Maersk.com/Mitas �e G
I joined MITAS because for Engine
I wanted real responsibili� Ma
Month 16
I was a construction Mo
supervisor ina const
I was
the North Sea super
advising and the No
Real work he
helping foremen advis
International
al opportunities
Internationa
�ree wo
work
or placements ssolve problems
Real work he
helping fo
International
Internationaal opportunities
�ree wo
work
or placements ssolve pr

12
Fig. 1-5. Back: Drawings showing the structural parts of a thoracic vertebra in superior (A)
and lateral (B) view (Modified from Gray, 1918) and a radiograph of the thoracic spine in frontal
view (C). Notice the articulation of the ribs with the body and transverse process. The numbers
in the image indicate: 1. Vertebral body. 2. Transverse processes. 3. Vertebral foramen.
4. Spinous process. 5. Pedicle. 5b. Laminae. 6. Costal tubercle facet. 7. Superior articular facet.
8. Inferior articular facet. 9. Costal facets on vertebral body. 10. Inferior intervertebral notch.
11. Heart. 12. Diaphragm. 13. Rib
LUMBAR VERTEBRAE are characterized by their large vertebral bodies, short and wide
spinous processes, and the absence of articular surfaces for the ribs and transverse foramen
(Fig. 1-6).

13
Fig. 1-6. Back: Drawings showing the structural parts of a lumbar vertebra in superior
(A) and lateral (B) view (Modified from Gray 1918). Radiographs of the lumbar spine and
sacrum in frontal (C) and lateral (D) view: 1. Vertebral body. 2. Transverse processes.
3. Vertebral foramen. 4. Spinous process. 5. Lamina. 6. Pedicle. 7. Superior articular facet.
8. Inferior articular facet. 9. Mammillary process. 10. Inferior intervertebral notch. 11. Pars
interarticularis. 12. Sacroiliac joints. 13. Sacrum, 14. Vertebral disc
The SACRUM develops from the fusion of 5 sacral vertebrae that are separated by intervertebral
discs during the first two decades of life (Fig. 1-7). Superiorly, the sacrum articulates with the
fifth lumber vertebra (L5), and inferiorly with the coccyx. On each side, it articulates with
the AURICULAR SURFACE and TUBEROSITY OF THE ILIUM at the SACROILIAC
JOINT. The sacrum is divided into anterior and posterior parts. Anteriorly, it consists of
the BASE, PROMONTORY, ALA, ANTERIOR SACRAL FORAMINA and the BODY.
Posteriorly, it contains the MEDIAN and LATERAL SACRAL CRESTS, the SUPERIOR

14
ARTICULAR PROCESSES, POSTERIOR SACRAL FORAMINA, the SACRAL HORNS

and SACRAL CANAL.
Fig. 1-7. Back: The structural parts of the sacrum and coccyx in anterior (Left) and posterior
(Right) view. 1. Superior articular facets. 2. Body. 3. Promontory of sacrum. 4. Sacral ala.
5. Anterior sacral foramina. 6. Posterior sacral foramina. 7. Cornua. 8. Coccygeal transverse
process. 9. Sacral hiatus. 10. Sacral tuberosity. 11. Articular surface for ilium. Ili = Iliacus,
La = Latissimus dorsi. Sa = Sacrospinalis. Mu = Multifidus. Gma. =Gluteus maximus. Pi.
360°
= Piriformis (Modified from Gray, 1918).
The small COCCYX (Fig. 1-7) is formed by the fusion of four COCCYGEAL VERTEBRAE
thinking
and is usually a single bony structure after age 30. Its superior-most aspect has two
TRANSVERSE PROCESSES and two HORNS or CORNUA extending cranially. The
middle and inferior regions of the coccyx have no transverse processes or cornua.
.
360°
thinking . 360°
thinking .
Discover the truth at www.deloitte.ca/careers Dis
© Deloitte & Touche LLP and affiliated entities.
Discover the truth at www.deloitte.ca/careers © Deloitte & Touche LLP and affiliated entities.
Deloitte & Touche LLP and affiliated entities.
Discoverfree
Download theeBooks
truth atatbookboon.com
www.deloitte.ca/careersClick on the ad to read more
15
SPINE AND NECK VERTEBRAL JOINTS AND LIGAMENTS
2 VERTEBRAL JOINTS
AND LIGAMENTS
2.1 VERTEBRAL JOINTS
2.1.1 ATLANTOAXIAL AND ATLANTO-OCCIPITAL JOINTS
The first cervical vertebra (atlas) and second cervical vertebrae (axis) have SUPERIOR
AND INFERIOR ARTICULAR FACETS. The body of the atlas is replaced in part by a
TRANSVERSE LIGAMENT that cradles the dens (Figs. 1-3; 1-13). The dens of the axis
articulates with the anterior arch of the atlas at the MEDIAN ATLANTOAXIAL JOINT
(Fig. 1-4). The inferior articular facets of the atlas and the superior facets of the axis form
the LATERAL ATLANTOAXIAL JOINTS. The superior articular facets of the atlas and
the occipital condyles of the skull form the ATLANTO-OCCIPITAL JOINTS.
2.1.2 FACET JOINTS
Each vertebra has superior and inferior articular facets forming SYNOVIAL FACET
JOINTS (Fig. 1-8) and an intervertebral disc between each vertebral body from the axis
to the lumbosacral joint.

16
Fig. 1-8. Back: Diagram showing a sagittal section of a facet joint, with articular
surfaces and menisci. 1. Superior articular process. 2. Spinous processes. 3. Inferior
articular process. 4. Intervertebral foramen. 5. Joint capsule. 7. inferior articular
process. 8. Inferior articular facet. 9. Caudal meniscus. 10. Superior articular facet.
11. Cephalad meniscus.
The ARTICULAR CARTILAGE of the facet joints is hyaline cartilage. The JOINT
CAPSULE is dense connective tissue containing mainly Type 1 collagen (Fig. 1-9). The
anterior part of the facet joint is adjacent to the elastic LIGAMENTUM FLAVUM which
attaches to the joint capsule (Fig. 1-9). The posterior part of the joint capsule is covered
by the MUTIFIDUS MUSCLE which also attaches to the joint capsule.

17
Fig. 1-9. Back. Drawing of a lumbar facet joint showing the capsule and at-
tachment of the multifidus muscle. 1. Superior articular process and facet,
2. Inferior articular process, 3. Joint capsule (cut in bottom left figure), 4. Mul-
tifidus muscle cut and reflected laterally, 5. Transverse process, 6. Superior
articular process, 7. Spinous process.
> Apply now
redefine your future

AxA globAl grAduAte
progrAm 2015
- © Photononstop
axa_ad_grad_prog_170x115.indd 1 19/12/13 16:36

18
2.1.3 COSTAL JOINTS
Thoracic vertebrae have articulations for the heads of the ribs on the lateral aspect of
the vertebral body (Fig. 1-5). These articular surfaces are called COSTAL FACETS or
DEMIFACETS. Vertebrae T1-T10 also have COSTAL TUBERCLE FACETS on the
transverse processes for the tubercle of the rib (Fig. 1-10). The articulation between the
head of the rib and the costal facets on the vertebral body is the COSTOVERTEBRAL
JOINT (Fig. 1-10). The articulation between the tubercle of the rib and the costal tubercle
facet on the transverse process is the COSTOTRANSVERSE JOINT (Fig. 1-10).
Fig. 1-10. Back: Image showing the ligaments supporting the costovertebral and
costotransverse joints in lateral (A) and superior (B) view. 1. Superior articular
process. 2. Superior articular facet of costovertebral joint. 3. Costal tubercle facet
of costotransverse joint. 4. Vertebral body. 5. Superior costotransverse ligaments.
6. Radiate ligaments. 7. Rib. 8. Costovertebral joint. 9. Intervertebral disc.
10. Costotransverse ligament proper. 11. Lateral costotransverse ligament. 12.
Spinous process. 13. Vertebral foramen. 14. Superior articular facet. 15. Costal
tubercle. (Modified from Gray 1918).

19
2.1.4 INTERVERTEBRAL JOINTS
The bodies of adjacent vertebrae also articulate forming a cartilaginous joint consisting of a
fibrocartilaginous intervertebral disc sandwiched between adjacent vertebral bodies (Fig. 1-11).
The disc itself has a fibrous outer ring called the ANNULUS FIBROSUS. The innermost
lamina of the annulus fibrosus surround a spherical- to oval-shaped gelatinous mass called
the NUCLEUS PULPOSUS (Fig. 1-11).
Fig. 1-11. Back: Photomicrograph of an intervertebral disc of a cadaver, showing the brownish
nucleus pulposus and white rings of the annulus fibrosus.
2.1.5 SACROILIAC JOINTS
The AURICULAR SURFACES of the sacrum and ilium form the SACROILIAC (SI)
JOINT (Fig. 1-12). The articular surfaces of the anterior joint are covered with hyaline
cartilage, but the posterior part has a fibrous connection between the two bones.

20
Fig 1-12. Back: Sacroiliac Joint (LEFT) Drawing of an oblique transverse section of the sacroiliac joint
(modified from Gray, 1918). (RIGHT) Photograph of an oblique sagittal section of the sacroiliac joint.
1. Sacrum, 2. Iliolumbar ligament, 3. Fibrous interosseous part of the joint, 4. Ilium, 5. Hyaline cartilage
part of the joint.
Excellent Economics and Business programmes at:
“The perfect start

of a successful,
international career.”
CLICK HERE
to discover why both socially
and academically the University
of Groningen is one of the best
places for a student to be
www.rug.nl/feb/education

21
2.2 VERTEBRAL LIGAMENTS

ATLANTOAXIAL and ATLANTO-OCCIPITAL LIGAMENTS (Fig. 1-13)
Anterior atlanto-occipital membrane connects the anterior arch of the atlas with the base
of the occipital bone and is continuous laterally with the atlanto-occipital joint capsule
Posterior atlanto-occipital membrane connects the posterior arch of the atlas with the
occipital bone and is continuous with the lateral atlanto-occipital ligament
Anterior atlanto-axial membrane connects the body of the axis to the anterior arch of
the atlas and is continuous with the capsule of the atlanto-axial joint
Posterior atlanto-axial membrane connects the posterior body of the axis to the posterior
arch of the atlas and is continuous with the capsule of the atlanto-axial joint
Lateral atlanto-occipital ligament connects the transverse process of the atlas with the
occipital bone and strengthens the atlanto-occipital joint

22
Fig. 1-13. Back. Images of (A) the cruciform and alar ligaments in posterior view with
the tectorial membrane removed and (B) a midsagittal view of the atlanto-axial (A/A)
joint showing the position of the posterior ligaments. 1. Tectorial membrane. 2. Superior
longitudinal ligament of cruciform (retracted). 3. Apical ligament. 4. Atlanto-occipital
(A/O) articular capsule. 5. Alar ligament. 6. Transverse ligament of atlas. 7. A/A articular
capsule. 8. Inferior longitudinal ligament of cruciform. 9. Posterior A/O membrane. 10.
Posterior arch of atlas (cut). 11. Posterior A/A membrane. 12. Spinous process of axis
(cut). 13. Ligamentum flavum. 14. Anterior longitudinal ligament. 15. Intervertebral
disc. 16. Anterior A/A membrane. 17. Dens (cut). 18. Anterior arch of atlas (cut).
(Modified from Gray 1918)
Tectorial membrane is the continuation of the posterior longitudinal ligament connecting

the posterior arch of the axis to the occipital bone and covering the cruciform, alar and
apical ligaments

23
Cruciform ligament consists of the transverse ligament of the atlas and extending
vertically from it the superior band attaching to the occipital bone and the inferior band
attaching to the body of the axis
Transverse ligament of the atlas cups the posterior surface of the dens and attaches to
the posterior surface of the anterior arch of the atlas on each side of the median atlanto-
axial joint
Alar ligaments (paired) attach to the sides and posterior surface of the dens and run
laterally with a superior band attaching to the occipital bone, a middle band attaching
to the lateral mass of the atlas and an inferior band attaching to the axis
Apical ligament lies anterior to the superior band of the cruciform ligament and connects
the apex of the dens to the occipital bone
DENMARK
Are you looking to further your cleantech career
in an innovative environment with excellent
IS HIRING work/life balance? Think Denmark!

Visit cleantech.talentattractiondenmark.com
“In Denmark you can find great engineering jobs and develop
yourself professionally. Especially in the wind sector you can learn
from the best people in the industry and advance your career in a
stable job market.”
Mireia Marrè,
Advanced Engineer from Spain.
Working in the wind industry in Denmark since 2010.

24
VERTEBRAL COLUMN LIGAMENTS (Fig. 1-14)
Fig 1-14. Back. Image showing the lateral view of the lumbar spine (A) with the major vertebral ligaments and
the superior view of a vertebra (B) showing the location of these ligaments relative to a vertebra. 1. Anterior
longitudinal ligament. 2. Intervertebral disc. 3. Posterior longitudinal ligament. 4. Ligamentum flavum. 5. Supras-
pinous ligaments. 6. Interspinous ligaments. 7. Anteromedial capsule of facet joint. 8. Intertransverse ligaments.
9. Superior articular process. 10. Inferior articular process. 11. Vertebral body. (Modified from Gray 1918)
Anterior longitudinal ligament attaches to the anterior rim of the vertebral bodies and
anterior aspect of the intervertebral disc as it runs from the sacrum to the atlas where it
is continuous with the anterior atlanto-occipital membrane
Posterior longitudinal ligament attaches to the posterior rim of the vertebral bodies
and posterior aspect of the intervertebral disc as it runs along the anterior surface of the
spinal canal from the sacrum to the axis where it (is) becomes the tectorial membrane
Ligamenta flava are paired segmental elastic ligaments that lie on the posterior aspect of the
spinal canal from the sacrum to the axis and interconnect the lamina of adjacent vertebrae
Supraspinous ligament attaches to the tips of the spinous processes from C7 where it is
continuous with the ligamentum nuchae to about L4 where it is replaced by the erector
spinae fascia
Interspinous ligaments interconnect the inferior and superior aspects of adjacent spinous
processes from C7 where the ligamentum nuchae arises to L5/S1
Ligamentum nuchae is a complex fibrous septum that runs along the posterior midline
of the neck from C7 to the occiput interconnecting the tips and superior and inferior
aspects of the cervical spinous processes to the occipital bone
Intertransverse ligament connects the transverse processes of adjacent vertebrae

25
SACROILIAC LIGAMENTS (Figs. 1-15, 1-16)
Fig. 1-15. Back. Images, in anterior (A) and posterior (B) view, showing the iliolumbar and
sacroiliac ligaments. 1. Anterior longitudinal ligament. 2. and 3. Iliolumbar ligament. 4. An-
terior sacroiliac (SI) ligament. 56. Sacrospinous ligament. 6. Sacrotuberous ligament. 7. Pubic
symphysis 8. Short dorsal SI ligaments. 9. Long dorsal SI ligament. 10. Continuation of Su-
praspinous ligament. (Modified from Gray 1918)
Iliolumbar ligament, which begins as a muscle but becomes ligamentous by age 40,
runs from the transverse process of L5 in males and L4-L5 in females to the superior SIJ
and ilium
Sacrotuberous ligament runs obliquely from the posterior surface of the posterior inferior
iliac spine, and posterolateral aspect of the lower sacrum and upper coccyx to the medial
aspect of the ischial tuberosity and the ramus of the ischium
Sacrospinous ligament runs obliquely from posterolateral surface of the lower sacrum
and coccyx to the ischial spine
Interosseous sacroiliac ligament connects the iliac and sacral tuberosities at the fibrosus
part of the SIJ
Short dorsal sacroiliac ligament runs horizontally from the dorsolateral aspect of the
superior part of the sacral tuberosity to the dorsal aspect of the tuberosity of the ilium
Long dorsal sacroiliac ligament runs obliquely from the dorsolateral aspect of the inferior
part of the sacral tuberosity and the dorsal surface of the sacrotuberous ligament to the
posterior superior iliac spine

26
Ventral sacroiliac ligament runs horizontally from the ventrolateral margin of the sacrum
to ventral aspect of the auricular surface of the ilium
Fig. 1-16. Back: Photographs of the (LEFT) ventral and (RIGHT) dorsal sacroiliac joint ligaments. 1. Sa-
crum, 2. Ventral sacroiliac ligaments, 3. Iliolumbar ligament, 4. Quadratus lumborum fibers attaching
to iliolumbar ligament, and 5. probe. Sacroiliac joint line, 6. Ilium, 7. Short dorsal sacroiliac ligaments,
8. Long dorsal sacroiliac ligament.
American online
LIGS University
is currently enrolling in the
Interactive Online BBA, MBA, MSc,
DBA and PhD programs:
▶▶ enroll by September 30th, 2014 and

▶▶ save up to 16% on the tuition!
▶▶ pay in 10 installments / 2 years
▶▶ Interactive Online education
▶▶ visit www.ligsuniversity.com to
find out more!
Note: LIGS University is not accredited by any

nationally recognized accrediting agency listed
by the US Secretary of Education.
More info here.

27
COSTAL LIGAMENTS (Fig. 1-10)
Radiate ligament stabilizes the costovertebral joint and extends from the body of the
vertebra to the head of the rib
Interarticular ligament stabilizes the costovertebral joint and extends from the crest of
the head of the rib to the intervertebral disc.
Superior costotransverse ligament stabilizes the costotransverse joint and extends from
the crest of the neck of the rib to the transverse process of the vertebra directly above
Costotransverse ligament proper stabilizes the costotransverse joint and extends from
the posterior neck of the rib to the adjacent transverse process
Lateral costotransverse ligament stabilizes the costotransverse joint and extends from
the tubercle of the rib to the tip of the adjacent transverse process
1- Study questions:
1) What structures are common to vertebrae?

2) What is the difference between the atlas and 5th cervical vertebra?
3) What is the difference between thoracic and lumbar vertebrae?
4) How are the costovertebral and costotransverse joints different?
5) What makes up the cruciform ligament?
6) What ligaments lie in the spinal canal?
7) What ligaments attach to the lumbar spinous process?

28
SPINE AND NECK VERTEBRAL BLOOD SUPPLY
3 VERTEBRAL BLOOD SUPPLY
Fig. 1-17. Back: Diagrams showing the arterial blood supply to a vertebra with arrows
showing direction of blood flow. (Modified from Bogduk, 1983).
SEGMENTAL ARTERIES provide the arterial blood supply to the vertebrae and the spinal
cord (Fig. 1-17). These arteries arise from the vertebral arteries, the deep cervical arteries and
the ascending cervical arteries, intercostal arteries, lumbar arteries and lateral sacral arteries.
A segmental artery gives divides into a VENTRAL and a DORSAL RAMUS ARTERY
(Fig. 1-17). Before the dorsal ramus artery reaches the paraspinal muscles, it give off a
SPINAL ARTERY that into an ANTERIOR and POSTERIOR RADICULAR ARTERY
(Fig. 1-17). The anterior radicular artery supplies the vertebral body, dura mater, spinal
nerve and communicates with the ANTERIOR SPINAL ARTERY of the spinal cord. The
posterior radicular artery supplies the vertebral arches, facet joints, dura mater, spinal nerve
and communicates with the POSTERIOR SPINAL ARTERIES of the spinal cord.

29
Fig. 1-18. Back: Diagrams showing the venous blood return from a vertebra with arrows showing
direction of outward blood flow. (Modified from Bogduk, 1983).

30
Veins draining the vertebrae are spinal canal are the ANTERIOR and POSTERIOR
INTERNAL VERTEBRAL PLEXUSES in the spinal canal, and ANTERIOR and
POSTERIOR EXTERNAL VERTEBRAL PLEXUSES on the outside of the vertebra (Fig.
1-18). The BASIVERTEBRAL VEIN drains the vertebral body into the anterior internal
plexus. Both internal vertebral sinuses connect with the ANTERIOR and POSTERIOR
LONGITUDINAL SINUSES that also lie in the spinal canal. The posterior external
vertebral plexus communicates with the posterior longitudinal sinuses and the anterior
external vertebral plexus connects to the anterior longitudinal sinuses. INTERVERTEBRAL
VEINS receive blood from both internal and external vertebral plexuses, and both anterior
and posterior longitudinal sinuses. The intervertebral vein passes through the intervertebral
foramen and drains into segmental vertebral veins.
Vessels Blocked Vessels with Flow Reduced Areas Involved
Segmental A., Anterior and Posterior Spinous process, Lamina,
Dorsal Ramus A., Radicular A. Transverse processes, Pedicle,
Spinal A. Vertebral body
Anterior Radicular A. Branches off Anterior Vertebral body
Radicular A.
Posterior Radicular A. Branches off Posterior Spinous process, Lamina,
Radicular A. Transverse processes, Pedicle
Intervertebral V., Anterior Longitudinal Compression of Spinal Cord
Segmental V. Sinus from sinus dilation
Table 1-1. Vertebral Vascular Blockage and Nerve Lesions
2 – Study Questions:
1) What areas of the vertebra could be affected by blocking the spinal artery off the
dorsal ramus artery?
2) What areas of the vertebra could be affected by blocking the posterior radicular artery?
3) If venous output is reduced by blockage of the intervertebral vein, what venous
structures in the spinal canal could dilate and compress the spinal cord?

31
SPINE AND NECK SPINAL NERVES
4 SPINAL NERVES
4.1 NERVE COMPOSITION

Spinal nerves are part of the peripheral nervous system which extend outwardly to the
extremities, trunk, viscera, and head. Peripheral nerve are wrapped by an outer thick,
dense irregular connective tissue layer called the EPINEURIUM which penetrates the
nerve, dividing it into bundles of nerve fibers called FASCICLES. The connective tissue
surrounding fascicles is the PERINEURIUM. From the perineurium extends a delicate
layer of connective tissue called the ENDONEURIUM that wraps individual nerve fibers
located within each fascicle (Fig. 1-19).
Fig. 1-19. Nerve: A) Photomicrograph of a cross-section of two peripheral nerves show-

ing its connective tissue jacket of epineurium and its perineurium lying between the
nerve fascicles. B) High magnification of a nerve showing individual nerve fibers sepa-
rated by endoneurium.

32
The nerve fibers contained in peripheral nerves have different functions (Table 1-2):
• SENSORY or AFFERENT FIBERS carry signals from the periphery to the central
nervous system.
• MOTOR or EFFERENT FIBERS carry signals from the central nervous system
to the periphery.
• GENERAL SOMATIC AFFERENT and GENERAL SOMATIC EFFERENT
nerve fibers innervate the skin, skeletal muscle, connective tissues and joints.
• GENERAL VISCERAL AFFERENT and GENERAL VISCERAL EFFERENT
nerve fibers innervate the thoracic, abdominal and pelvic organs, cardiac and smooth
muscles, and blood vessels.
www.sylvania.com
We do not reinvent
the wheel we reinvent
light.
Fascinating lighting offers an infinite spectrum of
possibilities: Innovative technologies and new
markets provide both opportunities and challenges.
An environment in which your expertise is in high
demand. Enjoy the supportive working atmosphere
within our global group and benefit from international
career paths. Implement sustainable ideas in close
cooperation with other specialists and contribute to
influencing our future. Come and join us in reinventing
light every day.
Light is OSRAM

33
4.2 SPINAL NERVE CONFIGURATION

A spinal nerve is formed by the union of a DORSAL ROOT that contains sensory (afferent)
input to that level of the spinal cord and a VENTRAL ROOT that contains motor (efferent)
output from that spinal level (Figs. 1-20, 1-21).
Spinal nerve divide distally into rami containing motor, sensory and visceral nerve fibers
(Figs. 1-20, 1-21). The DORSAL RAMI innervate the deep muscles and joints of the spine
and the skin of the back and the VENTRAL RAMI innervate the structures of the anterior
neck, the upper limb through the brachial plexus, thoracic wall through the intercostals
nerves, and the abdominal wall and lower limb through the lumbar and sacral plexuses.
Fig. 1-20. Spinal Nerve: 1. Dorsal root sensory ganglion, 2. Sensory dorsal horn
of the spinal cord, 3. Motor ventral horn of the spinal cord, 4. Sensory dorsal
root, 5. Motor ventral root, 6. Spinal nerve, 7. Dorsal ramus, 8. Ventral ramus,
9. White and gray rami, and 10. Sympathetic chain ganglion of the visceral
autonomic nervous system.

34
Fig. 1-21. Nerve: Diagram of a cross-section of the spinal cord showing the general somatic afferent
(GSA) and efferent (GSE) and general visceral efferent (GVE) components of the spinal nerve. The
general visceral afferents (GVA) are not shown but these run with the general somatic afferents.

35
4.3 DERMATOMES
The sensory innervations of the skin of the body can be mapped by the distribution of the
spinal nerves which are called DERMATOMES and by the distribution of peripheral nerves
(Fig. 1-22). These sensory distributions are useful in diagnosing neuromusculoskeletal problems.
Figure 1-22. Nerve: The drawing shows the dermatome and peripheral nerve innervation of the body. The
figure on the viewer’s left is a ventral view and the one on the right is a dorsal view. The left side of each
image names the dermatomes; the right side numbers the peripheral nerves.
4.4 SPINAL NERVE INJURIES (REFER TO FIG. 1-21; TABLE 1-3)

• DORSAL ROOT INJURY (lesion) may result in impaired sensation along the
distribution of its spinal nerve but no clinically detectable motor loss.
• VENTRAL ROOT INJURY may result in motor impairment along the distribution
of its spinal nerve but no sensory loss.
• SPINAL NERVE INJURY may result in varying sensory and motor impairment
along the distribution of the spinal nerve.

36
• DORSAL RAMUS INJURY may result in varying sensory and motor impairment
to the structures innervated by that dorsal ramus, but no sensory or motor loss to
those structures innervated by the ventral ramus.
• VENTRAL RAMUS INJURY may result in varying sensory and motor impairment
to those structures innervated by that ventral ramus, but no sensory or motor loss
to those structures innervated by the dorsal ramus of the spinal nerve.

37
4.5 FACET JOINT AND DISC INNERVATION (FIG. 1-23)
Fig. 1-23. Back. Drawing of the innervations of the face joints and disc (modified from Paris, 1983;
Paris and Nyberg, 1989)
Fig. 1-24. Back. Line diagram showing the nerves to the facet joints and disc.

38
The facet joints of the lumbar spine are innervated by articular branches from the medial
division of the DORSAL RAMUS of the spinal nerve (Figs. 1-23, 1-24).
• LOCAL ARTICULAR BRANCH from the dorsal ramus innervates the facet joint
at the level of the spinal nerve.
• ASCENDING and DESCENDING ARTICULAR BRANCHES innervate the facet
joints above and below the level of the spinal nerve. Thus, each facet is innervated
by 3 spinal nerves: the spinal nerve at the level of the facet joint and the spinal
nerves above and below.
MEDIAL DIVISION OF THE DORSAL RAMI innervate the interspinous ligaments,

muscles medial to the facet joints and the periosteum of the vertebrae.
LATERAL DIVISION OF THE DORSAL RAMUS innervate muscles lateral to the facet
joints, vertebral periosteum and the skin of the back.
Brain power By 2020, wind could provide one-tenth of our planet’s

electricity needs. Already today, SKF’s innovative know-
how is crucial to running a large proportion of the
world’s wind turbines.
Up to 25 % of the generating costs relate to mainte-
nance. These can be reduced dramatically thanks to our
systems for on-line condition monitoring and automatic
lubrication. We help make it more economical to create
cleaner, cheaper energy out of thin air.
By sharing our experience, expertise, and creativity,
industries can boost performance beyond expectations.
Therefore we need the best employees who can
meet this challenge!
The Power of Knowledge Engineering
Plug into The Power of Knowledge Engineering.

Visit us at www.skf.com/knowledge

39
SINUVERTEBRAL NERVES travel up within the spinal canal (Figs. 1-23, 1-24).
• branches to the posterior and posterolateral surfaces of the annulus fibrosus,

• branches to the posterior longitudinal ligament and the ligamenta flava,
• braches to the anterior dura mater (meninges) and epidural blood vessels (Bogduk,
1983; Paris, 1983).
4.5.1 VERTEBRAL DISC INNERVATION
• POSTEROLATERAL ANNULUS FIBROSUS is innervated by branches from

ventral rami and gray rami communicans from sympathetic chain.
• LATERAL ANNULUS FIBROSUS is innervated by ascending and descending
branches from gray rami of sympathetic chain (Bogduk, 1983)
• ANTERIOR ANNULUS FIBROSUS and the ANTERIOR LONGITUDINAL
LIGAMENT are innervated by a branch from the sympathetic chain lying along
the anterolateral surface of the vertebral bodies (Bogduk, 1983).
• NUCLEUS PULPOSUS is not innervated.
4.5.2 NUMBERING SPINAL NERVE TO VERTEBRA
In the cervical region, the spinal nerves exit

above the matching numbered vertebra,
whereas in the thoracic and lumbar spines,
the nerves exit below the matching numbered
vertebra. The reason for this is simple. We have
eight spinal nerves in the cervical region, but
only seven cervical vertebrae as C1 exits above
the atlas.
For example the C7 nerve exits above the C7

vertebra. A lesion of the C7 nerve will affect
the facet joints at the levels of C6-7 (local), C5-
6, and C7-T1, as well as the discs at C5-6 and
C6-7. A lesion of the L2 spinal nerve will affect
the facet joints at L2-3 (local), L1-2, and L3-L4
and the discs at L2-3 and L1-2.

40
1) What is the function of the following nerve fibers:

a. GVE?
b. GSA?
c. GSE?
2) For each of the following, what is the nerve lesion:
a. Change in sensation and muscle weakness along the spine?
b. Change in sensation and muscle weakness in the arm?
c. Change in sensation and muscle weakness in the cervical paraspininal area
and arm?
d. Muscle weakness in the cervical paraspininal area and arm?
1) What structures would be affected with the following lesions:

C5 spinal nerve?
L3 spinal nerve?
Dorsal ramus of C6?
Dorsal ramus of L2?
2) What is the difference between a spinal nerve lesion and dorsal ramus lesion
relative to the facet and intervertebral disc?

41
4.6 AUTONOMIC NERVOUS SYSTEM

The AUTONOMIC NERVOUS SYSTEM (ANS) is an efferent (motor) system that controls
involuntary body functions, such as glandular secretion, changes in heart rate, the contraction
of smooth muscle in the intestines, and the dilation of peripheral arteries (Fig. 1-25).
• ANS has two divisions: PARASYMPATHETIC (craniosacral) and SYMPATHETIC

(thoracolumbar).
• Both divisions consist of a two GENERAL VISCERAL EFFERENT (GVE)
neuron chain.
• A PREGANGLIONIC neuron arises from the CNS and synapses in a GANGLION
with a POSTGANGLIONIC neuron that travels to the organ it innervates.
• PARASYMPATHETIC PREGANGLIONIC neurons division originate in brain
stem nuclei of cranial nerves and in the sacral (S2-S4) segments of the spinal cord.
○○ cranial nerve III (oculomotor N.) go to the eyes for visual reflexes, VII (facial
N.) and IX (glossopharyngeal N.) travel to visceral structures in the head, X
(vagus N.) go to visceral structures and organs in the neck, thorax and abdomen.
○○ S2-S4 spinal cord segments to the PELVIC SPLANCHNIC NERVES to the
rectum, pelvic organs and the external genitalia.
We will turn your CV into

an opportunity of a lifetime
Do you like cars? Would you like to be a part of a successful brand? Send us your CV on
We will appreciate and reward both your enthusiasm and talent. www.employerforlife.com
Send us your CV. You will be surprised where it can take you.

42
Fig. 1-25. Nerve: Schematic showing the sympathetic (LEFT) and parasympathetic (RIGHT)
innervations of the body.
• SYMPATHETIC PREGANGLIONIC neurons originate in the thoracic (T1-T12)

and upper two-three lumbar (L1-L3) segments of the spinal cord (Fig. 1-25).
○○ Preganglionic sympathetic nerve fibers leave the spinal cord through the ventral
root to enter the spinal nerve at the same level at which these originate (Fig. 1-21).
○○ Preganglionic fibers leave the spinal nerve through WHITE RAMUS
COMMUNICANS to enter the SYMPATHETIC CHAIN of GANGLIA that
lies along both sides of the vertebral bodies and extend from the neck and into
the pelvis (Figs. 1-21, 1-25).
○○ Preganglionic nerve fibers in the SYMPATHETIC CHAIN can synapse in a
chain ganglion.
○○ Postganglionic nerve fibers leave the chain to re-enter the spinal nerves for
distribution to the body through GRAY RAMUS COMMUNICANS at the
same level or at vertebral levels above or below (Figs. 1-21, 1-26).

43
○○ Pre-ganglionic fibers can also enter the sympathetic chain through a white
ramus from T1-T4 but postganglionic fibers exit the sympathetic chain directly
(rather than by a gray ramus) as the CERVICAL and THORACIC CARDIAC
NERVES (Fig. 1-26).
○○ Preganglionic nerve fibers can enter the sympathetic chain through a white ramus
but then leave the chain without synapsing in a sympathetic chain ganglion.
These preganglionic fibers enter THORACIC and LUMBAR SPLANCHNIC
NERVES and travel to a peripheral (prevertebral) ganglia outside of the sympathetic
chain where these synapses with a postganglionic neurons (Fig. 1-26). The
postganglionic nerve fibers leave the peripheral ganglion and innervate structures
in the abdomen and pelvis.
Fig. 1-26. Nerve: Diagram showing the sympathetic fibers leaving the thoracic spinal
cord and entering the sympathetic chain. Five different pathways are shown.

44
4.6.1 GENERAL SYMPATHETIC DISTRIBUTIONS
The distribution of the sympathetic nerves to the organs, glands and blood vessels of the
body show a regional innervation pattern (Fig. 1-25). This is important for assessing
lesions of the spinal cord and how these may affect the autonomic nervous system.
1) T1-T2 preganglionic sympathetic nerve fibers to postganglionic fibers to the head,

and neck.
2) T1-T4 preganglionic fibers to postganglionic fibers to the thorax and upper limb.
3) T5-T11 preganglionic fibers to postganglionic fibers to the viscera of the abdomen.
4) T12-L3 preganglionic fibers to postganglionic fibers to pelvic viscera and structures
in the lower limb (Westmoreland et al., 1994).
4.6.2 LESIONS OF THE AUTONOMIC NERVOUS SYSTEM
The autonomic nervous system is involved in regulates by AUTONOMIC REFLEXES

cardiopulmonary, cardiovascular, digestive, urinary, and reproductive functions and visual reflexes.
Join the best at Top master’s programmes

• 3
3rd place Financial Times worldwide ranking: MSc
the Maastricht University International Business
• 1st place: MSc International Business
School of Business and • 1st place: MSc Financial Economics
• 2nd place: MSc Management of Learning
Economics! • 2nd place: MSc Economics

• 2nd place: MSc Econometrics and Operations Research
• 2nd place: MSc Global Supply Chain Management and
Change
Sources: Keuzegids Master ranking 2013; Elsevier ‘Beste Studies’ ranking 2012;
Financial Times Global Masters in Management ranking 2012
Maastricht
University is
the best specialist
university in the
Visit us and find out why we are the best! Netherlands
(Elsevier)
Master’s Open Day: 22 February 2014
www.mastersopenday.nl

45
With spinal cord injuries, this regulatory function may be impaired depending on the level
of injury (Table 1-5).
Because the cell bodies of origin lie within the spinal cord for the sympathetic and part of
the parasympathetic divisions, only those cells at the level of injury will be involved and
only those autonomic reflexes located at that level will be impaired.
For example, a cervical spinal cord injury or a low lumbar (L4-L5) spinal injury will not
directly disrupt visceral reflexes from any of the preganglionic neurons of the ANS because
no cell bodies of the sympathetic and parasympathetic system originate at these spinal cord
levels. Thus, sympathetic and parasympathetic reflexes will be intact.
If the injury is in the upper thoracic spinal cord (T1-T2) then preganglionic sympathetic
neurons at that spinal cord level will be damaged. Autonomic reflexes to those structures
(i.e. head, neck, heart) innervated by the damaged segment will be impaired. Autonomic
reflexes to those structures below the injury (i.e. T-3-L-3 to the heart, lungs, upper and
lower limbs, abdominal and pelvic organs) will remain intact because their preganglionic
neurons are not damaged.
TABLE 1- 5

46
1) How do sympathetic fibers from the thoracic spinal cord enter the sympathetic chain?
2) How do sympathetic fibers from the sympathetic chain leave to enter a spinal nerve?
3) For the following spinal cord lesions, what autonomic division and region of the
body would be involved (example: sympathetic to upper limb):
a. C6?
b. T3?
c. L1?
d. S3?
Need help with your

dissertation?
Get in-depth feedback & advice from experts in your
topic area. Find out what you can do to improve
the quality of your dissertation!
Get Help Now
Go to www.helpmyassignment.co.uk for more info

47
SPINE AND NECK MUSCLES OF THE BACK
5 MUSCLES OF THE BACK
5.1 SUPERFICIAL SUBDIVISION

The superficial subdivision consists of 5 muscles that mainly produce movements at the
shoulder complex (Figs. 1-27. 1-28, 1-29). The most superficial are the TRAPEZIUS
and the LATISSIMUS DORSI. Deep to the trapezius are the other three muscles of
this superficial subdivision: the LEVATOR SCAPULAE, RHOMBOID MINOR, and
RHOMBOID MAJOR.
Fig. 1-27. Back Muscles: (LEFT) Drawing of the superficial back muscles and (RIGHT) diagram showing
the attachment sites of these muscles. 1a. Upper trapezius; 1b. Middle trapezius; 1c. Lower trapezius;
2. Deltoid; 3. Teres major, 4. Latissimus dorsi; 5. Thoraclumbar fascia, 6. Serratus posterior inferior, 7. Triceps,
8. Rhomboid major, 9. Rhomboid minor, 10. Levator scapulae, 11. Splenius cervicis, 12. Semispinalis
cervicis, 13. Splenius capitis, 14. Semispinalis capitis.
TRAPEZIUS (Figs. 1-27, 1-28).

• Medial Attachment (Origin): superior nuchal line of the occipital bone, external
occipital protuberance of the occipital bone, ligamentum nuchae, spinous processes
and supraspinous ligaments of C7 to T12
• Lateral Attachment (Insertion): posterior border of the lateral 1/3 of clavicle, anterior
border of the acromial process, anterior border of the entire spine of the scapula
• Nerve: spinal accessory (CN. XI; motor innervations) and C3, C4 (sensory
innervations)

48
○○ UPPER TRAPEZIUS: elevates and retracts the scapula, rotation of the glenoid
fossa upward, extends the head (both sides), laterally flexes the head (same side),
and rotates (opposite side) the head.
○○ MIDDLE TRAPEZIUS: retracts (adducts) the scapula
○○ LOWER TRAPEZIUS: depresses the scapula, rotation of the gleniod fossa upward
LATISSIMUS DORSI (Figs. 1-27, 1-28).

• Medial Attachment (Origin): spinous processes of T6 to T12, L1-L5 by thoracolumbar
fascia, base of the sacrum, iliac crest, and ribs 8-12, inferior angle of the scapula.
• Lateral Attachment (Insertion): floor of the intertubercular (bicipital) groove of
the humerus.
• Nerve: thoracodorsal
• Actions: humeral adduction, humeral internal (medial) rotation, assists in humeral
extension and flexion depending on humeral position
Fig. 1-28. Back Muscles: Photograph of the superficial back. 1a. Upper trapezius, 1b. Mid-
dle Trapezius, 1c. Lower trapezius, 2. Deltoid, 3. Teres major, 4. Latissimus dorsi, 5. Thora-
columbar fascia, 6. Infraspinatus, 7. Sternocleidomastoid, 8. Splenius capitis.

49
LEVATOR SCAPULAE (Figs. 1-27, 1-29).

• Medial Attachment (Origin): transverse processes of C1 to C4
• Lateral Attachment (Insertion): medial border of the scapula from the superior
angle to the root of the spine of the scapula
• Nerve: dorsal scapular, C3, C4
• Actions: elevates the scapula, rotation of the gleniod fossa downward; extends the neck
(both sides), laterally flexes the neck (same side), and rotates the neck (same side).
RHOMBOID MINOR (Figs. 1-27, 1-29).

• Medial Attachment (Origin): lower ligamentum nuchae, spinous processes and
supraspinous ligament of C7-T1
• Lateral Attachment (Insertion): medial border of the root of the spine of the scapula
• Nerve: dorsal scapular
• Actions: retracts the scapula, assists in elevation of the scapula
RHOMBOID MAJOR (Figs. 1-27, 1-29).

• Medial Attachment (Origin): spinous processes and supraspinous ligament of T2-T5
• Lateral Attachment (Insertion): lower medial border of the scapula from the root
of the spine to the inferior angle
• Nerve: dorsal scapular
• Actions: retracts the scapula, rotation of the glenoid fossa downward

50
This e-book
is made with SETASIGN
SetaPDF
PDF components for PHP developers
www.setasign.com

51
Fig. 1-29. Back Muscles: Photographs of the upper back region. Figure B is a closer view
of Figure A. 1. Trapezius, 2. Spinal Accessory nerve, 3. Levator scapula, 4. Rhomboid minor,
5. Rhomboid major, 6., Thoracolumbar fascia, 7. Latissimus dorsi, 8. Teres major, 9. Infraspinatus,
10. Sternocleidomastoid, 11. Splenius capitis, 12. Ligamentum nuchal, 13. Semispinalis capitis,
14. Serratus posterior superior
5.2 INTERMEDIATE SUBDIVISION

The intermediate subdivision contains the SERRATUS POSTERIOR SUPERIOR and the
SERRATUS POSTERIOR INFERIOR muscles. Both muscles are thin and rectangular in
shape and extend from the ribs to the vertebral column.
SERRATUS POSTERIOR SUPERIOR (Figs. 1-27, 1-29)

• Medial Attachment (Origin): caudal part of ligamentum nuchae, spinous processes
of C7-T3
• Lateral Attachment (Insertion): ribs 2-4 or 5
• Nerve: intercostal nerves T2-T4
• Actions: elevates upper ribs during ventilation

52
SERRATUS POSTERIOR INFERIOR (Fig. 1-27).

• Medial Attachment (Origin): spinous processes of T11-L2 or L3
• Lateral Attachment (Insertion): ribs 9-12
• Nerve: intercostal nerves T9-T11
• Actions: depresses lower ribs during ventilation
5.3 DEEP SUBDIVISION
5.3.1 SPLENIUS GROUP
SPLENIUS CAPITIS (Figs. 1-27, 1-28, 1-29, 1-30, 1-31, 1-32)

• Medial Attachment (Origin): ligamentum nuchae, spinous processes C7-T3 or T4
• Lateral Attachment (Insertion): mastoid process, posterolateral aspect of occipital
bone
• Nerve: dorsal rami of C4-C8
• Segmental Innervation: C4-C8
• Actions: extends (both sides), rotates (same side), laterally flexes (same side) the head
SPLENIUS CERVICIS (Fig. 1-27, 1-30, 1-31, 1-32)
• Medial Attachment (Origin): spinous processes of T3-T6

• Lateral Attachment (Insertion): transverse processes of C1-C3 or C4
• Nerve: dorsal rami C4-C8
• Segmental Innervation: C4-C8
• Actions: extends (both sides), rotates (same side), and laterally flexes (same side)
the cervical spine.
5.3.2 ERECTOR SPINAE GROUP
This group consists of the ILIOCOSTALIS, LONGISSIMUS and SPINALIS muscle

complexes. Each complex contains multiple divisions that correspond to their location along
the vertebral column. In general, the iliocostalis complex forms the lateral most part of the
erector spinae, the spinalis complex is the most medial, and the longissimus complex lies
between them.

53
ILIOCOSTALIS LUMBORUM (Figs. 1-30, 1-32, 1-34 )

• Inferior Attachment (Origin): transverse processes of L1-L4, posterior iliac crest,
sacrum, thoracolumbar fascia
• Superior Attachment (Insertion): angles of ribs 6-12
• Nerve: dorsal rami of lumbar spinal nerves crossed by muscle.
• Actions: extends (both sides), laterally flexes (same side), rotates (same side) the
lumbar spine
ILIOCOSTALIS THORACIS (Figs. 1-30, 1-32, 1-34)

• Inferior Attachment (Origin): posterior aspects of ribs 6-12, middle layer of the
thoracolumbar fascia
• Superior Attachment (Insertion): posterior aspects of ribs 1-6 and transverse process
of C7
• Nerve: dorsal rami of thoracic spinal nerves crossed by muscle.
• Actions: extends (both sides), laterally flexes (same side) and rotates (same side)
the thoracic spine.

54
ILIOCOSTALIS CERVICIS (Figs. 1-30, 1-31, 1-32)

• Inferior Attachment (Origin): angles of ribs 3-6
• Superior Attachment (Insertion): transverse processes of C4-C6
• Nerve: dorsal rami of upper thoracic and lower cervical spinal nerves crossed
by muscle.
the cervical neck
Fig 1-30. Back Muscles: Drawing of the erector spinae group and the transver-
sospinalis group.1. Muscles of the suboccipital region, 2. Semispinalis cervicis,
3. Semispinalis thoracis, 4. Levator costorum, 5. Multifidus thoracis, 6. Quadratus
lumborum, 7. Multifidus lumborum, 8. Tendon of the erector spinae, 9. Iliocostalis
lumborum, 10. Longissimus thoracis, 11. Spinalis thoracis, 12. Iliocostalis thoracis,
13. Longissimus thoracis, 14. Iliocostalis cervicis, 15. Longissimus capitis, 16. Sem-
ispinalis capitis. (modified from Grays 1918)

55
Fig. 1-31. Back Muscles: Photograph of deep back muscles. 1. Trapezius, 2. Spinal accessory nerve, 3. Levator
scapula, 4. Serratus posterior superior, 5. Iliocostalis thoracis, 6. Longissimus thoracis, 7. Splenius cervicis,
8. Spinalis, 9. Semispinalis cervicis, 10. Longissimus cervicis, 11. Iliocostalis cervicis, 12. Latissimus dorsi, 13. Teres
major, 14. Rhomboid major, 15. Infraspinatus, 16. Deltoid, 17. Supraspinatus, 18. Trapezius, 19. Splenius capitis,
20. Greater occipital nerve, 21. Ligamentum nuchae, 22. Semispinalis capitis.

56
Fig. 1-32. Back Muscles: Diagram of the splenius, iliocostalis, longissimus, and spinalis muscles showing
attachments. 1. Splenius capitis. 2. Splenius cervicis. 3. Serratus post. superior 4. Ilicostalis cervicis.
5. Spinalis cervicis. 6. Iliocostalis thoracis. 7. Spinalis thoracis. 8. Iliocostalis lumborum. 9. Longissimus
capitis. 10. Longissimus cervicis. 11. Longissimus thoracis. 12. Longissimus lumborum.

57
LONGISSIMUS LUMBORUM (Fig. 1-32 )

• Inferior Attachment (Origin): posterior ilium, posterior superior iliac spine
• Superior Attachment (Insertion): dorsal aspect of transverse processes of L1-L5
the lumbar spine.
LONGISSIMUS THORACIS (Figs. 1-30, 1-31, 1-32, 1-34)

• Inferior Attachment (Origin): posterior medial iliac crest, posterior sacrum, spinous
processes of L3-S3
• Superior Attachment (Insertion): transverse processes of T1-T12; ribs 3-12
• Nerve: dorsal rami of lumbar and thoracic spinal nerves crossed by muscle.
• Actions: extends (both sides) and laterally flexes (same side) the lumbar spine;
laterally flexes thoracic spine.
LONGISSIMUS CERVICIS (Figs. 1-31, 1-32)

• Inferior Attachment (Origin): transverse processes T1-T4 or T5
• Superior Attachment (Insertion): transverse processes of C2-C6
• Nerve: dorsal rami of thoracic and cervical spinal nerves crossed by muscle.
• Actions: extends (both sides), laterally flexes (same side), rotates (same side) the
cervical spine
LONGISSIMUS CAPITIS (Figs. 1-30, 1-32)

• Inferior Attachment (Origin): transverse processes of T1-T5, articular processes
of C7-C4
• Superior Attachment (Insertion): mastoid process
by muscle.
• Actions: extends (both sides), laterally flexes (same side), and rotates (same side)
the head

58
SPINALIS THORACIS (Figs. 1-30, 1-32, 1-34)

• Inferior Attachment (Origin): spinous processes of T11-L2
• Superior Attachment (Insertion): spinous processes of T1-T8
• Action: extends thoracic spine
SPINALIS CERVICIS (Figs. 1-32, 1-33)

• Inferior Attachment (Origin): spinous processes of C7, ligamentum nuchae
• Superior Attachment (Insertion): spinous processes of C2 (axis)
• Nerve: dorsal rami of cervical spinal nerves crossed by muscle.
• Action: extends cervical spine
SPINALIS CAPITIS (medial portion of the semispinalis capitis)

• Inferior Attachment (Origin): transverse processes C7-T7, articular processes of
C4-C6
• Superior Attachment (Insertion): occipital bone between superior and inferior
nuchal lines.
by muscle.
• Action: extends the head
5.4 TRANSVERSOSPINALIS GROUP
SEMISPINALIS THORACIS (Figs. 1-30, 1-33)

• Inferior Attachment (Origin): transverse processes of T6-T10
• Superior Attachment (Insertion): spinous processes of T4-C6
• Actions: extends the thoracic spine; rotates (opposite side) thoracic vertebrae

59
SEMISPINALIS CERVICIS (Figs. 1-27, 1-30, 1-31, 1-33)

• Superior Attachment (Insertion): spinous processes of C5-C2
• Nerve: dorsal rami of upper thoracic and cervical spinal nerves crossed by muscle.
• Actions: extends (both sides), controls laterally flexion (opposite side), and rotates
(opposite side) the cervical spine
SEMISPINALIS CAPITIS (Figs. 1-27, 1-29, 1-30, 1-31, 1-33)

• Inferior Attachment (Origin): transverse processes of T7-C7; articular processes of
C6-C4
• Superior Attachment (Insertion): occipital bone between superior and inferior
nuchal lines
by muscle.
• Actions: extends (both sides), controls laterally flexion (opposite side), and rotates
(opposite side) the head

60
Fig. 1-33. Back Muscles: Diagram showing the 1a. Semispinalis capitis, 1b. Semispinalis
thoracis, 2. Semispinalis cervicis, 3 & 6. Multifidus lumborum, 4. Multifidus cervicis,
5. Levator costorum, 7a. Quadratus lumborum (iliocostal part), 7b. Quadratus lumborum
(iliotransverse part), 8a. rotators longi and 8b. brevi, 9. Intertransversarius, 10. Interspinalis.

61
Fig. 1-34. Back muscles: Transversospinal group. 1. Multifidus lumborum, 2.Tendon of the
erector spinae, 3. Horizontal fascial band, 4. Thoracolumbar fascia, 5. Dorsal rami of spinal
nerves, 6. Iliocostalis lumborum, 7. Longissimus thoracis, 8. External intercostal muscle,
9. Transverse process, 10. Levator costorum, 11. Intertransverse ligament, 12. Rotators
longus and brevis, 13. Spinalis thoracis, 14. Longissimus thoracis 15. Iliocostalis thoracis.

62
MULTIFIDUS LUMBORUM (Figs. 1-30, 1-33, 1-34)

• Inferior Attachment: mammillary process; lumbar superior articular process and lamina
• Superior Attachment: lumbar spinous processes and supraspinous ligament; facet
capsule and lamina
• Actions: extends (both sides), controls lateral flexion and rotates (opposite side)
the lumbar spine
MULTIFIDUS THORACIS (Fig. 1-30)

• Superior Attachment (Insertion): spinous processes of vertebrae 1-4 levels superior
to vertebrae of origin
• Actions: extends (both sides), controls lateral flexion, and rotates (opposite side)
the thoracic spine

63
MULTIFIDUS CERVICIS (Fig. 1-34)

• Inferior Attachment (Origin): articular processes of C4-C7
• Superior Attachment (Insertion): spinous processes of vertebrae 1–4 levels superior
to vertebrae of origin up to C2
• Nerve: dorsal rami of cervical spinal nerves crossed by muscle
• Actions: extends (both sides), controls lateral flexion, and rotates (opposite side)
the cervical spine
ROTATORES LONGI (Figs. 1-33, 1-34)

• Inferior Attachment (Origin): sacrum and transverse process from L5-C4
• Superior Attachment (Insertion): spinous process and lamina of vertebra two levels
superior to the vertebra of origin.
• Nerve: dorsal rami of spinal nerve crossed by the muscle.
• Action: rotates superior vertebra (opposite side)
ROTATORES BREVI (Figs. 1-33, 1-34)

• Inferior Attachment (Origin): transverse process from L5-C4
• Superior Attachment (Insertion): spinous process of vertebra one level superior to
the vertebra of origin
• Nerve: dorsal rami of spinal nerve crossed by muscle.
• Action: rotates superior vertebra (opposite side)
5.4.1 SEGMENTAL GROUP
INTERSPINALES (Fig. 1-33)

• Inferior Attachment (Origin): apex of the spinous process from C2-L5
• Superior Attachment (Insertion): apex of the spinous process of the vertebra one
level superior to vertebra of origin
• Nerve: dorsal ramus of spinal nerve crossed by muscle.
• Actions: extends vertebra, postural control.

64
INTERTRANSVERARIUS (Fig. 1-33)

• Inferior Attachment (Origin): transverse process from C2-L5
• Superior Attachment (Insertion): transverse process of the vertebra one level superior
to the origin
• Nerve: ventral ramus of lumbar nerve crossed by the muscle
• Actions: laterally flexes (same side) the lumbar spine, postural control
LEVATOR COSTARUM (Figs. 1-30, 1-33, 1-34)

• Superior Attachment (Origin): transverse process from C7-T11
• Inferior Attachment (Insertion): angle of rib directly below vertebra of origin
• Nerve: dosal ramus from C8-T11 spinal nerves
• Actions: raises ribs; extends (both sides), laterally flexes (same side) and rotates
(opposite side) the thoracic spine
5.4.2 QUADRATUS LUMBORUM MUSCLE
This rectangular muscle extends from the 12th rib to the iliac crest, forming part of the
posterior abdominal wall.
QUADRATUS LUMBORUM (Figs. 1-30, 1-33)

• Inferior Attachment (Origin): iliac crest lateral to erector spinae, iliolumbar ligament
• Superior Attachment (Insertion): medial aspect of rib12; transverse processes of L1-L4
• Nerve: ventral rami L1-L4
• Actions: extends (both sides), laterally flexes (same side), and controls lateral flexion
(opposite side) of the lumbar spine
5.4.3 SUBOCCIPITAL REGION
This region contains the RECTUS CAPITIS POSTERIOR MAJOR and MINOR, and the
OBLIQUUS CAPITIS SUPERIOR and INFERIOR that lie deep to the semispinalis capitis
and between the occipital bone of the skull and the second cervical vertebra. On each side of

65
the midline, the rectus capitis major, obliquus capitis superior and obliquus capitis inferior
form the SUBOCCIPITAL TRIANGLE (Figs. 1-35, 1-36). Crossing the of the suboccipital
triangle are the VERTEBRAL ARTERY on its way to the brain, the SUBOCCIPITAL
NERVE from C1 passes through the triangle to innervate the suboccipital muscles and the
GREATER OCCIPITAL NERVE from C2 for sensation to the posterior scalp.
RECTUS CAPITIS POSTERIOR MAJOR (Figs. 1-35, 1-36)

• Inferior Attachment (Origin): spinous process of axis
• Superior Attachment (Insertion): inferior nuchal line of occipital bone
• Nerve: suboccipital nerve
• Actions: extends (both sides) and rotates the head (same side)
�e Graduate Programme
I joined MITAS because for Engineers and Geoscientists
I wanted real responsibili� www.discovermitas.com
Maersk.com/Mitas �e G
I joined MITAS because for Engine
I wanted real responsibili� Ma
Month 16
I was a construction Mo
supervisor ina const
I was
the North Sea super
advising and the No
Real work he
helping foremen advis
International
al opportunities
Internationa
�ree wo
work
or placements ssolve problems
Real work he
helping fo
International
Internationaal opportunities
�ree wo
work
or placements ssolve pr

66
RECTUS CAPITIS POSTERIOR MINOR (Figs. 1-35, 1-36)

• Inferior Attachment (Origin): posterior tubercle of atlas
• Superior Attachment) (Insertion: inferior nuchal line of occipital bone medial to
rectus capitis posterior major
• Action: extends the head (both sides)
OBLIQUUS CAPITIS SUPERIOR (Figs. 1-35, 1-36)

• Inferior Attachment (Origin): transverse process of atlas
• Superior Attachment (Insertion): between superior and inferior nuchal line of
occipital bone lateral to rectus capitis posterior major
• Actions: laterally flexes the head (same side) and extends (both sides)
OBLIQUUS CAPITIS INFERIOR (Figs. 1-35, 1-36)

• Inferior Attachment (Origin): spinous process of the axis
• Superior Attachment (Insertion): transverse process of atlas
• Action: rotates the neck (same side)

67
Fig. 1-35. Back Muscles: Drawing to the suboccipital region showing muscles and
other important structure of this region. 1. Semispinalis capitis (cut), 2. Obliquus capitis
superior, 3. Vertebral artery, 4. Obliquus capitis inferior, 5. Longissimus capitis,
6. Splenius capitis, 7. Trapezius, 8. Transverse process of axis, 9. Posterior A/A
membrane, 10. Transverse processes of atlas, 11. Posterior A/O membrane, 12. Greater
occipital (C2) N. 13. Suboccipital (C1) N. 14. Rectus capitis posterior major, and
15. Rectus capitis posterior minor.
Figure 1-36. Back Muscles: Suboccipital region. 1. Splenius capitis, 2. Greater occipital nerve,
3. Semispinalis capitis, 4. Rectus capitis posterior minor, 5. Rectus capitis posterior major, 6. Ver-
tebral artery, 7. Obliquus capitis superior, 8. Obliquus capitis inferior, 9. Semispinalis cervicis.

68

69
6 – Study questions:
1) Which of the superficial back muscles move the scapula?

2) With a forced forward flexion of the head and neck, which muscles could be
stretched and possibly damaged?
3) If you have pain in the lateral aspect of the low back, which muscles would most
likely be involved?
4) What muscles would generate the following actions:
a. Rotation of the head to the right?
b. Side bending of the head and neck?
c. Extension of the lumbar spine?
d. Extension of the thoracic spine?
e. Side bending of the lumbar spine?
5) If a person has a spinal nerve or a dorsal ramus lesion at L4, what muscles would
be involved? What movements would be weak? How would these lesions affect
the facet joints and vertebral discs?
360°
thinking .
360°
thinking . 360°
thinking .
Discover the truth at www.deloitte.ca/careers Dis
© Deloitte & Touche LLP and affiliated entities.
Discover the truth at www.deloitte.ca/careers © Deloitte & Touche LLP and affiliated entities.
Deloitte & Touche LLP and affiliated entities.
Discoverfree
Download theeBooks
truth atatbookboon.com
www.deloitte.ca/careers
70
SPINE AND NECK THE NECK
6 THE NECK
REGIONS (Fig. 1-37)

• POSTERIOR PARASPINAL REGION consists of muscles lying along the cervical
vertebrae.
• SUPERFICIAL ANTERIOR NECK
○○ HYOID BONE (Fig. 1-38)
○○ SUPRAHYOID REGION is triangular region that is posterior and inferior to
the chin (Fig. 1-37).
○○ INFRAHYOID REGION is bordered by the HYOID bone superiorly, the
STERNUM inferiorly and the superior belly of the OMOHYOID muscle and
the STERNOCLEIDOMASTOID muscle on the side (Fig. 1-37).
○○ SUBMANDIBULAR REGION is bound by the inferior body of the MANDIBLE
superiorly, the ANTERIOR DIGASTRIC anteriorly, and the POSTERIOR
DIGASTRIC and STYLOHYOID posteriorly (Fig. 1-37)
○○ CAROTID TRIANGLE is bound by the POSTERIOR DIGASTRIC superiorly, the
superior belly of the OMOHYOID inferiorly, and STERNOCLEIDOMASTOID
muscle posteriorly (Fig. 1-37)
• DEEP ANTERIOR NECK lies on the anterior surface of the cervical spine
(Figs. 1-49, 1-51)
• POSTERIOR CERVICAL TRIANGLE lies above the clavicle and between the
trapezius and sternocleidomastoid muscles (Fig. 1-37)
Fig. 1-37. Neck: Drawing of the anterior neck and posterior cervical triangle.
(Modified from Gray 1918)

71
6.1 SUPERFICIAL ANTERIOR NECK
6.1.1 HYOID BONE
The hyoid bone is “U” – shaped (Fig. 1-38). The thick anterior portion is the BODY and
the sides curve posteriorly as GREATER HORNS and LESSER HORNS (cornua) The
body and horns of the hyoid provide attachment sites for the muscles of the suprahyoid
and infrahyoid region and for the extrinsic muscles of the tongue.
Fig. 1-38. Neck: Drawing of the superior aspect of the hyoid bone showing muscle
attachment sites.
6.1.2 MUSCLES IN THE SUPRAHYOID REGION
ANTERIOR BELLY OF THE DIGASTRIC (Figs. 1-39, 1-40)

• Anterior attachment (origin): Lower anterior margin of the internal surface of the
mandible (digastric fossa).
• Posterior attachment (insertion): Intermuscular tendon to the posterior belly of
the digastric.
• Nerve: Mylohyoid nerve from the trigeminal (V).
• Action: Depression and retraction the mandible; elevation and stabilization of the
hyoid bone.

72
MYLOHYOID (Figs. 1-39, 1-40)

• Lateral attachment (origin): Lower internal surface of the mandible along the
mylohyoid line.
• Medial attachment (insertion): Superior body of the hyoid.
• Nerve: Mylohyoid nerve from the inferior alveolar nerve off the mandibular division
of the trigeminal.
• Action: Elevation of the hyoid, floor of the mouth and tongue.
GENIOHYOID (Figs. 1-39, 1-40)

• Anterior attachment (origin): Inferior mental spine on the oral surface of the
anterior tip of the mandible.
• Posterior attachment (insertion): Body of the hyoid bone.
• Nerve: C1 through hypoglossal nerve.
• Action: Elevation and protrusion of the hyoid; elevation of the larynx; depression
of the mandible.
> Apply now
redefine your future

AxA globAl grAduAte
progrAm 2015
- © Photononstop
axa_ad_grad_prog_170x115.indd 1 19/12/13 16:36

73
Fig. 1-39. Neck: Diagram of the anterior and posterior bellies of the digastric, mylohyoid, and geniohyoid
showing their attachment sites
Fig. 1-40. Neck: Dissection of suprahyoid region and anterior neck. 1. Anterior digastric,
2. Mylohyoid, 3.Sternohyoid, 4. Sternothyroid, 5. Omohyoid, 6. Thyrohyoid, 7. Internal
jugular vein, 8. Posterior digastric tendon, 9. Submandibular gland, 10. Facial artery.

74
6.1.3 MUSCLES IN THE INFRAHYOID REGION
STERNOHYOID (Figs. 1-41, 1-42)

• Inferior attachment (origin): Medial end of the clavicle and manubrium of the sternum.
• Superior attachment (insertion): Body of the hyoid.
• Nerve: ansa cervicalis. (Figs. 1-42, 1-43, 1-44)
• Actions: Depression of the hyoid; assists in depression of the lower jaw.
STERNOTHYROID (Figs. 1-41, 1-42)

• Inferior attachment (origin): Posterior aspect of the manubrium of the sternum.
• Superior attachment (insertion): External surface of the thyroid cartilage along the
oblique line.
• Action: Depression of the thyroid cartilage and hyoid bone.
THYROHYOID (Figs. 1-41, 1-42)

• Inferior attachment (origin): External surface of the thyroid cartilage, superior to
attachment of the sternothyroid.
• Superior attachment (insertion): Inferior body and greater horn of the hyoid.
• Nerve: ansa cervicalis (Figs. 1-42, 1-43, 1-44)
• Actions: Depression of the hyoid; elevation of the thyroid cartilage.
OMOHYOID (Figs. 1-41, 1-42)

• Inferior attachment (origin):
○○ INFERIOR BELLY: near the suprascapular notch of the scapula;
○○ SUPERIOR BELLY: intermuscular tendon connecting the superior and inferior
bellies, superior of the clavicle
• Superior attachment (insertion):
○○ INFERIOR BELLY: intermuscular tendon connecting the superior and inferior
bellies, superior of the clavicle
○○ SUPERIOR BELLY: body of the hyoid.

75

• Actions: Depression and stabilization of the hyoid.
STERNOCLEIDOMASTOID (Figs. 1-41, 1-42, 1-44)

• Inferior attachment (origin):
○○ STERNAL HEAD: anterior aspect of the manubrium of the sternum;
○○ CLAVICULAR HEAD: superior surface of the medial part of the clavicle.
• Superior attachment (insertion): Mastoid process and lateral half of the superior
nuchal line of the occipital bone.
• Nerve: Spinal accessory nerve; C2 and C3 spinal nerves.
• Actions: Tilts head laterally to the ipsilateral side with concurrent rotation of the
head to the contralateral side and extension so that the chin points upward and away
(unilateral); extension of the head (bilateral); elevation of the sternum (bilateral).
Excellent Economics and Business programmes at:
“The perfect start

of a successful,
international career.”
CLICK HERE
to discover why both socially
and academically the University
of Groningen is one of the best
places for a student to be
www.rug.nl/feb/education

76
Fig. 1-41. Neck: Diagram of the 1. Sternohyoid, 2. Thyrohyoid, 3. Sternothyroid, 4. Su-

perior belly of omohyoid, 5. Inferior belly of omohyoid, 6. Stylohyoid 7. Sternal head of
sternocleidomastoid, 8. Clavicular head of sternocleidomastoid, and 9. Hyoglossus mus-
cles showing the attachment sites.

77
Fig. 1-42. Neck: Dissection of infrahyoid and carotid regions. 1. sternocleidomastoid, 2. Submandibular
gland, 3. Internal jugular vein, 4. Common carotid artery, 5. Ansa cervicalis, 6. Omohyoid,
7. Sternohyoid, 8. Sternohyoid, 9. Sternocleidomastoid, 10, Thyrohyoid, 11. Mylohyoid. M = Mandible.

78
Fig. 1-43 Neck: Diagram showing the ansa cervicalis and its innervations of the
infrahyoid muscles. Notice that a branch from the C1 spinal nerve joins the
hypoglossal Nerve (XII) to form the descending hypoglossal root of the ansa
cervicalis nerve loop. Branches from C2 and C3 spinal nerves join to form the
descending cervical root of the ansa.
DENMARK
Are you looking to further your cleantech career
in an innovative environment with excellent
IS HIRING work/life balance? Think Denmark!

Visit cleantech.talentattractiondenmark.com
“In Denmark you can find great engineering jobs and develop
yourself professionally. Especially in the wind sector you can learn
from the best people in the industry and advance your career in a
stable job market.”
Mireia Marrè,
Advanced Engineer from Spain.
Working in the wind industry in Denmark since 2010.

79
6.1.4 MUSCLES IN THE SUBMANDIBULAR REGION
ANTERIOR BELLY OF THE DIGASTRIC (Figs. 1-39, 1-40, 1-44)

SEE MUSCLES IN SUPRAHYOID REGION FOR DETAILS
POSTERIOR BELLY OF THE DIGASTRIC (Figs. 1-39, 1-44)

• Posterior attachment (origin): Mastoid notch medial to the mastoid process of the
temporal bone.
• Anterior attachment (insertion): Intermuscular tendon to the anterior belly of the
digastric; body and greater horn of the hyoid.
• Nerve: facial nerve (VII)
• Actions: Depression and retraction of the mandible with the anterior digastric;
retraction, elevation and stabilization of the hyoid.
MYLOHYOID (Figs. 1-39, 1-40, 1-42)

SEE MUSCLES IN SUPRAHYOID REGION FOR DETAILS
HYOGLOSSUS (Figs. 1-41, 1-44)

• Inferior attachment (origin): Superior surface of the body and greater horn of the
hyoid bone.
• Superior attachment (insertion): Inferior surface of the side of the tongue.
• Nerve: Hypoglossal nerve.
• Actions: Depression and retraction of the tongue.
STYLOHYOID (Figs. 1-41, 1-44)

• Superior attachment (origin): Styloid process of the temporal bone.
• Inferior attachment (insertion): Superior surface of the body of the hyoid.
• Nerve: Cervical branch of the facial nerve.
• Actions: Retraction and elevation of the hyoid.

80
Fig 1-44. Neck: Dissection of the submandibular region and carotid regions. 1. Subman-
dibular gland, 2. Anterior digastric, 3. Hyoglossus, 4. Hypoglossal and descending hypoglos-
sal nerves, 5. Ansa cervicalis, 6. Descending cervical nerve, 7. Internal jugular vein, 8.
Sternocleidomastoid, 9. Common carotid artery, 10. Posterior digastric tendon, 11. Stylo-
hyoid, 12. Facial artery.
1) What are the suprahyoid muscles and actions?

2) What forms the ansa cervicalis?
3) What muscles of the infrahyoid region would be affected by damage to the
ansa cervicalis?
4) What muscles form and lie in the submandibular triangle?

81
6.1.5 MAJOR SUPERFICIAL ANTERIOR NECK STRUCTURES
THYROID AND PARATHYOID GLANDS are in the infrahyoid region superficial to the
thyroid cartilage (Fig. 1-45). It consists of two lobes and embedded within the thyroid
lobes of the thyroid gland are the four small parathyroid glands.
American online
LIGS University
is currently enrolling in the
Interactive Online BBA, MBA, MSc,
DBA and PhD programs:
▶▶ enroll by September 30th, 2014 and

▶▶ save up to 16% on the tuition!
▶▶ pay in 10 installments / 2 years
▶▶ Interactive Online education
▶▶ visit www.ligsuniversity.com to
find out more!
Note: LIGS University is not accredited by any

nationally recognized accrediting agency listed
by the US Secretary of Education.
More info here.

82
Fig. 1-45. Neck: Thyroid Gland on the surface of the thyroid cartilage.
LARYNX is made up of a cartilaginous skeleton formed mainly by THYROID CARTILAGE,

CRICOID CARTILAGE, and ARYTENOID CARTILAGE (Figs. 1-45, 1-46, 1-47).
The thyroid cartilage connect hyoid bone by the THYROHYOID MEMBRANE
and MEDIAN THYROHYOID LIGAMENT and inferiorly to the trachea by the
CRICOTHYROID LIGAMENT.

83
Fig. 1-46: Drawings of (A) the cartilage skeleton of the of the larynx in the anterior, sagittal and posterior
views and (B) the membranes and ligaments of the larynx on anterior, oblique and sagittal views and the
vocalis ligament and muscle in sagittal view.

84
Fig.1-47. Neck: Sagittal dissections showing the tongue, pharynx and larynx. 1. Mandibular symphysis,
2. Genioglossus, 3. Geniohyoid, 4. Mylohyoid, 5. Body of hyoid bone, 6. Epiglottis, 7. Arytenoids cartilage,
8. Thyroid cartilage, 9. Vocal fold (true), 10. Cricoid cartilage, 11. Esophagus, 12. False vocal folds, 13. Vocalis
muscle, 14. Vocal ligament, T = Tongue, Ph = Oral pharynx.

85
6.1.6 MUSCLES AND INNERVATION OF THE LARYNX
The EXTRINSIC MUSCLES of the larynx that depress the entire larynx are the (1) omohyoid,
(2) sternohyoid, and (3) the sternothyroid. Those muscles that elevate the larynx are the
(1) stylohyoid, (2) anterior and posterior digastrics, (3) mylohyoid, and (4) geniohyoid. The
INTRINSIC MUSCLES that change the tension on the vocal folds, and change the size
and shape of the rima glottis are (1) the cricoarytenoid, (2) arytenoid (3) thyroarytenoid,
(4) vocalis and (5) the cricothyroid muscles.
The CRICOTHYROID muscle is innervated by the EXTERNAL LARYNGEAL NERVE

and all the other intrinsic muscles of the larynx by the RECURRENT LARYNGEAL
NERVE of the vagus (Fig. 1-48). Sensory innervation of the larynx is by the INTERNAL
LARYNGEAL NERVE (Fig. 1-48).
Fig, 1-48. Neck. Diagram of the innervation of the larynx.
COMMON CAROTID ARTERY divides into the INTERNAL CAROTID ARTERY

which is a major source of blood to the brain, and the EXTERNAL CAROTID ARTERY
(Figs. 1-49, 1-50) which branches extensively in the neck, face and oral cavity regions.

86
Fig. 1-49. Neck. Drawing (LEFT) of the common carotid artery and its branches in the superficial neck and (RIGHT)
the internal jugular connecting to the subclavian vein, forming the brachiocephalic vein.
www.sylvania.com
We do not reinvent
the wheel we reinvent
light.
Fascinating lighting offers an infinite spectrum of
possibilities: Innovative technologies and new
markets provide both opportunities and challenges.
An environment in which your expertise is in high
demand. Enjoy the supportive working atmosphere
within our global group and benefit from international
career paths. Implement sustainable ideas in close
cooperation with other specialists and contribute to
influencing our future. Come and join us in reinventing
light every day.
Light is OSRAM

87
INTERNAL JUGULAR VEIN The INTERNAL JUGULAR VEIN lies deep to the
sternocleidomastoid and joins the SUBCLAVIAN VEIN from the arm to form the
BRACHIOCEPHALIC VEIN (Figs. 1-49, 1-50). The right and left brachiocephalic veins
unite to form the SUPERIOR VENA CAVA
VAGUS NERVE (X cranial nerve) runs with the internal jugular vein and common carotid
artery in the carotid sheath (Fig. 1-50). It contains preganglionic parasympathetic visceral
motor and sensory fibers to the larynx (Fig. 1-48) and continues into the thorax and
abdomen to provide parasympathetic innervation to the viscera in these regions.
Fig 1-50. Neck: Dissection of anterior neck showing structures in the submandibular, carotid and
infrahyoid regions. 1. Stylohyoid, 2. Posterior digastric, 3. Hypoglossal nerve, 4. Internal carotid artery,
5. Vagus (X) nerve, 6. Internal jugular vein, 7. Common carotid artery, 8. Sternohyoid (cut),
9. Sternohyoid, 10. Sternothyroid, 11. Omohyoid (cut and reflected), 12. Thyrohyoid, 13. Superior
thyroid artery, 14. Anterior digastric, 15. Mylohyoid, 16. Facial artery. M= Mandible, SCM =
Sternocleidomastoid.

88
1) Which ligaments connect the thyroid and the cricoid cartilages?

2) Which muscle runs with the vocal ligament?
3) Damage to the external laryngeal nerve would affect which intrinsic muscle of the
larynx?
4) What would be impaired in the larynx with damage to the internal laryngeal nerve?
5) Where do the external and the internal carotid arteries go?
6) What two structures run with the common carotid artery in the neck?
7) What are innervated by the Vagus nerve?
6.2 DEEP ANTERIOR NECK

The deep anterior neck (Figs. 1-49, 1-51) contains the (1) SUBCLAVIAN ARTERY and
VEIN, (2) CERVICAL SYMPATHETIC TRUNK and (3) the LONGUS CAPITIS and
COLI MUSCLES.
SUBCLAVIAN ARTERY branches:
1) VERTEBRAL ARTERY which runs cranially through the transverse foramen of

the cervical vertebrae to supply the brain,
2) INTERNAL THORACIC ARTERY to the infrahyoid muscles and rib cage,
3) COSTOCERVICAL TRUNK to the first and second intercostal spaces and deep
paraspinal muscles of the neck,
4) THYROCERVICAL TRUNK branches:
• INFERIOR THYROID ARTERY to the thyroid gland and infrahyoid muscles
• SUPRASCAPULAR ARTERY to muscles in the scapular region
• TRANSVERSE CERVICAL ARTERY to muscles in the scapular region
• ASCENDING CERVICAL ARTERY to the longus capitis and coli and the
scalenus anterior, scalenus medius and posterior scalenus muscles.
CERVICAL SYMPATHETIC TRUNK is an extension of the sympathetic trunk found

in the thorax (Figs. 1-51, 1-52). It lies along the deep anterior muscles of the cervical
neck and has an INFERIOR, MIDDLE, and SUPERIOR CERVICAL GANGLIA These
sympathetic ganglia innervate the carotid body and sinus as well as glands and blood vessels
within head and neck region.

89
Fig. 1-51. Neck: Drawing of the anterior deep neck showing the muscle, nerves and arteries of this region.

90
Fig 1-52. Neck: Dissection showing the cervical sympathetic chain and the muscles in the deep
anterior neck. 1. Longus coli, 2. Vertebral bodies, 3. Vertebral artery, 4. Scalenus anterior, 5. Roots
and trunks of brachial plexus, 6. Scalenus medius, 7. Inferior sympathetic ganglion, 8. Sympathetic
trunk, 9. Superior sympathetic ganglion.

91
6.2.1 DEEP ANTERIOR NECK MUSCLES
LONGUS CAPITIS (Figs. 1-51, 1-53)

• Inferior attachment (origin): Anterior tubercle of the transverse process of vertebrae
C3-C6.
• Superior attachment (insertion): Basioccipital portion of the occipital bone.
• Nerve: C1, C2, C3 spinal nerves.
• Action: Flexion of the head.
LONGUS COLI- SUPERIOR OBLIQUE PORTION (Figs. 1-51, 1-52, 1-53)

• Inferior attachment (origin): Anterior tubercle of the transverse processes of C3-C5.
• Superior attachment (insertion): Anterior arch of the atlas.
• Nerve: C2-C7, (C8) spinal nerves.
• Action: Flexion of the neck

92
LONGUS COLI-INFERIOR OBLIQUE PORTION (Fig. 1-53)

• Inferior attachment (origin): Anterior surface of the bodies of vertebrae T1-T3.
• Superior attachment (insertion): Transverse processes of C5-C6.
• Action: Flexion of the neck.
LONGUS COLI-VERTICAL PORTION (Fig. 1-53)

• Inferior attachment (origin): Anterior surface of the vertebral bodies of C5-T
• Superior attachment (insertion): Anterior surfaces of the vertebral bodies of C2-C4.
• Action: Flexion of the neck.
Fig. 1-53. Neck: Diagram of the longus capitis

and longus colli muscles in the deep anterior
neck showing their attachment sites.
RECTUS CAPITIS ANTERIOR (Fig. 1-51)

• Inferior attachment (origin): Anterior surface of the transverse process of the atlas (C1)
• Superior attachment (insertion): Occipital bone, anterior to occipital condyle
• Nerve: C2, C3 spinal nerves.
• Actions: Flexion of the head

93
RECTUS CAPITIS LATERALIS

• Inferior attachment (origin): Transverse process of the atlas (C1)
• Superior attachment (insertion): Jugular process of the occipital bone
• Nerve: C2, C3 spinal nerves.
• Actions: Lateral flexion of the head.
1) What are the main branches directly off the subclavian artery in the deep anterior
neck?
2) Occlusion of the thyrocervical trunk would affect which arteries?
3) What two muscles in the deep neck flex the head?
4) What muscle group flexes the neck?
6.2.2 POSTERIOR CERVICAL TRIANGLE
Fig. 1-54. Neck: Diagram showing the boundaries of the posterior cervical triangle relative
to the regions of the anterior neck

94
6.2.3 BOUNDARIES
This region is bound anteriorly by the STERNOCLEIDOMASTOID, posteriorly by the

TRAPEZIUS, inferiorly by the CLAVICLE, and superiorly by the SUPERIOR NUCHAL
LINE of occipital bone (Fig. 1-54). The cervical fascia separates the posterior cervical
triangle into a SUPERFICIAL REGION (Fig. 1-55) and DEEP REGION (Fig. 1-56).
Brain power By 2020, wind could provide one-tenth of our planet’s

electricity needs. Already today, SKF’s innovative know-
how is crucial to running a large proportion of the
world’s wind turbines.
Up to 25 % of the generating costs relate to mainte-
nance. These can be reduced dramatically thanks to our
systems for on-line condition monitoring and automatic
lubrication. We help make it more economical to create
cleaner, cheaper energy out of thin air.
By sharing our experience, expertise, and creativity,
industries can boost performance beyond expectations.
Therefore we need the best employees who can
meet this challenge!
The Power of Knowledge Engineering
Plug into The Power of Knowledge Engineering.

Visit us at www.skf.com/knowledge

95
6.2.4 SUPERFICIAL POSTERIOR CERVICAL TRIANGLE
Fig. 1-55: Drawing of the superficial cervical triangle showing its contents. 1. lesser occipital N.,
2. greater auricular N. 3. greater occipital N., 4. spinal accessory N. 5. dorsal scapular N., 6.
supraclavicular N., 7. suprascapular N. 8. inferior belly of omohyoid, 9. transverse cervical N.,
10. sternocleidomastoid, 11. sternohyoid, 12. sternothyroid, 13. superior belly of omohyoid, 14.
hyoid bone, 15. cervical branch of facial N., 16. submandibular gland, 17. anterior digastric, 18.
mandibular branch of facial N. 19. masseter, and 20. parotid gland.
MUSCLES IN THE SUPERFICIAL POSTERIOR

CERVICAL TRIANGLE (Fig. 1-55)
• TRAPEZIUS
• STERNOCLEIDOMASTOID
• OMOHYOID
NERVES IN THE SUPERFICIAL POSTERIOR CERVICAL TRIANGLE (Fig. 1-55)

• SPINAL ACCESSORY NERVE to the trapezius,
• SUPRASCAPULAR NERVE to the supraspinatus and infraspinatus muscles,

96
• DORSAL SCAPULAR NERVE to the levator scapulae, rhomboid minor and major,
• MEDIAL, INTERMEDIATE, and LATERAL SUPRACLAVICULAR NERVES
to the skin over the medial, middle and lateral surfaces of the clavicle
• LESSER OCCIPITAL NERVE to the skin behind the ear
• GREATER AURICULAR NERVE to the inferior ear and the skin over the
mastoid process
• TRANSVERSE CERVICAL NERVE to the skin in the anterior neck region
6.2.5 DEEP POSTERIOR CERVICAL TRIANGLE
Fig. 1-56. Shoulder: Drawing of the deep posterior triangle showing its contents and the muscles
forming the floor of this region. 1. N. to sternocleidomastoid, 2. C2 nerve, 3. splenius cervicis,
4. C3 nerve, 5. spinal accessory N., 6. levator scapulae, 7. trapezius, 8. C4 nerve, 9. dorsal scapular
N., 10. scalenus medius, 11. long thoracic N., 12. C5 nerve, 13. suprascapular N., 14. superior
trunk, 15. inferior belly of omohyoid, 16. C6 nerve, 17. sternocleidomastoid (cut), 18. internal
jugular vein, 19. phrenic N., 20. scalenus anterior, 21. ansa cervicalis, 22. superior belly of
omohyoid, 23. sternohyoid, 24. external carotid artery,

97
MUSCLES IN THE DEEP POSTERIOR CERVICAL TRIANGLE (Fig. 1-56)

• SPLENIUS CAPITIS
• SPLENIUS CERVICIS
• LEVATOR SCAPULAE
• SCALENUS POSTERIOR
• SCALENUS MEDIUS
• SCALENUS ANTERIOR
NERVES IN THE DEEP POSTERIOR CERVICAL TRIANGLE (Figs. 1-56, 1-57)

• SPINAL ACCESSORY NERVE to the trapezius
• DORSAL SCAPULAR NERVE to innervate the levator scapulae and rhomboids;
• LONG THORACIC NERVE to the serratus anterior muscle;
• VENTRAL RAMI OF C5 AND C6 forming the SUPERIOR TRUNK OF THE
BRACHIAL PLEXUS
• VENTRAL RAMUS OF C7 forming the MIDDLE TRUNK OF THE
BRACHIAL PLEXUS
We will turn your CV into

an opportunity of a lifetime
Do you like cars? Would you like to be a part of a successful brand? Send us your CV on
We will appreciate and reward both your enthusiasm and talent. www.employerforlife.com
Send us your CV. You will be surprised where it can take you.

98
• VENTRAL RAMI OF C8 AND T1 forming the INFERIOR TRUNK OF THE

BRACHIAL PLEXUS
• SUPRASCAPULAR NERVE to the supraspinatus and the infraspinatus
• NERVE TO THE SUBCLAVIUS to the subclavius muscle
• PHRENIC NERVE from C3, C4 and C5 to the diaphragm
Fig. 1-57. Shoulder. Dissection of the supraclavicular part of the brachial plexus in the deep posterior cervical
triangle. 1. Scalenus medius, 2. C-5 ventral ramus, 3. C-6 ventral ramus, 4. Scalenus anterior, 5. Sternocleidomastoid,
6. Phrenic nerve, 7. Clavicle, 8. Transverse cervical artery and vein, 9. Lower trunk of brachial plexus, 10. Subclavian
artery, 11. Suprascapular nerve and artery, 12. Middle trunk of brachial plexus, 13. Upper trunk of brachial plexus.
1) What nerves in the superficial part of the posterior cervical triangle go to the skin?
2) What nerves in the deep part of the posterior cervical triangle innervate muscles?
3) What parts of the brachial plexus are in this region?

99
SPINE AND NECK STUDY QUESTION ANSWERS
7 STUDY QUESTION ANSWERS
1 – Study Questions
What structures are common to vertebrae?
A = Body, Spinous process, Transverse process, Lamina, Pedicle, Superior articular process of
the inferior vertebra, 2. inferior articular process of the upper vertebra, 3. superior articular
facet of the inferior vertebra, 4. inferior articular facet of the upper vertebra 5. menisci,
6. capsule.
What are the difference between the atlas and the 5th cervical vertebra?
A = Atlas has no vertebral body but an anterior arch with an articulation for the dens
and a posterior tubercle but no spinous process. Both have transverse processes, transverse
foramen, superior and inferior articular processes, and a posterior arch.
What are the differences between thoracic and lumbar vertebra?

A = Thoracic spinous processes are long and narrow but lumbar are short and wide, lumbar
bodies are larger than the thoracic bodies, thoracic vertebrae have costal facets on the body
and costal tubercle facets on the transverse process but lumbar vertebrae have no costal facets.
How are the costovertebral and costotransverse joints different?

A = The costovertebral joint is between the head of the rib and the costal facets of two adjacent
vertebrae, plus the intervening intervertebral disc. The costotransverse joint is between the
tubercle of the rib and the inferior aspect of the rib costal facet on the transverse process.
What makes up the cruciform ligament?

A = Superior longitudinal ligament, inferior longitudinal ligament, and transverse ligament
of the atlas.
What ligaments lie in the spinal canal?

A = Ligamentum flavum, posterior longitudinal ligament, tectorial membrane, cruciform ligament
What ligaments attach to the lumbar spinous process?

A = supraspinous, interspinous

100
What areas of the vertebra could be affected by blocking the spinal artery off the dorsal
ramus artery?
A = The spinal artery divides into the anterior and posterior radicular arteries. The areas
affected are: vertebral body (due to decreased flow in the anterior radicular artery) and the
vertebral arch formed by the pedicle, lamina, spinous process, transverse process and facet
joints (due to decreased flow in the posterior radicular artery).
What areas of the vertebra could be affected by blocking the posterior radicular artery?
A = See above. Other areas affected by decreased flow in the posterior radicular artery are
the dura mater, spinal nerves and spinal cord.
If venous output is reduced by blockage of the intervertebral vein, what venous structures
in the spinal canal could dilate and compress the spinal cord?
A = Anterior and posterior longitudinal sinuses, and anterior and posterior vertebral plexi.
Join the best at Top master’s programmes

• 3
3rd place Financial Times worldwide ranking: MSc
the Maastricht University International Business
• 1st place: MSc International Business
School of Business and • 1st place: MSc Financial Economics
• 2nd place: MSc Management of Learning
Economics! • 2nd place: MSc Economics

• 2nd place: MSc Econometrics and Operations Research
• 2nd place: MSc Global Supply Chain Management and
Change
Sources: Keuzegids Master ranking 2013; Elsevier ‘Beste Studies’ ranking 2012;
Financial Times Global Masters in Management ranking 2012
Maastricht
University is
the best specialist
university in the
Visit us and find out why we are the best! Netherlands
(Elsevier)
Master’s Open Day: 22 February 2014
www.mastersopenday.nl

101
What are the functions of the following nerve fibers, GVE, GSA, and GSE?
A = GVE are general visceral efferent nerves. These are motor innervation to smooth muscles
of the viscera and blood vessels and cardiac muscle. GVA are general visceral afferent nerves
that provide sensory innervation to visceral structures. GSE are general somatic efferent
nerves that are motor nerves to skeletal muscles. GSA are general somatic afferent and these
are responsible for mediating sensation from the skin, joints, and skeletal muscles (touch,
pressure, temperature, pain and proprioception).
For each of the following, what is the nerve lesion?

-- Change in sensation and a muscle weakness along the spine? A = Lesion of the
dorsal ramus.
-- Change in sensation and a muscle weakness in the arm? A = Lesion of the
ventral ramus.
-- Change in sensation and a muscle weakness in the cervical paraspinal area and arm?
A = Lesion of the spinal nerve. (cervical paraspinal region is dorsal ramus and the
arm is ventral ramus)
-- Muscle weakness in the cervical paraspinal area and arm? A = Lesion of the ventral root
What vertebral structures would be affected with the following lesions?
– C5 spinal nerve?
A = Spinal nerves contain four functional components, somatic afferent and efferent and
visceral afferent and efferent fibers. They split into ventral and dorsal rami and the sinuvertebral
nerves also arise from the spinal nerves within the spinal canal. Thus, a lesion of the spinal
nerve would affect the sinuvertebral nerve and the dorsal and ventral rami. It would affect:
a) sinuvertebral nerve innervation to the posterior and posterolateral surfaces of the annulus
fibrosus of C4/C5 and C3/C4, as well as the posterior longitudinal ligament, the ligamentum
flava, the anterior dura mater and epidural blood vessels in the region; b) dorsal ramus to
the facet joints of C4/5, C3/4, and C5/6, interspinous ligament and the periosteum of the
vertebrae and c) the anterior surface of the annulus fibrosus and the anterior longitudinal
ligament by branches of sympathetic chain at the spinal level.
-- L3 spinal nerve?
A = See answer above: The facet joints are L2/3, L3/4, and L4/5 and the discs are L2/3
and L3/4

102
-- Dorsal ramus of C6?

A = Facet joints of C4/C5, C5/6, and C6/7.
-- Dorsal ramus of L2?
A = Facet joints of L1/2, L2/3, and L3/4.
What is the difference between a spinal nerve lesion and dorsal ramus lesion relative
to the facet and intervertebral disc?
A. = A spinal nerve lesion impairs the vertebral disc at the level of the spinal nerve and above
and the facet joints at the level above and below the spinal nerve lesion. A dorsal ramus
lesion impairs only the facet joints at the level, above and below the spinal nerve lesion.
How do sympathetic fibers from the thoracic spinal cord enter the sympathetic chain?
A = Through the ventral root, spinal nerve and then the white ramus communicans.
How do sympathetic fibers from the sympathetic chain leave to enter a spinal nerve?
A = Through the gray ramus communicans to enter a spinal nerve.
For the following spinal cord lesions, what autonomic division and region of the body
would be involved (example: T1 = sympathetics to head, neck, heart):
-- C6? A = None
-- T3? A = Sympathetics to the thorax and upper limb
-- L1? A = Sympathetic to the pelvis and lower limb
-- S3? A = Parasympathetic to the pelvic organs
Which of the superficial back muscles move the scapula?
A = Trapezius, levator scapulae, and the rhomboids (latissimis dorsi if attached to the inferior
angle of the scapula)

103
With a forced forward flexion of the head and neck, which muscles could be stretched
and possibly damaged?
A = The extensor of the head and neck may be damaged with forced forward bending
(upper trapezius, splenius capitis and cervicis, semispinalis capitis and cervicis, iliocostalis
cervicis, longissimus capitis and cervicis, multifidus cervicis, spinal cervicis, interspinalis,
spinalis, SCM, rectus capitis major and minor, obliquus capitis inferior).
If you have pain in the lateral aspect of the low back, which muscles would most likely
be involved?
A = Quadratus lumborum, iliocostal lumborum, and latissimus dorsi
What muscles would generate the following actions?

A=
• Rotation of the head to the right? A = Left trapezius, left, sternocleidomastoid,
right splenius capitis, right longissimus capitis, left semispinalis capitis, right rectus
capitis posterior major, and right obliquus capitis inferior
• Side bending of the head and neck? A (head) = Sternocleidomastoid, upper, trapezius,
splenius capitis, longissimus capitis, and obliquus capitis superior. A (neck) = Splenius
cervicis, iliocostalis cervicis, longissimus cervicis, intertransversarius, scalenes, lev.
Scapulae, and trapezius
Need help with your

dissertation?
Get in-depth feedback & advice from experts in your
topic area. Find out what you can do to improve
the quality of your dissertation!
Get Help Now
Go to www.helpmyassignment.co.uk for more info

104
• Extension of the lumbar spine? A = Iliocostalis lumborum, multifidus, interspinalis,

quadratus lumborum
• Extension of the thoracic spine? A = Iliocostalis thoracis, longissimus thoracis,
semispinalis thoracis, multifidus, spinalis, and interspinalis.
• Side bending of the lumbar spine? A = Iliocostalis lumborum, multifidus,
intertransversarius, and quadratus lumborum, psoas major.
If a person has a spinal nerve or a dorsal ramus lesion at L4, what muscles would
be involved?
What movements would be weak?
How would these lesions affect the facet joints and vertebral discs?
A=
• If the dorsal ramus is involved, the iliocostalis lumborum, multifidus, rotatores

longi & brevi, and interspinalis.
• If the spinal nerve is involved, these same muscles plus the quadratus lumborum would
be affected. The weak movements would be extension, lateral flexion, and rotation.
• The facet joints at L3/L4, L4/5, and L5/S1 would be affected, but not the
intervertebral discs if the dorsal ramus is involved.
• If the spinal nerve is involved, then the same facets and the discs at L3/L4 and
L4/L5 would be affected.
What are the suprahyoid muscles and actions?
A = The anterior digastric which depresses and retracts the mandible and the mylohyoid
which elevates the hyoid and the floor of the mouth.
What forms the ansa cervicalis?

A = Descending hypoglossal which carries fibers from C1 and the descending cervical which
has fibers from C2-C3.
What muscles of the infrahyoid region would be affected by damage to the ansa cervicalis?
A = Sternohyoid, sternothyroid, thyrohyoid, omohyoid muscles.

105
What muscles form and lie in the submandibular triangle?

A = Anterior digastric which depresses and retracts the mandible, posterior digastric which
depresses and retracts the mandible and elevates and retracts the hyoid; stylohyoid which
elevates and retracts the hyoid; mylohyoid which elevates the hyoid and the floor of the
mouth; hyoglossus which depresses and retracts the tongue; and the middle pharyngeal
constrictor which squeezes food downward from the mouth to the esophagus.
Which ligaments connect the thyroid and the cricoid cartilages?
A = Median and lateral cricothyroid ligaments
Which muscle runs with the vocal ligament?

A = Vocalis muscle
Damage to the external laryngeal nerve would affect which intrinsic muscle of the larynx?
A = Cricothyroid muscle
What would be impaired in the larynx with damage to the internal laryngeal nerve?
A = Sensation of the larynx
Where does the internal carotid artery supply blood?

A = Brain
What two structures run with the common carotid artery in the neck?
A = Internal jugular V. and the vagus N.
What structures are innervated by the vagus nerve in the neck?

A = The recurrent laryngeal and external laryngeal nerves to the muscles of the larynx are
in this region as are the internal laryngeal nerve which is sensory to the larynx and sensory
nerves to the carotid sinus and body.

106
What are the main branches directly off the subclavian artery in the deep anterior neck?
A = Costocervical trunk, internal thoracic A., thyrocervical trunk, vertebral A.
Occlusion of the thyrocervical trunk would affect which arteries?

A = Inferior thyroid a., ascending cervical A., transverse cervical A., and suprascapular A.
(if it arises from the trunk and this varies).
What two muscles in the deep neck flex the head?

A = Flexion of head = longus capitis and rectus capitis anterior;
What muscle group flexes the neck?

A = flexion of the neck = longus colli group; excessive backward extension of the head and
neck might tear these flexors.
This e-book
is made with SETASIGN
SetaPDF
PDF components for PHP developers
www.setasign.com

107
What nerves in the superficial part of the posterior cervical triangle go to the skin?
A = Medial, intermediate, and lateral supraclavicular nerves (C3, C4; the skin over the
medial, middle and lateral surfaces of the clavicle), lesser occipital nerve (C2; skin behind
the ear), greater auricular nerve (C2, C3; inferior ear and the skin over the mastoid process)
and transverse cervical nerve (C2, C3; skin in the anterior neck region).
What nerves in the deep part of the posterior cervical triangle innervate muscles?
A = Motor nerves: a) Branches of C3 and C4 to levator scapulae; b) dorsal scapular
nerve to levator scapulae and rhomboids; c) long thoracic nerve to the serratus anterior;
d) suprascapular nerve off the superior trunk innervating supraspinatus and infraspinatus;
e) the nerve to the subclavius off the superior trunk of the brachial plexus; and f ) the
phrenic nerve to the diaphragm.
What major parts of the brachial plexus lie in the deep part of the posterior cervical
triangle?
here are considerable effects on the brachial plexus since the following structures are affected:
ventral rami of C5 and 6 to the superior trunk of the brachial plexus; ventral ramus of C7
to the middle trunk; and ventral rami of C8 and T1 to the inferior trunk

108
SPINE AND NECK REFERENCES
REFERENCES
Basmajian, J.V. Grant’s Method of Anatomy, (ed.8), William & Wilkins, Baltimore. 1971
Bogduk, N. The Innervation of the lumbar spine. Spine, 8:286, 1983.
Gray H. Gray’s Anatomy of the Human Body. (ed 20), Lea & Febiger, Philadelphia. 1918.
Gray H. and Goss C.M. Gray’s Aantomy of the Human Body. (ed 28), Lea & Febiger,
Philadelphia. 1966.
Hollingshead, W.H. and Rosse, C. Textbook of Anatomy. (ed. 4), Harper and Row Publ.,
Philadelphia. 1985.
Jenkins, D.B. Hollingshead’s Functional Anatomy of the Limbs and Back. (ed. 6), W.B.
Sanders, Philadelphia. 1991.
LeVangie, P.K and Norkin, C.C. Joint Structure and Function: A Comprehensive Approach.
(ed.5), F.A. Davis. 2011.
Moore K.L., Dalley A.F. Agur MR. Clinically Oriented Anatomy. (ed 7), Lippincott Williams
& Wilkins. 2013.
Nordin, M. and Frankel H. (eds.) Basic Biomechanics of the Musculoskeletal System. (ed.
4), Lippincott, Williams & Wilkins. 2012.
Paris, S.V. Anatomy as related to function and pain. Orthop Clin North Amer. 14:475–489,
1983.
Paris, S.V. and Nyberg, R. Innervation of the posterior lateral aspect of the lumbar
intervertebral disc. Inter Soc of the Lumbar Spine, Kyoto, Japan. 1989.
Ross, M.H. and Pawlina, W. Histology: A Text and Atlas. (ed.7), Lippincott, William &
Wilkins, Baltimore. 2015.

109

Human Anatomy Synopsis Spine PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Human Anatomy Synopsis Spine PDF

Uploaded by

Copyright:

Available Formats

﻿

GERARD GORNIAK &

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

2 Vertebral joints and ligaments 16

3 Vertebral blood supply 29

Download free eBooks at bookboon.com

5 Muscles of the back 48

7 Study question answers 100

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

1.1 SPINAL COLUMN

Download free eBooks at bookboon.com

Fig. 1-1. Back: 1. Cervical spine. 2. Thoracic spine. 3. Lumbar spine.

1.2 CHARACTERISTICS OF VERTEBRAE

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

The second cervical vertebra is called the AXIS.

It has a BODY, SPINOUS and TRANSVERSE PROCESSES, TRANSVERSE FORAMEN,

Download free eBooks at bookboon.com

1.3 DIFFERENCES AMONG VERTEBRAE

CERVICAL VERTEBRAE are characterized by a TRANSVERSE FORAMEN for the

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

ARTICULAR PROCESSES, POSTERIOR SACRAL FORAMINA, the SACRAL HORNS

© Deloitte & Touche LLP and affiliated entities.

Deloitte & Touche LLP and affiliated entities.

2.1 VERTEBRAL JOINTS

2.1.1 ATLANTOAXIAL AND ATLANTO-OCCIPITAL JOINTS

2.1.2 FACET JOINTS

Download free eBooks at bookboon.com

Download free eBooks at bookboon.com

> Apply now

redefine your future

axa_ad_grad_prog_170x115.indd 1 19/12/13 16:36

Download free eBooks at bookboon.com

2.1.3 COSTAL JOINTS

Download free eBooks at bookboon.com

2.1.4 INTERVERTEBRAL JOINTS

2.1.5 SACROILIAC JOINTS

Download free eBooks at bookboon.com

Excellent Economics and Business programmes at:

“The perfect start

Download free eBooks at bookboon.com

2.2 VERTEBRAL LIGAMENTS

Download free eBooks at bookboon.com

Tectorial membrane is the continuation of the posterior longitudinal ligament connecting

Download free eBooks at bookboon.com

IS HIRING work/life balance? Think Denmark!

Download free eBooks at bookboon.com

VERTEBRAL COLUMN LIGAMENTS (Fig. 1-14)

Intertransverse ligament connects the transverse processes of adjacent vertebrae

Download free eBooks at bookboon.com

SACROILIAC LIGAMENTS (Figs. 1-15, 1-16)

Download free eBooks at bookboon.com

▶▶ enroll by September 30th, 2014 and

Note: LIGS University is not accredited by any

Download free eBooks at bookboon.com

COSTAL LIGAMENTS (Fig. 1-10)

1) What structures are common to vertebrae?

Download free eBooks at bookboon.com

2 Vertebral joints and ligaments 16