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Imaging in
Jeffrey S. Ross, MD
Senior Associate Consultant
Neuroradiology Division
Department of Radiology
Mayo Clinic Arizona
Professor of Radiology
Mayo Clinic College of Medicine
Phoenix, Arizona
Bernard R. Bendok, MD, FAANS

Chair, Neurologic Surgery
William J. and Charles H. Mayo Professor
Professor of Neurosurgery, Radiology, and Otolaryngology
Mayo Clinic Arizona
Phoenix, Arizona
Jamal McClendon, Jr., MD

Neurological Surgery
Mayo Clinic Arizona
Phoenix, Arizona
iii
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
IMAGING IN SPINE SURGERY ISBN: 978-0-323-48554-8
Copyright © 2017 by Elsevier. All rights reserved.
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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
of products liability, negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Publisher Cataloging-in-Publication Data
Names: Ross, Jeffrey S. (Jeffrey Stuart) | Bendok, Bernard R. | McClendon, Jamal, Jr.
Title: Imaging in spine surgery / [edited by] Jeffrey S. Ross, Bernard R. Bendok, and
Jamal McClendon, Jr.
Description: First edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-48554-8
Subjects: LCSH: Spine--Surgery--Handbooks, manuals, etc. | Spine--Imaging--Handbooks,
manuals, etc. | MESH: Spine--surgery--Atlases. | Spine--anatomy & histology--Atlases. |
Spine--radiography--Atlases. | Spinal Diseases--diagnosis--Atlases.
Classification: LCC RD768.I43 2017 | NLM WE 725 | DDC 617.3’7507548--dc23
International Standard Book Number: 978-0-323-48554-8

Cover Designer: Tom M. Olson, BA
Printed in Canada by Friesens, Altona, Manitoba, Canada
Last digit is the print number: 9 8 7 6 5 4 3 2 1
iv
Dedications
Wise words bring many benefits,
And hard work brings rewards.
~ Proverbs 12:14
JR
To my parents, wife, and children.

BB
To my family.
JM
v
Contributing Authors
Bryson Borg, MD
Chief of Neuroradiology
David Grant Medical Center
Travis Air Force Base, California
Michael P. Federle, MD, FACR

Professor and Associate Chair for Education
Stanford University School of Medicine
Stanford, California
Bronwyn E. Hamilton, MD
Director of Head & Neck Radiology
Oregon Health & Science University
Portland, Oregon
R. Brooke Jeffrey, MD
Professor and Vice Chairman
Stanford University School of Medicine
Stanford, California
Donald V. La Barge, III, MD

Adjunct Assistant Professor of Radiology
Diagnostic and Interventional Neuroradiology
University of Utah School of Medicine
Salt Lake City, Utah
Assistant Professor of Radiology
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Kevin R. Moore, MD
Pediatric Neuroradiology
Intermountain Pediatric Imaging
Primary Children’s Hospital
vi
Anne G. Osborn, MD, FACR
University Distinguished Professor
William H. and Patricia W. Child Presidential Endowed Chair
C. Douglas Phillips, MD, FACR

Director of Head and Neck Imaging
Weill Cornell Medical College
NewYork-Presbyterian Hospital
New York, New York
Lubdha M. Shah, MD
Associate Professor of Radiology
Division of Neuroradiology
vii
Preface
The spine is complicated, the variety of pathologies legion, and you are busy. Where can you go for up-to-
date, easily accessible information regarding spine imaging? Look no further!
This book’s purpose is to provide key imaging findings for the most common and important spine surgical
disorders in an easy-to-understand format, using typical imaging examples, pathologic examples when
appropriate, and spectacular illustrations that demonstrate key findings.
This book covers a wide variety of pathologic conditions with sections on congenital and genetic disorders,
disorders of alignment, trauma, degenerative arthritides, infection and inflammation, neoplasms, vascular
disorders, and peripheral nerve and plexus diseases. There are overview chapters to problematic subjects
like scoliosis, fracture classifications, degenerative disc disease nomenclature, surgical complications, and
instrumentation. There are anatomic overviews of the cervical, thoracic, lumbar, and sacral spine as well as
craniovertebral junction, vascular anatomy, and brachial and lumbar plexus. The wide variety of common
image-guided procedures are also covered, including epidural, nerve root, and facet injections, as well as
more complicated procedures such as kyphoplasty/vertebroplasty and percutaneous discectomy.
Each chapter is written to point out the main imaging findings for each disorder or anatomic area. Then,
the key clinical features are addressed. The organization of each chapter makes it easy for a surgeon to
quickly know the key terminology, imaging findings, pathologic underpinnings, and important clinical
details. The images were specifically chosen to be classic examples with the liberal use of arrows
describing the key findings.
We see this book being of value to every practicing surgeon or physician who sees patients with spine
pathology. Additionally, we see residents using this book to study for board and in-service examinations.
We hope you find this resource of value in providing ongoing care to your patients.
Jeffrey S. Ross, MD
Neuroradiology Division
Mayo Clinic Arizona
Mayo Clinic College of Medicine
Phoenix, Arizona
ix
Acknowledgments
Text Editors
Arthur G. Gelsinger, MA
Terry W. Ferrell, MS
Lisa A. Gervais, BS
Karen E. Concannon, MA, PhD
Matt W. Hoecherl, BS
Megg Morin, BA
Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS
Illustrations
Lane R. Bennion, MS
Richard Coombs, MS
Laura C. Sesto, MA
Art Direction and Design

Tom M. Olson, BA
Laura C. Sesto, MA
Lead Editor
Nina I. Bennett, BA
Production Coordinators
Angela M.G. Terry, BA
Rebecca L. Hutchinson, BA
Emily C. Fassett, BA
xi
Sections
Section 1:
Normal Anatomy and Techniques
Section 2:
Devices and Instrumentation
Section 3:
Congenital and Genetic Disorders
Section 4:
Disorders of Alignment
Section 5:
Trauma
Section 6:
Degenerative Diseases and Arthritides
Section 7:
Infection and Inflammatory Disorders
Section 8:
Neoplasms, Cysts, and Other Masses
Section 9:
Vascular Disorders
Section 10:
Complications
Section 11:
Remote Complications
Section 12:
Differential Diagnosis
Section 13:
Peripheral Nerve and Plexus
Section 14:
Image-Guided Procedures
xiii
Normal Anatomy Overview
Imaging Anatomy almost face each other; inferior articular processes are
directed anteriorly and laterally
There are 33 spinal vertebrae, which are composed of 2
components: A cylindrical ventral bone mass, which is the Joints
vertebral body, and the dorsal arch. • Synarthrosis is immovable joint of cartilage and occurs
during development and in 1st decade of life;
7 cervical, 12 thoracic, 5 lumbar bodies
neurocentral joint occurs at union point of 2 centers of
• 5 fused elements form sacrum
ossification for 2 halves of vertebral arch and centrum
• 4-5 irregular ossicles form coccyx
• Diarthrosis is true synovial joint that occurs in articular
Arch processes, costovertebral joints, and atlantoaxial and
• 2 pedicles, 2 laminae, 7 processes (1 spinous, 4 articular, sacroiliac articulations; pivot type joint occurs at median
2 transverse) atlantoaxial articulation; all others are gliding joints
• Pedicles attach to dorsolateral aspect of body • Amphiarthroses are nonsynovial, movable connective
• Pedicles unite with pair of arched flat laminae tissue joints; symphysis is fibrocartilage fusion between
• Lamina capped by dorsal projection called spinous 2 bones, as in intervertebral disc; syndesmosis is
process ligamentous connection common in spine, such as paired
• Transverse processes arise from sides of arches ligamenta flava, intertransverse ligaments, and
• 2 articular processes (zygapophyses) are diarthrodial interspinous ligaments; unpaired syndesmosis is present
joints: Superior process bearing facet with surface in supraspinous ligament
directed dorsally and inferior process bearing facet with • Atlantooccipital articulation is composed of diarthrosis
surface directed ventrally between lateral mass of atlas and occipital condyles and
Pars interarticulars is the part of the arch that lies between syndesmoses of atlantooccipital membranes; anterior
the superior and inferior articular facets of all subatlantal atlantooccipital membrane is extension of anterior
movable elements. The pars are positioned to receive longitudinal ligament (ALL); posterior atlantooccipital
biomechanical stresses of translational forces displacing membrane is homologous to ligamenta flava
superior facets ventrally, while inferior facets remain attached • Atlantoaxial articulation is pivot joint; transverse
to dorsal arch (spondylolysis). C2 exhibits a unique anterior ligament maintains relationship of odontoid to anterior
relation between the superior facet and the posteriorly placed arch of atlas; synovial cavities are present between
inferior facet. This relationship leads to an elongated C2 pars transverse ligament/odontoid and atlas/odontoid
interarticularis, which is the site of the hangman fracture. junctions
Cervical Disc
• Cervical bodies are small and thin relative to size of arch • Intervertebral disc is composed of 3 parts: Cartilaginous
and foramen with transverse > AP diameter; lateral endplate, annulus fibrosis, and nucleus pulposus
edges of superior surface of body are turned upward • Height of lumbar disc space generally increases as one
into uncinate processes; transverse foramen perforates progresses caudally; annulus consists of concentrically
transverse processes oriented collagenous fibers, which serve to contain the
• C1 has no body and forms circular bony mass; superior central nucleus pulposus (these fibers insert into
facets of C1 are large ovals that face upward, and inferior vertebral cortex via Sharpey fibers and also attach to
facets are circular in shape; large transverse processes anterior and posterior longitudinal ligaments)
are present on C1 with fused anterior and posterior • Type I collagen predominates at periphery of annulus,
tubercles while type II predominates in inner annulus; normal
• C2 complex consists of axis body with dens/odontoid contour of posterior aspect of annulus is dependent
process; odontoid embryologically arises from centrum upon contour of its adjacent endplate (typically this is
of 1st cervical vertebrae slightly concave in axial plane, although commonly at L4-
• C7 shows transitional morphology with prominent 5 and L5-S1 these posterior margins will be flat or even
spinous process convex; convex shape on axial images alone should not
be interpreted as degenerative bulging)
Thoracic • Nucleus pulposus is remnant of embryonal notochord
• Bodies are heart-shaped and increase in size from and consists of well-hydrated noncompressible
superior to inferior proteoglycan matrix with scattered chondrocytes;
• Facets are present for rib articulation, and laminae are proteoglycans form major macromolecular component,
broad and thick; spinous processes are long, directed including chondroitin 6-sulfate, keratan sulfate, and
obliquely caudally; superior facets are thin and directed hyaluronic acid
posteriorly • Proteoglycans consist of protein core with multiple
• T1 shows complete facet for capitulum of 1st rib and attached glycosaminoglycan chains; nucleus occupies
inferior demifacet for capitulum of 2nd rib eccentric position within confines of annulus and is more
• T12 resembles upper lumbar bodies with inferior facet dorsal with respect to center of vertebral body
directed more laterally • At birth, ~ 85-90% of nucleus is water; this water content
Lumbar gradually decreases with advancing age; within nucleus
• Lumbar vertebral bodies are large, wide, and thick and pulposus on T2-weighted sagittal images, there is often
lack transverse foramen or costal articular facets; linear hypointensity coursing in anteroposterior
pedicles are strong and directed posteriorly; superior direction, intranuclear cleft (this region of more
articular processes are directed dorsomedially and prominent fibrous tissue should not be interpreted as
intradiscal air or calcification)
4

Anterior Longitudinal Ligament Nerves
• Runs along ventral surface of spine from skull to sacrum; • Spinal nerves are arranged in 31 pairs and grouped
ALL is narrowest in cervical spine and is firmly attached at regionally: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1
ends of each vertebral body; it is loosely attached at coccygeal
midsection of disc • Ascensus spinalis is apparent developmental rising of
Posterior Longitudinal Ligament (PLL) cord related to differential spinal growth
• Runs on dorsal surface of bodies from skull to sacrum; • Course of nerve roots becomes longer and more oblique
PLL has segmental denticulate configuration and is wider at lower segments
at disc space but narrows and becomes thicker at • C1 nerve from C1 segment and exits above C1
vertebral body level • C8 nerve from C7 segment and exits at C7-T1
• T6 nerve from T5 segment and exits at T6-T7
Craniocervical Ligaments • T12 nerve from T8 segment and exits at T12-L1
• Located anteriorly to spinal cord and occur in 3 layers: • L2 nerve from T10 segment and exits at L2-3
Anterior, middle, and posterior • S3 nerve from T12 segment and exits at the S3 foramen
• Anterior ligaments consist of odontoid ligaments (apical
Meninges are divided into dura, arachnoid, and pia.
and alar); apical ligament is small fibrous band extending
• Dura is dense, tough covering corresponding to
from dens tip to basion; alar ligaments are thick,
horizontally directed ligaments extending from lateral meningeal layer of cranial dura; epidural space is filled
surface of dens tip to anteromedial occipital condyles; with fat, loose connective tissue, and veins; dura
continues with spinal nerves through foramen to fuse
middle layer consists of cruciate ligament
with epineurium; cephalic attachment of dura is at
• Transverse ligament is strong horizontal component of
foramen magnum and caudal attachment at back of
cruciate ligament extending from behind dens to medial
coccyx
aspect of C1 lateral masses; craniocaudal component
• Arachnoid is middle covering, which is thin, delicate, and
consists of fibrous band running from transverse
ligament superiorly to foramen magnum and inferiorly continuous with cranial arachnoid; arachnoid is
to C2; posteriorly, tectorial membrane is continuation of separated from dura by potential subdural space
PLL and attaches to anterior rim of foramen magnum • Pia is inner covering of delicate connective tissue closely
applied to cord; longitudinal fibers are laterally
Vertebral Artery concentrated as denticulate ligaments lying between
• Vertebral artery arises as 1st branch of subclavian artery posterior and anterior roots and attach at 21 points to
on both sides; vertebral artery travels cephalad within dura; longitudinal fibers are concentrated dorsally as
foramen transversarium within transverse processes septum posticum attaching dorsal cord to dorsal midline
• 1st segment of vertebral artery extends from its origin to dura
entrance into foramen of transverse process of cervical
vertebrae, usually 6th; most common variation is origin Selected References
of left vertebral from arch, between left common 1. Modic MT et al: Lumbar degenerative disk disease. Radiology. 245(1):43-61,
carotid and left subclavian arteries (2-6%) (vertebral 2007
artery in these cases almost always enters foramen of 2. Battie MC et al: Lumbar disc degeneration: epidemiology and genetics. J
Bone Joint Surg Am. 88 Suppl 2:3-9, 2006
the transverse process of C5) 3. Grunhagen T et al: Nutrient supply and intervertebral disc metabolism. J
• 2nd segment runs within transverse foramen to C2 level; Bone Joint Surg Am. 88 Suppl 2:30-5, 2006
nerve roots pass posterior to vertebral artery 4. Haughton V: Imaging intervertebral disc degeneration. J Bone Joint Surg
• 3rd segment starts at C2 level where artery loops and Am. 88 Suppl 2:15-20, 2006
5. Roh JS et al: Degenerative disorders of the lumbar and cervical spine.
turns lateral to ascend in C1 transverse foramen; it then Orthop Clin North Am. 36(3):255-62, 2005
turns medial crossing on top of C1 in groove 4 6. Fardon DF et al: Nomenclature and classification of lumbar disc pathology.
• 4th segment starts where artery perforates dura and Recommendations of the Combined Task Forces of the North American
arachnoid at lateral edge of posterior occipitoatlantal Spine Society, American Society of Spine Radiology, and American Society of
Neuroradiology. Spine (Phila Pa 1976). 26(5):E93-E113, 2001
membrane, coursing ventrally on medulla to join with
other vertebral artery to make basilar artery
Vertebral Column Blood Supply
• Paired segmental arteries (intercostals, lumbar arteries)
arise from aorta and extend dorsolaterally around
middle of vertebral body; near transverse process,
segmental artery divides into lateral and dorsal branches
• Lateral branch supplies dorsal musculature, and dorsal
branch passes lateral to foramen giving off branch(es)
providing major vascular supply to bone and vertebral
canal contents; posterior central branch supplies disc and
vertebral body, while prelaminal branch supplies inner
surface of arch and ligamenta flava, regional epidural
tissue
• Neural branch entering neural foramen supplies pia,
arachnoid, and cord; postlaminar branch supplies
musculature overlying lamina and branches to bone
5
SPINE ANATOMY GENERAL OVERVIEW
Atlas
7 cervical vertebral bodies
Axis
12 thoracic vertebral bodies
Transverse process
5 lumbar vertebral bodies
Iliac wing
5 fused sacral vertebral bodies

Sacral ala
4 coccygeal bodies
Brachial plexus
C8 root exiting at C7-T1 level
Thoracic intervertebral discs

Intercostal nerves
T12 root exiting at T12-L1 level
Lumbar intervertebral discs

L4 root exiting at L4-5 level
Lumbosacral plexus
Sacral nerve roots
Sciatic nerve
(Top) Coronal graphic of the spinal column shows the relationship of 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 coccygeal
bodies. Note the cervical bodies are smaller with the neural foramina oriented at 45° and capped by the unique C1 and C2 morphology.
Thoracic bodies are heart-shaped, have thinner intervertebral discs, and are stabilized by the rib cage. Lumbar bodies are more massive
with prominent transverse processes and thick intervertebral discs. (Bottom) Coronal graphic demonstrates exiting spinal nerve roots.
C1 exits between the occiput and C1, while the C8 root exits at the C7-T1 level. Thoracic and lumbar roots exit below their respective
pedicles.
6

(Left) Sagittal CVJ graphic
shows 1) ant. atlantooccipital
membrane, 2) apical ligament,
3) ALL, 4) cruciate ligament, 5)
tectorial membrane, 6)
transverse ligament, 7) post.
longitudinal ligament, 8) post.
atlantooccipital membrane:
Red star = basion, blue star =
opisthion. (Right) Posterior
CVJ graphic shows 1) sup.
cruciate ligament, 2) cruciate
lig., 3) odontoid ant. to
cruciate lig., 4) atlantoaxial jt.,
5) accessory atlantoaxial lig.,
6) inf. cruciate lig., 7)
transverse lig., 8) alar lig., and
9) atlantooccipital jt. (Red star
= basion).
(Left) Graphic shows the

cervical vertebra from above.
The vertebral body is broad
transversely; the central canal
is large & triangular in shape;
the pedicles are directed
posterolaterally; the laminae
are delicate. Lateral masses
contain the vertebral foramen
for passage of vertebral artery
& veins. (Right) Mid C5 body at
the pedicle level shows
transverse foramina are
prominent ﬅ, encompassing
the vertical course of the
vertebral artery. The anterior
and posterior tubercles ﬆ
give rise to muscle
attachments in the neck.
(Left) Graphic shows thoracic

vertebral body from above.
Thoracic bodies are
characterized by long spinous
processes and transverse
processes. Complex rib
articulation includes both
costotransverse joints ﬅ &
costovertebral joints ﬆ. Facet
joints are oriented in the
coronal plane. (Right) Image
through the pedicle level of
the thoracic spine shows the
coronal orientation of the
facet joints is well identified
﬈ in this section. The pedicles
are thin & gracile with
adjacent rib articulations.
7
(Left) Graphic shows the

lumbar body from above.
Large, sturdy lumbar bodies
connect to thick pedicles and
transversely directed
transverse processes. Facets
maintain oblique orientation
favoring flexion/extension.
(Right) Lateral 3D scan of the
lumbar spine shows large
bodies joined by thick
posterior elements with
superior and inferior articular
processes angled in the lateral
plane. Transverse processes jut
out laterally for muscle
attachments. Pars
interarticularis form junction
between articular processes.
(Left) Oblique view of the

lumbar spine shows the typical
Scotty dog appearance of the
posterior elements. The neck
of the dog is the pars
interarticularis ﬈. (Right)
Oblique 3D exam of the
lumbar spine shows the
surface anatomy of the
"Scotty dog": Transverse
process (nose) ﬇, superior
articular process (ear) ﬅ,
inferior articular process (front
leg) ﬆ, and intervening pars
interarticularis (neck) ﬈. The
pedicle that forms the "eye"
on CT reconstructions is
obscured.
(Left) Graphic shows lumbar

vertebral bodies joined by disc
& ant. & post. longitudinal
ligaments. Posteriorly are
paired pedicles, transverse
processes, articular facets,
lamina, & spinous process.
Paired ligamentum flavum &
interspinous ligaments join
posterior elements with
midline supraspinous
ligaments. (Right) Graphic
shows spinal cord & coverings:
1) dura mater, 2) subdural
space, 3) arachnoid mater, 4)
subarachnoid space, 5) pia
mater, 6) ant. spinal artery, 7)
epidural space, & 8) root
sleeve.
8

VASCULAR ANATOMY
Medullary branches Posterior spinal arteries
Anterior spinal artery

Posterior radiculomedullary
artery
Artery of Adamkiewicz
Ventral branch of segmental

artery
Anterior radiculomedullary
artery
Postcentral branch to
vertebral body Muscular branch
Intercostal artery (segmental

supply) Dorsal ramus
Intercostal artery
Intercostal artery
Posterior branch of segmental
artery
Anterior spinal artery

Pia mater
Ventral radiculomedullary
artery
Postcentral branch to
vertebral body
Radiculomedullary artery
Medullary arteries
Dorsal radiculomedullary
Dura mater artery
Subdural potential space

Epidural space
Muscular branch
Posterior spinal arteries
(Top) Axial oblique graphic of the thoracic spinal cord and arterial supply at T10 shows segmental intercostal arteries arising from the
lower thoracic aorta. The artery of Adamkiewicz is the dominant segmental feeding vessel to the thoracic cord, supplying the anterior
aspect of the cord via the anterior spinal artery. Adamkiewicz has a characteristic hairpin turn on the cord surface as it first courses
superiorly, then turns inferiorly. (Bottom) Axial graphic shows the anterior and posterior radiculomedullary arteries anastomosing with
the anterior and posterior spinal arteries. Penetrating medullary arteries in the cord are largely end-arteries with few collaterals. The
cord "watershed" zone is at the central gray matter.
9
Craniovertebral Junction
– Transverse ligament: Strong horizontal component

TERMINOLOGY between lateral masses of C1, passes behind dens
Definitions – Craniocaudal component: Fibrous band running from
• Craniocervical junction (CCJ) = C1, C2, and articulation with transverse ligament superiorly to foramen magnum
skull base and inferiorly to C2
○ Tectorial membrane: Continuation of posterior
GROSS ANATOMY longitudinal ligament; attaches to anterior rim foramen
magnum (posterior clivus)
Overview ○ Posterior atlantooccipital membrane
• Craniocervical junction comprises occiput, atlas, axis, their – Posterior arch C1 to margin of foramen magnum
articulations, ligaments – Deficit laterally where vertebral artery enters on
Components of Craniocervical Junction superior surface of C1
• Bones • Biomechanics
○ Occipital bone ○ Atlantooccipital joint: 50% cervical flexion/extension and
limited lateral motion
– Occipital condyles are paired, oval-shaped, inferior
prominences of lateral exoccipital portion of occipital ○ Atlantoaxial joint: 50% cervical rotation
bone
– Articular facet projects laterally IMAGING ANATOMY
○ C1 (atlas) Overview
– Composed of anterior and posterior arches, no body • Lateral assessment of CCJ
– Paired lateral masses with their superior and inferior ○ C1-C2 interspinous space: ≤ 10 mm
articular facets ○ Atlantodental interval (ADI)
– Large transverse processes with transverse foramen – Adults < 3 mm, children < 5 mm in flexion
○ C2 (axis) ○ Pseudosubluxation
– Large body and superiorly projecting odontoid – Physiologic anterior displacement seen in 40% at C2-
process C3 level and 14% at C3-C4 level to age 8
– Superior articulating facet surface is convex & directed – Anterior displacement of C2 on C3 up to 4 mm
laterally ○ Posterior cervical line: Line is drawn from anterior
– Inferior articular process + facet surface is typical of aspect of C1-C3 spinous processes → anterior C2 spinous
lower cervical vertebrae process should be within 2 mm of this line
– Superior facet is positioned relatively anteriorly; ○ Wackenheim line
inferior facet is posterior with elongated pars – Posterior surface of clivus → posterior odontoid tip
interarticularis should lie immediately inferior
• Joints – Relationship does not change in flexion/extension
○ Atlantooccipital joints ○ Welcher basal angle
– Inferior articular facet of occipital condyle: Oval, – Angle between lines drawn along plane of sphenoid
convex surface, projects laterally bone and posterior clivus
– Superior articular facet of C1: Oval, concave – Normal < 140°, average 132°
anteroposteriorly, projects medially ○ Chamberlain line
○ Median atlantoaxial joints – Between hard palate and opisthion
– Pivot-type joint between dens + ring formed by – Odontoid tip ≥ 5 mm above line abnormal
anterior arch + transverse ligament of C1
○ McGregor line
– Synovial cavities between transverse
– Between hard palate to base of occipital bone
ligament/odontoid & atlas/odontoid articulations
– Odontoid tip ≥ 7 mm above line abnormal
○ Lateral atlantoaxial joints
○ Clivus canal angle
– Inferior articular facet of C1: Concave mediolaterally,
– Junction of Wackenheim line and posterior vertebral
projects medially in coronal plane
body line
– Superior articular facet of C2: Convex surface, projects
– 180° extension, 150° flexion, < 150° abnormal
laterally
○ McRae line
• Ligaments (from anterior to posterior)
– Drawn between basion and opisthion
○ Anterior atlantooccipital membrane: Connects anterior
arch C1 with anterior margin foramen magnum – Normal 35-mm diameter
○ Odontoid ligaments • Frontal assessment of CCJ
– Apical ligament: Small fibrous band extending from ○ Lateral masses of C1 and C2 should align
dens tip to basion – Overlapping lateral masses can be normal variant in
– Alar ligaments: Thick, horizontally directed ligaments children
extending from lateral surface of dens tip to ○ Atlantooccipital joint angle
anteromedial occipital condyles – Angle formed at junction of lines traversing joints
○ Cruciate ligament – 125-130° normal, < 124° may reflect condyle
hypoplasia
10

LIGAMENT ANATOMY
Clivus
Basion
Cruciate ligament
Anterior atlantooccipital
Tectorial membrane
membrane
Apical ligament Opisthion

Posterior atlantooccipital
Anterior arch C1 (atlas) membrane
Anterior median atlantoaxial
Posterior median atlantoaxial
joint
joint
Odontoid process (dens)
Transverse ligament
Anterior longitudinal ligament Posterior longitudinal

ligament
Body of C2 (axis)
Ligamentum nuchae
Basion
Atlantooccipital joint
Superior extension cruciate
ligament
Alar ligament
Cruciate ligament Transverse ligament
Odontoid anterior to cruciate

ligament
Inferior extension cruciate
ligament
Lateral atlantoaxial joint
Body C2 (axis)
Accessory atlantoaxial
ligament
(Top) Sagittal midline graphic shows the craniocervical junction. The complex articulations and ligamentous attachments are
highlighted. The midline atlantoaxial articulations consist of anterior and posterior median atlantoaxial joints. The anterior joint is
between the posterior aspect of the anterior C1 arch and the ventral aspect of odontoid process. The posterior joint is between the
dorsal aspect of the odontoid process and the cruciate ligament. The midline view shows a series of ligamentous connections to the
skull base including the anterior atlantooccipital membrane, apical ligament, superior component of cruciate ligament, tectorial
membrane, and posterior atlantooccipital membrane. (Bottom) Posterior view of the craniocervical junction with posterior elements
cut away to define the components of the cruciate ligament and alar ligaments is shown.
11
C1 GRAPHICS
Anterior arch
Articular facet for dens
Anterior tubercle of
transverse process Transverse process
Superior articular facet

Posterior tubercle of
transverse process
Transverse foramen
Posterior arch
Anterior arch of C1
Articular facet for dens
Anterior tubercle of
transverse process Transverse process
Posterior tubercle of
transverse process Inferior articular facet
Vertebral canal
Posterior arch
(Top) Axial graphic shows the atlas viewed from above. The characteristic ring shape is shown, composed of anterior and posterior
arches and paired large lateral masses. The superior articular facet is concave anteroposteriorly and projects medially for articulation
with the convex surface of the occipital condyle at the atlantooccipital joint. The anterior arch articulates with the odontoid process at
the anterior median atlantoaxial joint. (Bottom) In this atlas viewed from below, the large inferior facet surface is concave
mediolaterally and projects medially for articulation with the convex surface of the superior articular facet of C2. The canal of the atlas
is ± 3 cm in AP diameter: The spinal cord, odontoid process, and free space for the cord are each about 1 cm in diameter. The size of the
anterior midline tubercle of the anterior arch and spinous process of posterior arch are quite variable.
12

C2 GRAPHICS
Odontoid process
Anterior articular facet for

median atlantoaxial joint
Lateral mass
Body Transverse process
Inferior articular facet
Odontoid process
Articular facet for posterior

median atlantoaxial joint

Posterior body cortical margin
Lamina Transverse process
Inferior articular process

Spinous process (bifid)
(Top) In this atlas viewed from the anterior perspective, the odontoid process is the "purloined" embryologic centrum of C1, which is
incorporated into C2, giving C2 its unique morphology. The C2 body laterally is defined by large lateral masses for articulation with the
inferior facet of C1. The elongated pars interarticularis of C2 ends with the inferior articular process for articulation with the superior
articular facet of C3. (Bottom) The atlas viewed from the posterior perspective shows that the odontoid process has anterior and
posterior joints for articulation with C1. The anterior median joint articulates with the C1 arch, while the posterior median joint (shown
here) involves the transverse ligament.
13
RADIOGRAPHY
Odontoid
Lateral mass C1
Atlantoaxial joint
Transverse process C1
Lateral cortical margins
aligning at C1-C2
C2 body
C2 bifid spinous process
C2-C3 disc space
C3 body
Clivus
Basion
Opisthion
Anterior arch C1
Posterior arch C1
Odontoid process
C2 spinous process
Body C2
Posterior spinolaminar line

C2-C3 disc space
Facet joint
(Top) AP open-mouth view shows the odontoid process. With proper positioning, the odontoid process is visualized in the midline with
symmetrically placed lateral C1 masses on either side. The medial space between the odontoid and C1 lateral masses should be
symmetric as well. The lateral cortical margins of the C1 and C2 lateral masses should align. The atlantooccipital and atlantoaxial joints
are visible bilaterally with smooth cortical margins. The bifid C2 process should not be confused for fracture. (Bottom) In this lateral
radiograph of craniocervical junction, there is smooth anatomic alignment of the posterior vertebral body margins and the posterior
spinolaminar line of the posterior elements. The anterior arch of C1 should assume a well-defined oval appearance with sharp
margination between the anterior C1 arch and the odontoid process.
14

CORONAL BONE CT
Basion Occipital condyle

C1 lateral mass
Odontoid process
Atlantoaxial joint
Normal alignment of lateral
cortical margins C1 & C2 C2 body
Uncinate process C2-C3 intervertebral disc
Neural foramen
Jugular foramen
Hypoglossal canal
Occipital condyle
C1 lateral mass Odontoid process
Atlantoaxial joint
C2 body C2-C3 intervertebral disc
(Top) The 1st of 2 coronal bone CT reconstructions of the craniocervical junction presented from anterior to posterior is shown. The
odontoid process is visualized in the midline as a sharply corticated bony peg with symmetrically placed lateral C1 masses on either side.
The lateral cortical margins of the C1 lateral masses and the C2 lateral masses should align. The atlantooccipital and atlantoaxial joints
are visible bilaterally with even joint margins and sharp cortical margins. (Bottom) The more posterior view of the craniocervical
junction shows that both the atlantooccipital joints are now well defined with smooth cortical margins, sloping superolateral to
inferomedial. The atlantoaxial joints are smoothly sloping inferolateral to superomedial.
15
AXIAL BONE CT
Superior cortex of anterior arch C1
Styloid process
Occipital condyle
Foramen magnum
Retrocondylar vein
Anterior arch C1
Anterior atlantodental joint
Odontoid tip C1 lateral mass
Foramen magnum
Opisthion
Odontoid
Transverse process
Transverse foramen Superior articular facet C1
Transverse ligament
Posterior arch C1
(Top) The 1st of 6 axial bone CT images through the craniocervical junction presented from superior to inferior is shown. The
anterolateral margin of the foramen magnum is formed by the prominent occipital condyles, which articulate with the superior
articular facets of the C1 lateral masses. (Middle) This more inferior image of the craniocervical junction shows that the anterior arch of
C1 is now well defined with the odontoid process of C2 coming into plane. The atlantooccipital joint is seen in oblique section and
therefore has poorly defined margins. The odontoid is tightly applied to the posterior margin of the C1 arch, held in place by the strong
transverse component of the cruciate ligament. (Bottom) Image at the level of the atlas shows the unique morphology of the C1 body,
defined with its large transverse process, with a transverse foramen and ring shape.
16

AXIAL BONE CT
C2 superior articular facet

Junction base of odontoid with body C2
Atlantoaxial joint
C1 inferior articular facet

Spinal canal
C1 posterior arch
Transverse process Inferior body C2
Pedicle Transverse foramen
Lamina
Spinous process
C2-C3 intervertebral disc
C3 uncinate process C2-C3 neural foramen
C3 superior articular process

Facet joint
C2 lamina C2 inferior articular process
C2 bifid spinous process
(Top) In this image through the lateral atlantoaxial joints, this section defines the junction of the odontoid process with the body of C2.
The obliquely oriented atlantoaxial joints are partially seen with the C1 component lateral to the joint space and the C2 component
medial. (Middle) This image through the inferior C2 body level shows a large C2 vertebral body and vertebral arch formed by gracile
pedicles and laminae. (Bottom) This image through the C2-C3 intervertebral disc level shows the C2-C3 neural foramen well defined
with the posterior margin formed by the superior articular process of C3. The spinous process of C2 is large and typically bifid. The C2-
C3 disc assumes the characteristic cervical cup-shaped morphology bound by uncinate processes.
17
SAGITTAL CT & MR
Basion
Anterior atlantooccipital membrane
Tectorial membrane
Odontoid tip
Apical ligament
Cruciate ligament
Anterior arch C1
Opisthion
C1 posterior arch
Base of odontoid process
C2 spinous process
Basion
Apical ligament
Anterior atlantooccipital membrane
Tectorial membrane
Anterior arch C1 Opisthion
Cruciate ligament
Anterior longitudinal ligament C1 posterior arch
C2 spinous process
Basion
Anterior atlantooccipital membrane Superior extension of cruciate ligament
Apical ligament Tectorial membrane
Anterior arch C1 Odontoid tip

Cruciate ligament
Anterior longitudinal ligament C1 posterior arch

Posterior longitudinal ligament
(Top) Sagittal midline CT reformat shows the ligamentous structures visible at the craniocervical junction. The apical ligament is visible
as a linear band between the odontoid tip and clivus. The tectorial membrane is the superior extension of the posterior longitudinal
ligament. The anterior atlantooccipital membrane is the extension of the anterior longitudinal ligament. (Middle) Sagittal T1 MR
midline image shows the craniocervical junction. The atlantodental interval is well defined by the adjacent low signal cortical margins
of the C1 anterior arch and the odontoid process. The cruciate ligament is a low signal band dorsal to the odontoid. (Bottom) Sagittal
T2 MR shows the craniocervical junction. The tectorial membrane, superior extension of the cruciate ligament, apical ligament, and
anterior atlantooccipital membranes are evident.
18

SAGITTAL T1 MR
Clivus
Tectorial membrane
Lateral margin of odontoid process
Anterior margin foramen magnum
(basion)
Posterior margin foramen magnum
Anterior arch C1
(opisthion)
Transverse ligament
Posterior arch C1
C2 body
C3 body
Jugular tubercle
Hypoglossal canal
Occipital condyle
Superior articular facet C1
Vertebral artery
Inferior articular facet C1
Atlantoaxial joint
Hypoglossal canal
Occipital condyle
Vertebral artery
C1 posterior arch
Superior articular facet C2 Atlantoaxial joint
Inferior articular process C2

Superior articular process C3
(Top) The 1st of 3 parasagittal T1 MR images shown from medial to lateral through the atlantooccipital joint is shown. This image
extends through the lateral cortical margin of the odontoid, which is incompletely visualized. The anterior arch of C1 is obliquely
visualized as it curves posterolaterally. The lateral extension of the cruciate ligament and the transverse ligament is prominent.
(Middle) The relationship of the occipital condyle, C1 lateral mass + the atlantoaxial joint is highlighted in this image. The articular
surface of occipital condyle is convex, and the superior facet of C1 is concave allowing for flexion/extension. (Bottom) More lateral
image of the craniocervical junction shows the atlantooccipital joint and atlantoaxial joints with sharp, smooth cortical margins.
19
Cervical Spine
– Uncinate process develops during childhood with

TERMINOLOGY uncovertebral joint forming by fibrillation and
Synonyms fissuring in fibers of annulus fibrosus
• Uncovertebral joint (joint of Luschka) ○ Facet (zygapophyseal) joints
• C1 (atlas), C2 (axis) – Facet joints oriented ~ 45° superiorly from transverse
plane in upper cervical spine; assume more vertical
Definitions orientation toward C7
• Subaxial cervical spine = C3-C7 – Formed by articulation between superior & inferior
articular processes = articular pillars
GROSS ANATOMY – Form 2 sides of flexible tripod of bone (vertebral
Overview bodies, right and left articular pillars) for support of
cranium
• Consists of 7 vertebrae (C1-C7)
• Ligaments
○ Craniocervical junction (CCJ): C1, C2, & articulation with
○ Anterior & posterior longitudinal, ligamentum flavum,
skull base constitute craniocervical junction
interspinous & supraspinous ligaments
○ Subaxial spine: C3-C7
○ Additional ligaments of CCJ include apical, alar, and
– C3-C6 typical cervical vertebrae cruciate ligaments
– C7 has features that differ slightly from C3-C6 • Biomechanics
Components of Subaxial Cervical Spine ○ Subaxial cervical spine shows free motion range relative
• Bones C3-C7 to remainder of presacral spine
○ Body – Cervical extension checked by anterior longitudinal
ligament & musculature
– Small, broader transversely than in AP dimension
– Cervical flexion checked by articular pillars &
– Posterolateral edges of superior surface are turned
intertransverse ligaments
upward = uncinate process
○ Vertebral arches
IMAGING ANATOMY
– Pedicle: Delicate, project posterolaterally
– Lamina: Thin and narrow Lateral Assessment of Subaxial Spine
– Vertebral foramen: Large, triangle-shaped • Principles apply equally to radiography, CT, or MR
○ Transverse processes • Prevertebral soft tissues: Distance between air column
– Project laterally and contain foramen for vertebral and anterior aspect of vertebral body
artery ○ Adults: < 7 mm at C2 & < 22 mm at C6
– Anterior and posterior tubercles are separated by ○ Child: < 14 mm at C6
superior groove for exiting spinal nerve • Bony alignment
○ Articular processes ○ Anterior vertebral line: Smooth curve paralleling
– Superior and inferior articular processes with articular anterior vertebral cortex
facets oriented ~ 45° superiorly from transverse plane – Less important than posterior cortical line
– Form paired osseous shafts posterolateral to vertebral ○ Posterior vertebral line: Smooth curve paralleling
bodies = articular pillars posterior vertebral cortex
○ Spinous process: Short and bifid – Translation > 3.5 mm is abnormal
○ C7 unique features – Flexion and extension allow physiological offset < 3
– Spinous process: Long, prominent mm of posterior cortical margin of successive
– Transverse process: Short and project inferolaterally vertebral bodies
compared with T1 spinous processes, which are long & ○ Spinolaminar line: Smooth curve from opisthion to C7
project superolaterally formed by junction of laminae with spinous processes
• Intervertebral foramen ○ Spinous process angulation: Cervical spinous processes
○ Oriented anterolaterally below pedicles at ~ 45° to should converge toward common point posteriorly
sagittal plane – Widening is present when distance is > 1.5x
• Joints interspinous distance of adjacent spinal segments
○ Intervertebral disc
Frontal Assessment of Subaxial Spine
– Narrowest in cervical region
• Lateral masses: Bilateral smooth undulating margins
– Thinner posteriorly than anteriorly
• Spinous processes: Midline
– Do not extend to lateral margins of vertebral bodies in
cervical spine → joints of Luschka ○ Lateral rotation of 1 spinous process with respect to
others is abnormal
○ Uncovertebral joint (joints of Luschka)
• Interspinous distance: Symmetric throughout
– Oblique, cleft-like cavities between superior surfaces
of uncinate processes & lateral lips of inferior articular ○ Interspinous distance 1.5x distance of level above or
surface of next superior vertebra below is abnormal
– Lined by cartilaginous endplate of vertebral body
– No true synovial lining present; contains serum,
simulating synovial fluid
20
Cervical Spine

GRAPHICS
Anterior tubercle
Vertebral body
Transverse foramen
Posterior tubercle
Pedicle
Vertebral canal
Lamina
Spinous process
Intervertebral disc
Uncinate process
Uncovertebral joint
Superior articular process

Articular pillar
Groove for exiting spinal nerve
Transverse process
Vertebral body
Superior articular process & facet
Pars interarticularis
Transverse process
Neural (intervertebral) foramen Facet joint

Spinous process
Inferior articular process & facet
(Top) Graphic of a typical cervical vertebra viewed from above demonstrates important morphology. The vertebral body is broader
transversely than in the AP dimension, the central vertebral canal is large and triangular in shape, the pedicles are directed
posterolaterally, and the laminae are delicate and give rise to a spinous process with a bifid tip. Lateral masses contain the vertebral
foramen for passage of vertebral artery and veins. (Middle) Frontal graphic of subaxial cervical spine with cutout shows the
intervertebral disc and uncovertebral joints. Paired lateral articular pillars are formed by articulation between the superior and inferior
articular processes. (Bottom) Lateral graphic of 2 consecutive typical cervical vertebrae with cutout shows facet (zygapophyseal) joint
detail. Note also the prominent groove on the superior surface of the transverse process for exiting spinal nerves.
21
Cervical Spine
GRAPHIC & 3D VRT NECT
C1 root exiting above C1

C1, atlas
C2 root exiting at C1-C2 level

C2, axis
Transverse process C5 root exiting at C4-C5 level
Neural foramen C6 root exiting at C5-C6 level

C8 root exiting at C7-T1 level
T1 root exiting at T1-T2 level
Occipital condyle
Odontoid process
C1 lateral mass
Body C2
C2-C3 facet joint

Articular pillar
(Top) Coronal graphic of the cervical spine shows vertebrae and corresponding cervical nerves. The vertebrae are numbered and are
shown with their exiting nerves. There are 8 cervical nerves, with the C1 nerve exiting above the C1 body and the C2 nerve exiting at the
C1-C2 level. The C8 nerve exits at C7-T1. Below this level, the thoracic roots exit below their respective numbered vertebrae. The roots
exit inferiorly within the neural foramen along the bony groove in the transverse process. (Bottom) Coronal 3D-VRT examination shows
the cervical spine, viewed posteriorly with the dorsal elements partially removed to show the dorsal vertebral body surface. The
concept of the cervical articular pillars is well shown in this view with the facets forming paired columns of bone with superior and
inferior articulating facets.
22
Cervical Spine

RADIOGRAPHY
C3 body
Cervical lateral masses pillars
C4 body
Intervertebral disc space
C6 uncinate process
C7 transverse process C7 pedicle
T1 transverse process
1st rib
Clavicle
Posterior arch C1
C2 body
Anterior cortical margin, C3

Corticated margin defining

Prevertebral soft tissues spinolaminar line
C7 spinous process
Posterior cortical margin, C6
(Top) AP plain film view shows the cervical spine. The articular facets are viewed obliquely in this projection and therefore not defined,
giving the appearance of smoothly undulating lateral columns of bone. The superior and inferior vertebral endplate margins are sharp,
with regular spacing of the intervertebral discs. The spinous processes are midline. The C7 transverse process is directed inferolaterally
compared with T1, which is directed superolaterally. (Bottom) Lateral radiograph shows the cervical spine. The prevertebral soft tissues
should form a defined, abrupt "shelf" at approximately C4/5 where the hypopharynx/esophagus begins, hence thickening the
prevertebral soft tissues. The bony cervical spine is aligned, from anterior to posterior, with the anterior vertebral body margins, the
posterior vertebral body margins, and the ventral margins of the spinous processes (spinolaminar line).
23
Cervical Spine
RADIOGRAPHY & 3D VRT NECT
C2 pedicle
C3 body
C4 body Articular pillar
C5-C6 neural foramen C6 spinous process
C6 pedicle C6 lamina
C7 uncinate process
C2-C3 neural foramen

C3 body
C4 body
C5 transverse process
Uncinate process
C7 spinous process
(Top) Oblique radiograph of the cervical spine best demonstrates the neural foramina, as these are oriented obliquely at ~ 45° from the
sagittal plane. With the patient rotated to the left, the radiograph demonstrates the right-sided foramina. The anterior boundary of the
neural foramina includes the uncinate process, intervertebral disc, and vertebral body. The posterior boundary is the facet joint
complex. The articular pillar facet joints are viewed obliquely and therefore are not well defined. The lamina is seen end-on and hence is
sharply corticated. (Bottom) Oblique 3D-VRT examination of the cervical spine shows the neural foramina end-on. The groove on the
superior surface of the transverse processes for the exiting spinal nerves is well shown.
24
Cervical Spine

AXIAL BONE CT
C5 body Anterior tubercle transverse process
Posterior tubercle transverse process Transverse foramen

Basivertebral veins C5 pedicle
Vertebral canal
Lamina
Spinous process (bifid)
C5 body
Anterior tubercle transverse process
Neural foramen
Neural foramen
Uncinate process C6
Vertebral canal
Lamina
Spinous process
C5-C6 intervertebral disc Neural foramen

Uncinate process C6
Facet pillar Facet joint
Lamina Inferior articular facet
Spinous process
(Top) Image through mid C5 body at the pedicle level is shown. The transverse foramina are prominent at this level, with the round,
sharply marginated transverse foramen encompassing the vertical course of the vertebral artery. The anterior and posterior tubercles
give rise to muscle attachments in the neck. The vertebral body is interrupted along the posterior cortical margin for the passage of the
basivertebral venous complex. (Middle) In this image at the inferior C5 body level, the uncinate process arising off of the next inferior
vertebral body is coming into view. The inferior margins of the transverse processes are incompletely visualized. The spinous process is
well seen joining with the thin lamina. (Bottom) View at C5-C6 level shows the next neural foraminal level bound by uncovertebral joint
anteriorly and facet posteriorly.
25
Cervical Spine
AXIAL BONE CT
C4 inferior endplate Uncinate process C5

C4-C5 intervertebral disc Neural foramen

Facet joint
Lamina
Spinal cord
C4 inferior endplate
Transverse process Uncinate process C5

C4-C5 intervertebral disc C5 pedicle

Facet joint Spinal cord
Lamina
C5 body
Anterior tubercle transverse process
Posterior tubercle transverse process Transverse foramen
C5 pedicle
Spinal cord
Lamina
Spinous process
(Top) This is the 1st of 6 axial bone CT images presented from superior to inferior through the cervical spine starting at the C4-C5 level.
The cup-shaped intervertebral disc of the cervical region is seen centrally, bound along the posterolateral margin by the uncinate
processes. The uncinate process defines the joint of Luschka between adjacent vertebral segments. The neural foramina exit at around
45° in an anterolateral direction, bound posteriorly by the superior articular process. (Middle) In this image through the inferior margin
of the intervertebral disc, the gracile pedicles arise obliquely from the posterolateral margins of the vertebral bodies. The bony canal is
large relative to the posterior elements and assumes a triangular configuration. (Bottom) In this image through the C5 body level, the
transverse process contains the transverse foramen for the vertebral artery.
26
Cervical Spine

SAGITTAL T2 MR
Occipital condyle Posterior arch C1
C1 lateral mass C2 pars interarticularis
Vertebral artery in C2 transverse Inferior articular facet C2

foramen
C4-C5 facet joint
C6 transverse process C6-C7 facet joint
Vertebral artery C5 facet
C5-C6 facet joint
Vertebral artery entering transverse

foramen
1st rib
Anterior arch C1
Spinous process C2
C2 body
Prevertebral soft tissues Ligamentum nuchae
Ventral dural margin/posterior Interspinous ligament

longitudinal ligament
Dorsal dura margin
Cerebrospinal fluid
Spinal cord
(Top) The 1st of 3 sagittal T2 MR images viewed from lateral to medial is shown. The view through the articular pillars demonstrates
normal alignment of the facet joints. The rhomboidal configuration of the cervical facets is noted, with their complementary superior
and inferior articular facets. The exiting spinal nerves run in the groove along the superior aspect of transverse processes. (Middle) More
medial section shows the overlapping facets at each level and the flow void of the vertebral artery within the transverse foramen.
(Bottom) Midline image shows the relationship of the cervical cord, vertebral bodies, and spinous processes with smooth, straight
margins and alignment. The posterior dural margin merges with the ligamentum flavum and the low signal of the spinous process
cortex. The anterior dural margin merges with the posterior body cortex and posterior longitudinal ligament.
27
Cervical Spine
AXIAL T2 MR
Anterior atlantoaxial joint Anterior arch C1

Odontoid process
Transverse ligament
C1 lateral mass
Transverse foramen
Vertebral artery flow void Spinal cord
Cerebrospinal fluid
Atlantoaxial joint/superior articular facet

C2
Vertebral body C2/base of odontoid
Vertebral artery Anterior internal venous plexus/epidural

fat
Spinal cord
Cerebrospinal fluid
Vertebral artery
C2 body
Neural foramen
Cerebrospinal fluid
Lamina
Spinal cord
Spinous process
(Top) The 1st of 6 axial T2 MR images from superior to inferior beginning at the level of the anterior arch of C1 is shown. The anterior
atlantodental joint is well identified, bound by the low signal cortical margins of the anterior odontoid and anterior arch of C1.
Posterior to the odontoid is the low signal transverse ligament complex. (Middle) In this image at odontoid/C2 body level, the base of
the odontoid is at the level of the lateral atlantoaxial articulation. This joint is sloped, being more superior at the medial margin. The
vertebral arteries are identified by their flow voids located just lateral to the lateral masses and passing superiorly toward the C1
transverse foramen. (Bottom) In this image at the C2 body level, the relationship of the vertically oriented vertebral artery to the neural
foramen is highlighted.
28
Cervical Spine

AXIAL T2
Intervertebral disc
Vertebral endplate
Vertebral artery flow void
Uncinate process
CSF flow artifact

Spinal cord
Vertebral artery
Transverse process
Pedicle
Articular pillar
Spinal cord
Ligamentum flavum
C3 inferior endplate
Vertebral artery
Neural foramen
Facet joint Cerebrospinal fluid
Spinal cord
Lamina
Spinous process
(Top) In this image at the C2-C3 disc level, the intervertebral disc is fully visualized as low signal, with the bounding posterior lateral
uncovertebral joints. (Middle) Image through the pedicles of C3 is shown. Pedicles are delicate and are directed posterolaterally from
the vertebral body. The superior and inferior articular processes and intervening facet joints form the articular pillars. Prominent
vertebral artery flow voids are seen within the transverse foramina of the transverse processes. (Bottom) Image through the neural
foramina of C3 is shown, which are oriented ~ 45° anterolaterally. The posterior margin of the neural foramen is the facet joint; the
ventral margin is the disc and uncinate process.
29
Thoracic Spine
– Costovertebral joint: Rib head articulates with 2

TERMINOLOGY costal demifacets; superior costal facet of same
Abbreviations number vertebra as rib & inferior costal facet of next
• Costovertebral (CV) vertebral body
– Costotransverse joint: Transverse process of
Synonyms vertebral body T1-T10
• Costal facet = demifacet • Muscles
○ Superficial muscles include trapezius, rhomboid,
GROSS ANATOMY latissimus dorsi, & serratus inferior & superior
Overview ○ Deep muscles include erector spinae (sacrospinalis),
iliocostalis, longissimus, spinalis & semispinalis thoracis,
• Consists of 12 vertebrae (T1-12)
multifidus, rotatores, & interspinalis
• Thoracic kyphosis
• Ligaments
○ 1 of 2 primary spinal curves (thoracic & sacral) present at
○ Anterior & posterior longitudinal, interspinous,
birth, maintained throughout life
supraspinous ligaments & ligamentum flavum
○ Cervical & lumbar lordoses are secondary curves, more
○ Costovertebral ligaments
flexible than thoracic, & result of development
– Radiate ligament connects head of rib & adjacent
– Considerable variability in amount of kyphosis (20-45°)
vertebral bodies
– Each body contributes 3.8° of kyphosis via wedge-
– Costotransverse ligaments (lateral & superior) connect
shaped angulation
neck of rib with transverse process
– Apex at T7
• Biomechanics
– Increases with age
○ Intact rib cage increases axial load resistance 4x
– M<F
○ Rib cage & facets limit rotation
• Thoracolumbar junction
○ Transition from rigid thoracic spine to more mobile IMAGING ANATOMY
lumbar spine
○ T11, T12 ribs provide less rigidity compared to rest of Radiography
thoracic spine • Short C7 transverse process projects inferolaterally; long T1
○ No connection to sternum (free floating) transverse process projects superolaterally
○ Only single rib articulation on vertebral bodies MR
• Unique features of thoracic spine
• Body: Signal intensity of marrow varies with age
○ Articulation with rib cage
○ Hemopoietic ("red") marrow is hypointense on T1WI,
○ Coronal facet orientation
becomes hyperintense with conversion from red →
○ Small spinal canal relative to posterior element size
yellow (age 8-12 years)
Components ○ Endplate, reactive marrow changes normally with aging
• Bones (can be fibrovascular, fatty, or sclerotic)
○ Thoracic vertebrae increase in size from T1 → T12 • Intervertebral disc: Signal intensity varies with age
○ Body ○ Hyperintense on T2WI in children, young adults;
– Typical body contains 2 costal demifacets laterally progressive ↓ water → hypointense on T2WI
– T1 has complete facet superiorly and demifacet ○ Disc degeneration, desiccation, shape change (bulge)
inferiorly; T10 has superior demifacet only; T11 and 12 normal after 2nd decade
have complete facet • Ligaments: Hypointense on both T1 & T2WI
○ Arch
– Pedicle: Projects directly posterior ANATOMY IMAGING ISSUES
– Transverse process: T1 transverse process projects Questions
superolaterally; T1-10 transverse process costal facet • Thoracic spinal cord is protected & shielded from injury by
articulates with costal tubercle paraspinal muscles & rib cage
– Articular processes: Superior & inferior articular • Narrow spinal canal of thoracic spine allows for easy cord
process with coronally oriented facet joint compression with malalignment or trauma
– Lamina • Normal kyphotic posture increases risk of fracture
– Spinous process: T1-T9 project inferiorly; T10-T12 • Thoracolumbar junction at more traumatic risk due to lack
project more horizontally of rib cage stabilization
• Intervertebral foramen
○ Oriented laterally below pedicle Imaging Pitfalls
• Joints • Cervicothoracic junction
○ Intervertebral disc ○ Cervical ribs arising from C7 found in 0.5% population
○ Facet (zygapophyseal) joints ○ Short C7 transverse process projects inferolaterally
– Facets oriented near vertical in coronal plane ○ Long T1 transverse process projects superolaterally
– Limit flexion & extension
○ Rib articulations
30
Thoracic Spine

3D VRT NECT
Spinous process
Lamina
Spinal canal
Medial portion of rib
Transverse process with costotransverse

joint
Anterior cortical margin of vertebral

Inferior demifacet of costovertebral joint body
Intervertebral disc
Superior demifacet of costovertebral
joint
Costovertebral joint
Medial portion of rib Transverse process

Pedicle
Lateral cortical margin of vertebral body
Facet (zygapophyseal) joint
Neural foramen Inferior demifacet of costovertebral joint

Intervertebral disc joint
Medial portion of rib Spinous process
Transverse process with costotransverse

Neural foramen joint
Pedicle
Inferior demifacet of costovertebral joint
Intervertebral disc

joint
(Top) Oblique anterior 3D VRT examination shows the thoracic spine. The complex costovertebral and costotransverse joints are
highlighted in the projection. The superior and inferior demifacets are identified with the joint proper crossing the intervertebral disc
space. (Middle) Lateral oblique 3D VRT examination shows the thoracic spine. The relationship of the neural foramen and the posterior
elements and costal joints is visualized in this projection. The foramen is bounded posteriorly by the facet joint, superiorly by the
pedicle, and ventrally by the posterior margin of the vertebral body. (Bottom) Lateral 3D VRT examination shows the thoracic spine.
The neural foramina are oriented laterally, therefore viewed en face in this projection and bound by the vertebral body anteriorly,
pedicle superiorly, and facet joint posteriorly.
31
Thoracic Spine
3D VRT NECT
Costotransverse joint
Medial portion of rib Spinous process

Lamina
Neural foramen
Left rib Facet joint
Intervertebral disc
Right transverse process
Left transverse process
Neural foramen
Medial portion of rib
Transverse process
Spinous process
Lamina
Left transverse process with
costotransverse joint
Right rib
Left rib
Right transverse process with
Lateral cortical margin of vertebral body
Spinal canal
Medial portion of rib Costovertebral joint
Neural foramen
Pedicle
Facet joint
Right rib
Left rib
Right transverse process
Left transverse process with
Spinous process Lamina
(Top) Oblique anterior 3D VRT examination shows the thoracic spine. The facet joints are partially seen in this projection, primarily
obscured by the posterior surface of the inferior articular facet, which overlaps the dorsal surface of the superior articular facet from
the next caudal vertebra. The thoracic spinous processes are long and directed inferiorly, overlapping the next vertebral body level.
(Middle) Posterior 3D VRT examination shows the thoracic spine. The posterior bony projections of the thoracic spine are highlighted in
this projection, including the spinous processes, transverse processes, and the costotransverse articulations. (Bottom) Axial 3D VRT
examination shows the thoracic spine. The 2 costal articulations are viewed in this projection. The neural foramen is immediately
adjacent to the costovertebral articulations.
32
Thoracic Spine

AXIAL BONE CT
Aorta
Vertebral endplate
Thoracic intervertebral disc
Neural foramen
Spinal canal
Facet (zygapophyseal) joint
Lamina
Spinous process
Aorta
Vertebral body
Spinal canal
Costovertebral joint Pedicle

Facet joint
Lamina
Spinous process
Aorta
Vertebral body
Spinal canal
Superior articular facet Pedicle
Medial rib Costotransverse joint

Transverse process
Spinous process
(Top) The 1st of 6 axial bone CT images presented from superior to inferior at the intervertebral disc level is shown. Neural foramina are
directed laterally and bound anteriorly by the posterior vertebral body margin and dorsally by the facet joint (superior articular facet).
The facet joints are oriented in a coronal plane and strongly resist rotation combined with the costovertebral joints. (Middle) In this
image through the pedicle level of the thoracic spine, the coronal orientation of the facet joints is well identified. The pedicles are
relatively thin and gracile with the adjacent rib articulations. (Bottom) In this image through vertebral body level, the posterior bony
projections are highlighted, including the spinous process, transverse processes, and medial ribs.
33
Thoracic Spine
SAGITTAL T2 MR
Spinal canal with spinal cord

Vertebral body
Ligamentum flavum
Superior endplate
Inferior endplate
Posterior dural margin
Anterior cortical margin
Epidural fat
Intervertebral disc
Spinous process
Anterior longitudinal ligament Interspinous ligament
Supraspinous ligament
Basivertebral vein
Conus medullaris
Facet joint
Pedicle
Neural foramen
Vertebral body
Anterior cortical margin
Lamina
Intervertebral disc
Epidural fat
Neural foramen
Erector spinae muscle
Intervertebral disc
Vertebral body Pedicle
(Top) The 1st of 3 sagittal T2 MR images of the thoracic spine presented from medial to lateral is shown. The square thoracic vertebral
bodies with the small intervening intervertebral discs are identified in this midline view. The spinous processes are large and dominate
the dorsal soft tissues. The thoracic cord is seen in its entirety with its smoothly tapering conus medullaris. (Middle) The facet joints are
identified on this sagittal image with the coronally oriented joints seen in lateral view. The superior and inferior articular processes and
neural foramen are easily viewed in this plane. (Bottom) The more lateral margin of the neural foramen is identified on this section as
well as the costovertebral joints at the disc levels.
34
Thoracic Spine

AXIAL T2 MR
Aorta
Spinal canal Vertebral body

Spinal cord
Pedicle
Transverse process Costotransverse joint
Rib Ligamentum flavum
Spinous process
Aorta
Vertebral body (endplate)

Spinal canal
Spinal cord
Neural foramen
Inferior articular facet Lamina

Spinous process
Aorta
Annulus fibrosus
Intervertebral disc (nucleus pulposus)

Spinal canal
Neural foramen
Superior articular facet Facet joint

Lamina
Supraspinous ligament Spinous process
(Top) The 1st of 3 axial T2 MR images of the thoracic spine is shown. The relationship of the medial rib forming the strong
costotransverse and costovertebral joints is highlighted. The transverse processes extend dorsally and laterally to articulate with the
medial ribs. The spinous process is large and directed caudally. (Middle) In this image through the foraminal level of the thoracic spine,
the neural foramina are directed laterally with their posterior margin formed by the facet joints and anterior margin by the vertebral
body and disc. (Bottom) In this image through the disc level, the coronal orientation of the facet joints is identified, forming the
posterior boundary of the neural foramen. The components of the intervertebral disc are also shown in this section with well-defined
nucleus pulposus and annulus fibrosus.
35
Lumbar Spine
– Superior facet: Concave, faces dorsomedially to meet

TERMINOLOGY inferior facet from above
Abbreviations – Inferior facet: Faces ventrolaterally to meet superior
• Anterior longitudinal ligament (ALL) facet from body below
• Posterior longitudinal ligament (PLL) • Ligaments
○ ALL and PLL, interspinous and supraspinous ligaments
Synonyms ○ Ligamentum flavum
• Articular processes = facets = zygapophyses – Thick in lumbar region
– Connects adjacent lamina
GROSS ANATOMY – Extends from capsule of facet joint to junction of
Overview lamina with spinous process, discontinuous in midline
• 5 discovertebral units (L1-L5) • Muscles
○ Erector spinae: Poorly differentiated muscle mass
Components composed of iliocostalis, longissimus, spinalis
• Bones ○ Multifidi (best developed in lumbar spine)
○ Body ○ Deep muscles: Interspinalis, intertransversarius
– Large oval cancellous ventral mass ○ Quadratus lumborum & psoas muscles
– Larger in transverse width than AP diameter • Biomechanics
○ Endplates ○ Lumbar articulations permit ventral flexion, lateral
– Formed by superior & inferior surfaces of vertebral flexion, extension
bodies ○ Facets prevent rotation
– Consist of concave surfaces of 1-mm-thick cortical ○ Lumbosacral junction motion checked by strong
bone & hyaline cartilage plates iliolumbar ligaments
– Endplates are transitional between fibrocartilage disc
& vertebral body IMAGING ANATOMY
– Nutrients to disc diffuse via endplates Radiography
○ Arch
• "Scotty dog" demonstrated on oblique view
– Pedicle: Project directly posteriorly
○ Nose = transverse process, eye = pedicle, ear = superior
– Transverse process: Extend out laterally, long and flat
articular process, neck = pars interarticularis, front leg =
on L1-L4, small at L5
inferior articular process
– Articular process: Superior and inferior articular
processes with pars interarticularis between; facet Cross-Sectional Imaging
joints oriented obliquely • Facet joint orientation
– Lamina: Broad, thick, overlap minimally ○ Facet joint angle is measured relative to coronal plane
– Spinous process ○ Normal facet joint angle ~ 40°
• Intervertebral foramen ○ More sagittally oriented facet joints (> 45°) at L4 & L5
○ Aperture giving exit to segmental spinal nerves and levels ↑ incidence of disc herniation & degenerative
entrance to vessels spondylolisthesis
○ Oriented laterally below pedicle
○ Boundaries ANATOMY IMAGING ISSUES
– Superior & inferior pedicles of adjacent vertebrae
Imaging Pitfalls
– Ventral boundary is dorsal aspect vertebral body
above and intervertebral disc below • Lumbosacral junction
– Dorsal boundary is joint capsule of facets and ○ Transitional lumbosacral vertebrae
ligamentum flavum – Congenital malformation of vertebrae, usually last
○ Vertical elliptical shape in lumbar region lumbar or 1st sacral vertebra
– Vertical diameter 12-19 mm – Bony characteristics of both lumbar vertebrae and
sacrum
– Transverse diameter from disc to ligamentum flavum
~ 7 mm; thus, little room for pathologic narrowing ○ Vertebral facet asymmetry (tropism)
• Joints – Asymmetry between left & right vertebral facet
(zygapophyseal) joint angles
○ Intervertebral disc
– Outer annulus fibrosus (alternating layers of collagen – Tropism defined as mild (6-10°), moderate (10-16°), or
fibers) severe (> 16°)
– Inner annulus fibrosus (fibrocartilaginous component) – Variable relationship between facet joint tropism &
disc herniation at L4 and L5 level
– Transitional region
– Central nucleus pulposus (elastic mucoprotein gel
with high water content)
○ Facet (zygapophyseal) joints
– Facet joints oriented obliquely
36
Lumbar Spine

RADIOGRAPHY
T12 ribs
Pedicle L1 body
Facet joint L2 body

L3 body
Transverse process
Spinous process
L4 body
Lamina
L5 body
Sacral ala
Sacroiliac joint Sacral foramen
T12 ribs
Neural foramen L1-L2
Inferior endplate L2
Pedicle
Superior endplate L3
Intervertebral disc space Inferior articular process L3
Superior articular process L4
L5 body Facet joint

L5-S1 intervertebral disc space Pars interarticularis L5
S1 body
"Scotty dog" Transverse process

Superior articular process (ear)
Transverse process (nose)
Pedicle (eye)
Pars interarticularis (neck) Inferior articular process (front leg)
Pars interarticularis L5
(Top) AP view shows the lumbar spine. The lumbar bodies are large and rectangular in shape with relatively thick intervertebral disc
spaces. The pedicles are viewed en face with the adjacent facet joints incompletely visualized due to their obliquity. The large
horizontal transverse processes are easily identified at the pedicle levels. (Middle) Lateral view shows the lumbar spine. The large,
strong lumbar bodies join with the stout lumbar pedicles and posterior elements. The neural foramina are large and directed laterally.
The boundary of the neural foramen includes the posterior vertebral body, inferior and superior pedicle cortex, and superior articular
process. (Bottom) Oblique view shows the lumbar spine. The typical Scotty dog appearance of the posterior elements is visible. The neck
of the dog is the pars interarticularis.
37
Lumbar Spine
3D VRT NECT
Transverse process
Neural foramen
Inferior endplate
Intervertebral disc space Superior articular process
Superior endplate
Pedicle
Vertebral body
Transverse process
Neural foramen
Vertebral body
Spinous process
Inferior endplate Inferior articular process
Superior endplate
Pedicle
Pars interarticularis
Transverse process
Pars interarticularis Lamina
Spinous process
Facet joint
(Top) Left anterior oblique 3D VRT NECT examination shows the lumbar spine. The broad, stout pedicle/vertebral body junction is
highlighted in this projection with the superior facet arising as the dorsal extension. (Middle) Left lateral 3D VRT NECT examination of
the lumbar spine shows the neural foramen seen en face as it projects laterally. (Bottom) Left posterior oblique 3D VRT NECT
examination shows the lumbar spine. This view shows the surface anatomy inherent in the "Scotty dog." The transverse process (nose),
superior articular process (ear), inferior articular process (front leg), and intervening pars interarticularis (neck) are well defined. The
pedicle that forms the "eye" on oblique radiographs is obscured. The oblique sagittal orientation of the facet joints is evident in this
view, restricting lumbar rotation and allowing flexion/extension.
38
Lumbar Spine

AXIAL BONE CT
Psoas muscle
Intervertebral disc
Neural foramen
Facet joint
Lamina
Spinous process
Vertebral body
Pedicle
Superior articular process & facet
Facet joint
Inferior articular process & facet
Ligamentum flavum
Spinous process
Vertebral body
Basivertebral vein
Vertebral canal Pedicle
Transverse process
Lamina
(Top) The 1st of 6 axial bone CT images through the lumbar spine is presented from superior to inferior. This image is at intervertebral
disc and lower neural foraminal level. The posterior intervertebral disc forms the lower anterior border of the neural foramen, which
contains primarily fat. Exiting nerves are in the upper neural foramen. (Middle) This image through the facet joint demonstrates the
typical lumbar morphology with the superior facet showing a concave posterior surface and inferior facet showing the complementary
convex anterior surface. Facet joints are oriented ~ 40° from the coronal plane. An angle of > 45° from the coronal plane increases
incidence of disc herniation and degenerative spondylolisthesis at L4 and L5 levels. (Bottom) This image shows the triangular central
vertebral canal and posteriorly oriented pedicles. Basivertebral veins enter the vertebral body through the posterior cortex.
39
Lumbar Spine
AXIAL BONE CT
Vertebral body
Basivertebral vein
Pedicle
Vertebral canal
Transverse process
Lamina
Spinous process
Psoas muscle
Vertebral body endplate
Posterior longitudinal ligament
Neural foramen
Ligamentum flavum
Vertebral canal Lamina
Spinous process
Psoas muscle Intervertebral disc
Neural foramen
Facet joint Superior articular process
Lamina
Ligamentum flavum
Spinous process
(Top) This image at the midvertebral body level shows a thick cortical vertebral body margin and midline posterior basivertebral veins.
The pedicles are strong, thick, and directed posteriorly. Large transverse processes project from the lateral margins. (Middle) In this
image at the endplate level, the neural foramen is identified, opening laterally. The posterior elements have a T pattern with the large
posteriorly directed spinous process. (Bottom) This image through the intervertebral disc level again demonstrates the lower neural
foramen bound anteriorly by intervertebral disc and posteriorly by the superior articular process and facet joint. Oblique coronal
orientation of the facet joints is again appreciated. Asymmetry between the left and right vertebral facet joint angles with 1 joint
having a more sagittal orientation than the other is termed tropism.
40
Another random document with
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as many inventions of real novelty and magnitude as ever, though
we doubt if there is; and yet there would be circumstances which
prevented a legislator regarding them as most important. One of
these circumstances is certainly the exaggerated importance of
minor improvements, in consequence of the great development of
machinery and manufacturing. A single improvement to save 10 per
cent, in fuel for the steam engine would probably add more
absolutely to the real wealth of this generation than the invention of
the steam-engine itself added to the real wealth of the generation in
which it was invented. A recent invention just spoken of—the
feathering of the blades of screws, increasing the facilities of using
auxiliary steam-power in ships—might compare on the same footing
with the most substantial invention of a poorer age. Just as the
refinement of the machinery of credit, and the extent of its
development, cause the least disturbance to be widely felt, so the
least improvement in mechanical or chemical knowledge, applied to
manufactures, may have great results. A revolutionary invention—
owing to the difficulty of introduction—might not tell so quickly even
as a minor improvement in an existing groove; but, in any case its
effects will now be matched at the first start by these minor
improvements.
These improvements again, as well as the great inventions
themselves, are usually come at in recent times in a different way
from that of the old inventor. Formerly the inventor had almost
nothing, before him—every department of industry had to be built up
from the foundation. Now a man must build upon extensive
knowledge of what has been accomplished, and must have great
means at his command. What Mr. Mill has just been explaining in his
new book in regard to original authorship in the present day is
equally true of invention: “Nearly all the thoughts which can be
reached by mere strength of original faculties have long since been
arrived at; and originality, in any high sense of the word, is now
scarcely ever attained but by minds which have undergone elaborate
discipline, and are deeply versed in the results of previous thinking. It
is Mr. Maurice, I think, who has remarked, on the present age, that
its most original thinkers are those who have known most thoroughly
what had been thought by their predecessors; and this will
henceforth be the case. Every fresh stone in the edifice has now to
be placed on the top of so many others, that a long process of
climbing, and of carrying up materials, has to be gone through by
whoever aspires to take a share in the present stage of the work.”
That is—when we speak of invention—the inventor must be a man
who is closely associated with capitalists, or be a capitalist himself.
In no other way can he have the means of knowing the thousand
improvements of machinery and processes which have culminated in
the present factories and machines; and in no other way can he find
means for experiments on the necessary scale. “Poor men,” says Sir
William Armstrong, “very often come to me imagining that they have
made some great discovery. It is generally all moonshine, or if it
looks feasible, it is impossible to pronounce upon its value until it has
passed through that stage of preliminary investigation which involves
all the labour, and all the difficulty, and all the trouble.” How is a poor
man to get this preliminary investigation undertaken, when the
subject is an amendment of a complicated manufacturing process?
The complaint, in fact, was made before the Select Committee on
Technical Instruction, that English manufacturing was suffering from
foreign competition, because there is less room now than formerly
for the play of “untaught invention.” The machine is too perfect for
the workman to meddle with; and thus the foreigner, supposed to be
more technically instructed, has room to excel us—our peculiar
power having been “untaught invention.”
Such having been the change in the character of invention, it is
easy to see why the Patent-Laws are not only not needed, but are
obstructive. The inventor, in the first place, is not in the position of an
old inventor. To give him scope he must be employed by a
manufacturer or capitalist—that is, his skill must be already highly
valued, the manufacturer naturally employing those who can
introduce amendments and improvements, and keep him abreast or
ahead of competitors. “I believe,” says Sir William Armstrong, again,
“that if you let the whole thing alone, the position which a man
attains, the introduction and the prestige, and the natural advantages
which result from a successful invention and from the reputation
which he gains as a clever and able man, will almost always bring
with them a sufficient reward.” And again: “I think that absolute
discoveries are very rare things; nearly all inventions are the result of
an improvement built up upon a preceding one. A poor man who has
the ability to make really practical improvements is almost sure to
rise in the world without the aid of Patents.” And if the inventor may
be thus indifferent to a Patent-Law, the question as to the
inducement to capitalists to take up inventions may be settled by
their general objection to Patents. Though there are one or two
manufacturers who have monopolised a number of Patents in their
trade, and so turned the law to account, it is from them that the
greatest complaints come—men like Mr. Platt, or Mr. Scott Russell,
or Mr. Macfie, who has just moved the abolition of the laws. The truth
is, capitalists are now in a position to obtain a profit without a Patent
—just as they can sometimes disregard a Patent for a long time till
competition forces it upon them. Patents, then, are not required as
an inducement either to inventors or capitalists, and the reason of
the law fails.
But this is not all. The complaint of manufacturers at the
obstruction of the present law would not be enough by itself, but it is
a very serious matter when invention is part of the business of
manufacturing. The law of Patents, in short, interferes with what has
become the normal process of invention. Mr. Platt states: “I think that
there is scarcely a week, certainly not a month, that passes but what
we have a notice of some kind or other of things that we have never
heard of in any way, and do not know of in the least that we are
infringing upon them.” Sir William Armstrong complains of a personal
grievance: “The necessity which I am under of taking out Patents,
not for the purpose of obtaining for myself a monopoly, but simply for
the purpose of preventing other persons from excluding me from my
own inventions.” And much similar evidence was given before the
Royal Commission, of which Lord Stanley was chairman. Thus the
present law is not wanted to promote invention, and it is injurious to
a kind of invention which would go on luxuriantly without it. The
gradual nature of most inventions is a sufficient security that it will
proceed under the law of competition. Perhaps the practice of
Government is the best indication of the necessity for the abolition of
Patents. A few years ago the manufacturing departments of
Government found themselves so hampered by Patents that they
resolved to try whether they were bound or not, the result being a
legal opinion that they were not bound. But Government is only a
great manufacturer, its work in some departments being less than in
many private businesses. Is there any reason why Government
should be released, and individuals bound to patentees? As to the
supposition that invention will cease, the mere interest of the
Government in paying for anything worth having is found a sufficient
stimulus to invention in the things which it requires; and so it is
assumed will be the interest of competing manufacturers.
There is a universal agreement, moreover, that no Patent-Law
should cover all the inventions which are now covered. It happens
that the strongest condemnation of things as they are before the
Royal Commission came from witnesses who wished a change,
though none suggested anything which commended itself to the
Commission. The idea seemed to be that a separation could be
made between substantial inventions and the improvements or
amendments which are now so important, but are admitted to be
unsuitable for Patents. It was thought that Patents, instead of being
granted indiscriminately, should only be granted in cases of proved
novelty and utility. But no working plan of a court to do this could be
devised, or one which would not probably discourage inventors as
much as the abolition of Patents altogether.
We come, then, to the conclusion that it is for the general interest
that Patent-Laws should be abolished, and that their abolition will do
no great harm to any one—least of all, to the great mass of inventors
or improvers. Perhaps we may point out that, if the circumstances
are as described, this country has a special interest in abolishing
such laws. As the leading manufacturing country in the world, a
Patent here is likely to be worth more to its holder than anywhere
else; consequently our manufacturers are more exposed than any
others to the interruption and worry of Patents. It may well be that
other countries which are less tempting to patentees will find the
balance of competition weighted in their favour in consequence.
Looked at another way, the more that invention falls into the hands of
great capitalists, the more likely is it to strengthen the manufacturing
of a country which is already most powerful. The normal condition of
things is all in our favour, and we should do nothing to thwart it.
Leading Article from the “Spectator,” June 5,

1869.
Those who doubt whether there are subjects upon which no
conclusion is possible, which baffle the ablest and most judicial
minds possessing the best attainable information, should read the
debate which has just taken place on the proposed abolition of the
Patent Laws. The most remarkable fact of the debate was the
uncompromising attack upon these laws by Sir Roundell Palmer, his
eager advocacy of the opinion that they should be at once abolished;
but the most significant speech was made by Lord Stanley, who
exhibited perfectly the incapacity of reasonable men to come to a
wholly satisfactory judgment upon them. In fact, there is a real
balance of considerations which were almost exhaustively stated by
Lord Stanley. If you look at one set of facts, you see good reason for
conceding Patent rights; if you look at another set, you find
innumerable mischiefs arising from the concession; and there is
hardly any means of measuring which set of arguments
preponderates. The motive of granting Patents is primâ facie very
simple and unobjectionable. You wish to encourage inventions, by
which the wealth of the world is so much increased, and you
therefore promise inventors a temporary monopoly of their use, on
the single condition that the inventions shall be made public. But for
some such guarantee, it is said, many inventors would have no
temptation to rack their brains, and capitalists would be afraid to help
them in putting their ideas into a complete shape. That invention, as
a matter of fact, is to some extent encouraged, is certain, though
Lord Stanley hardly touched upon the point. On the other hand,
hardly any Patent-Law can do what it professes, while it is certain to
do much harm; and this is, at least, the character of our own law.
The rewards with which it tempts inventors are too often delusive,
and they at least would have small real cause to complain of its
abolition. No Patent brings its holder any immediate pecuniary right.
He can only sue people who infringe his Patent, and the costliness of
Patent suits is such that he is seldom able to protect himself. To
make the property worth anything, a capitalist must take it up; but the
capitalist, in doing so, stipulates for the lion’s share of the profit.
Probably in ninety-nine cases out of a hundred the reward was
obtained by such speculators, and not by inventors. This, of itself, we
believe, would not be a sufficient argument against conceding
Patent-rights; but it would certainly be sufficient, if inventors could be
induced in some less costly way to surrender their ideas to the
public. Another reason against Patents, stated by Lord Stanley—that
the reward is usually but of all proportion to the service rendered—is
also a strong one, if a better plan can be thought of; but the main
reason, the injury to third parties, is most serious. There is a great
mass of well-founded complaints as to Patents being traps for
manufacturers. Improvements and amendments in the details of
machinery and manufacturing processes, which would inevitably be
come at by the manufacturers themselves, are appropriated
beforehand by inventors who do not possess in reality any particular
merit. Manufacturers, are afraid to make slight alterations, for fear an
inventor comes down upon them; but they never know but what they
may have to encounter an action for “something they have always
done.” Even inventors themselves suffer in this way. It commonly
happened that half-a-dozen men competing in the same line of
business would come almost simultaneously upon the same
discovery; but if A was a week or a fortnight before B, the latter was
excluded from his own discovery. The Patent-Law, then, not only
does little real good to patentees themselves, but a great deal of
mischief to other people. Who is to decide whether the balance of
advantage to the public, through encouraging invention by offering a
rather delusive reward, exceeds the disadvantage of impeding
manufacture and preventing people from using what they
themselves discover?
Lord Stanley, though only recommending the matter for the
“particular handling” of the Government, inclines, on the whole, to
the view that the Patent-Laws do more harm than good; and we are
quite disposed to agree with him. The decisive consideration
appears to be the unavoidable abuse of Patents for inconsiderable
inventions, or inventions of simultaneous discovery. The hardship of
excluding B from a discovery of his own because A had patented it a
week before, is such as to demand the clearest proof of the
expediency of the general law which deprives him of the fruit of his
labours. Where B is a manufacturer, led up to the discovery by the
necessities of competition and suddenly laid under contribution by a
stranger or a rival, the hardship is especially severe. We are not sure
but that to make any Patent-Law tolerably just, special provision
should be made for proof of simultaneous discovery, and either
compensation to all the discoverers by the patentees, or full liberty to
them to make use of their discovery. It is of equal importance,
however, that the amendment of manufacturing processes in detail
should not be checked; and perhaps the fact that the great majority
of Patents now only apply to what may be termed details is a main
reason for abolishing them. It is a simple monstrosity, to quote the
case given by Mr. Scott Russell, that every conceivable shape of a
boiler should be patented, so that the most obvious change of form,
which some particular exigency obviously suggests when it arises,
should not be permissible to a manufacturer unless he pays black
mail to somebody else. If it is said that details are often important,
the answer is that manufacturers and inventors have a sufficient
stimulus with regard to them without a Patent-Law. The pressure of
competition and the large scale of manufacturing, which make
details important, are sufficient inducements to those interested to
find out something new, or encourage others to find out something
for them. Just because invention must usually come in the way of
great manufacturers, who can recoup themselves without Patents,
Patents are no longer necessary. Men like Sir William Armstrong and
Mr. Scott Russell, who are themselves considerable inventors, do
not care for Patents, except to guard themselves against the
interference of others who might take advantage of the present law
to reap where they have not sowed. They are quite content to let
others alone, if they are let alone themselves, deriving their profit
from general excellence of manufacture, of which any single process
which might be the subject of a Patent is only one out of many
details, and perhaps not the most important. Nor do such inventors
conceal their detailed improvements, so that they are in no way
tempted to do anything for the advantage of the public by the present
law. It was observable in the debate that the defence of the present
law rested exclusively with representatives of probably the least
important inventors. Mr. Mundella’s assurance that working men are
attached to the present law, and that inventors of the working class
would either not be tempted to invent, or would be deprived of the
reward of their industry, was, in truth, the only argument in its favour.
But it was plainly insufficient. It would be necessary also to show that
such inventions are overwhelmingly valuable, so as to compensate
for all the injury a Patent-Law must do; but this was not, and we
believe could not be, attempted. The special case of poor inventors
might be met by an organised system of voting rewards to those
whose inventions had been largely adopted and used; but we should
not frame an entire law, which the public do not require, and which
would work a deal of harm, in order to suit their peculiar
circumstances.
Such being the nature of the discussion, it is, of course, not worth
while saying much on the particular defects of the present law. But
there is hardly a single point where some alteration is not called for.
In particular, the Courts for trying Patent cases could be very much
improved; and additional obstacles might be interposed to frivolous
or entrapping Patents. One of the main reasons for total abolition,
nevertheless, must always be the impossibility of suggesting an
amendment for some defect which is not itself open to equivalent
objections. Nothing, for instance, seems so obvious at first sight than
that the present law might be amended by compelling patentees to
grant licences. Yet the Royal Commission which reported in 1865
was decidedly opposed to this suggestion, after hearing all that could
be said for it. There is no means of saying beforehand what should
be the maximum charge for licences, while the moment this principle
is introduced the special use of a Patent as a stimulus to inventors is
tampered with—the prospect of a complete monopoly of which they
are to make as much as they can. Similar objections apply to any
suggestion for cancelling Patents which are not used in a year or two
to some material extent. The best inventions, requiring the greatest
changes in manufacturing machinery, are often the slowest to come
into operation. For the same reason, it would also be impracticable
to compel patentees to grant licences at fixed maximum rates after
their Patent had been two or three years old. It might be just as
impossible then, as at first, to say what the licence fee should be. If
we are to have a Patent-Law, then we can have no substantial
improvement upon the present one; and it is so bad that it can hardly
last. Perhaps there is at present a deficiency of evidence on the
subject—the workmen not having been heard before the last
Commission, and the information presented as to the Patent-Laws of
other countries and their working being very deficient; but though this
may be a good reason for having another inquiry, we anticipate that
it will only confirm the verdict of impartial judges against the present
system.
Extract from the “Saturday Review,” June 5,

1869.
If the interesting debate on Mr. Macfie’s motion proved, what
scarcely needed proving, that our existing Patent-Law is extremely
unsatisfactory in its working, it equally proved that the arguments
against having any Patent-Law at all are not less unsatisfactory. If it
were practicable to discriminate between true and sham discoverers,
and to ascertain with accuracy to whom the merit of every new
invention really belonged, and if it were at the same time easy to
secure to the man who increased the common stock of useful
knowledge the fruit of his own brain, no one would dream of
questioning the moral claim of an inventor to this peculiar kind of
property, any more than we now question the justice of giving to an
author a copyright in his own work. But when it is found, or
supposed, to be extremely difficult to do justice to one man without
causing much inconvenience and some occasional injustice to a
thousand others, there is a strong temptation to sacrifice individual
rights to public expediency. The advocates of a total repeal of the
Patent-Laws generally insist (as Sir Roundell Palmer did in his
ingenious speech), not only that they do a great deal of indirect
mischief, but that the discoverer of the most invaluable invention has
no claim to any reward except the consciousness of having enabled
a number of other men to make colossal fortunes. That such
arguments should be used at all proves little more than an uneasy
consciousness that the proposed repeal would work a certain
amount of real injustice. Men who are strongly impressed with the
expediency of ignoring the claims of inventors struggle to escape the
reproach of injustice by stoutly denying the rights which they desire
to disregard. We would rather see the subject discussed with more
courage and frankness. There are undoubtedly instances in which
private claims must yield to public expediency, and any persons who
think the case of inventors to be one to which this rule is applicable
would do better to say so openly than to try to persuade themselves
and others that those who have created the means of making wealth
have no claim to share in the fruits of their discovery. Sir Roundell
Palmer affected to dispose of the whole difficulty by saying that there
were essential differences between Copyright and invention; but a
principle is not the less sound because you may illustrate it by a
case which is not on all-fours with that to which you apply it. And the
distinctions between Copyright and invention are by no means so
radical as is sometimes assumed. The Copyright-Laws give an
author a special monopoly because it is conceived that the
production of a new work entitles him to a return proportioned to its
merit, as tested by the demand for it in the market. The Patent-Laws
give an analogous monopoly to an inventor on precisely the same
moral grounds. To say, as Sir Roundell did, that a book was a new
creation, whereas an invention was merely the application of the
facts and the laws of nature, which are common property, was to
speak like a lawyer rather than like a philosopher or a man of
science. Whatever other distinctions may be insisted on between
Copyright and invention, this, at any rate, will not bear a moment’s
examination. It may have a colour of plausibility in the case of a
poem, a play, or a novel, though even there it is not altogether
sound. But literature includes history, science, philosophy,
mathematics, and the like; and every book on these and most other
subjects, so far as it has any value, is based entirely upon facts and
laws which are no more the creation of the author than are the facts
and laws on which an invention may be founded. In each case there
is creation in the same qualified sense. Say that a man creates what
he reveals, or what he proves, and the author and the inventor are
equally entitled to be called creators. Say, on the other hand, with
perhaps more accuracy, that to proclaim a previously unnoticed truth
is only to announce what has all along existed in nature and nature’s
laws, and some more modest title than creator must be assumed by
author and inventor alike. The difference between the two cases is
not a difference of principle, but of convenience. The thing created,
either in the book or the machine, is the thought or the method; but
property in a thought or a method is not what the law allows in either
case, simply because it would be impossible to give an effect to such
an enactment. What the law does is to lay hold of the most profitable
mode of using the idea, and say that for a limited time no one but the
originator shall be at liberty, in the one case, to print the book or a
colourable imitation of it; or, in the other, to manufacture or use the
machine or any colourable imitation of that. It is impossible, we think,
to deny the abstract right of a real author or inventor, and more
palpably impossible to deny it in the one case while you admit it in
the other.
Apart from his abstract reasoning, there is much in Sir Roundell
Palmer’s argument to show wide differences in practice between the
cases of authors and inventors. It is undoubtedly true that in a vast
majority of instances the patentee of an invention is not the person to
whom the largest share of the merit belongs. The rule, equally in
scientific discovery and in practical invention, has almost always
been found to be that, when a great step in advance is completed,
no one man can claim the entire merit. If one wins the race, there are
mostly several competitors who get a place. Even Newton had rivals
treading on his heels, and his great discoveries would not have been
lost, though they would certainly have been delayed, if his
marvellous intellect had never been directed to science. The thought
of the world, as represented by a little cluster of inquiring minds, was
fast ripening for the harvest which Newton was the first to reap. But
no one on this account seeks to deprive Newton of his glory. And we
do not see why the pioneers of practical invention should be
deprived of the reward for which they work merely because what
they have done is but to forestall what would have been
accomplished, sooner or later, without them. The real vice of the
Patent-Laws is that they give a full fourteen years’ monopoly to the
first inventor who proclaims himself, even though it may be clear that
he has not a week’s start of a host of competitors. In order to make
sure of adequately rewarding a very few real benefactors of
mankind, you give an inordinate privilege to a great many who have
done nothing at all in proportion to what they receive; and not only
do you prohibit every one from borrowing the patentee’s ideas, but
you actually forbid a second inventor, who has arrived at the same
result without ever having heard of the first, to make any use for
fourteen years of the conclusions which he has worked out by his
own unassisted thought and labour. This, of course, is a gross
injustice, and the opponents of the Patent-Laws say that no
machinery can be devised by which it can be escaped. Another
serious objection to the system, as worked in this country, is the
indiscriminate grant of a Patent to any one who claims it, leaving it to
future litigation to determine whether the Patent is good or bad. The
Law Officers of the Crown receive an enormous amount of fees for
Patent business, and it is their function to determine in the first
instance whether a primâ facie title to the privilege is made out. It
might be supposed that, if the identical invention has been patented
or publicly used before, or if, on the face of it, it is no invention at all,
the application would be refused. Nothing of the sort happens. No
examination of the records at the Patent-office takes place to
ascertain the existence or non-existence of earlier Patents for the
alleged discovery; and even when there is an opposition, and it is
clearly proved (as in the case of the bullet which Mr. Metford devised
and Mr. Whitworth afterwards patented) that there is nothing new in
the invention, the Patent is allowed to go, in order that the claimant
may have the privilege of a jury to try an imaginary right. This is the
way in which the crop of litigation is raised which is so often pointed
to as a reproach to the law. The present Attorney-General, it seems,
has introduced the innovation of rejecting the claims of patentees
where the alleged inventions are palpably frivolous, but something
much more decided than this is needed to make the preliminary
investigation of any real value. The vast number of worthless and
catching Patents taken out merely as traps for manufacturers is
perhaps the greatest nuisance incidental to the system, but it is by
no means the most difficult to suppress.
All these evils must be cured, or sensibly abated, if the Patent-
Laws are to survive; and if this is to be done at all, it can only be by
an effective preliminary inquiry. That there are difficulties to be
encountered in such a scheme cannot be denied, but it is not yet
shown to be so complete an impossibility as Sir Roundell Palmer
assumed it to be. With the best machinery a few Patents would slip
through which, on closer investigation, would be held to be bad; but
even the clumsiest methods of bonâ fide inquiry would have sufficed
to weed out some ninety per cent. at least of the existing Patents. A
mere search by proper officials at the Patent-office, with the aid of
the excellent indexes which they possess, would settle the fate of the
great majority of applications, and the opposition of rival inventors or
manufacturers would expose a great many more if it were not
understood, as it is now, that any opposition before the Law Officers
is a mere waste of time. Under the existing system we have a
tribunal which is not, as a rule, competent for the work, and which
makes no real effort to do it. The Law Officers give up the
investigation in despair; but it by no means follows that a scientific
tribunal, with all the aids which the Patent-office could supply, might
not be found extremely useful. The experiment, at any rate, has not
been tried; and it is scarcely fair to inventors to deprive them of all
protection merely because a perfunctory inquiry by an unscientific
and busy lawyer may have failed to exclude from the list of
patentees a formidable body of mere impostors.
We take it to be quite clear that the attempt to do justice ought not
to be given up until the impossibility of putting the law on a
satisfactory footing is clearly made out. Mr. Mundella is probably as
ingenious as most manufacturers, but he says that all the inventions
in which he is interested came out of the brains of his workmen, and
that they are sharing with him and the public the benefit of their
discoveries. Apart from the serious inconveniences caused by the
law as it is now administered, no one could desire to confiscate the
ingenuity of artisans for the benefit of master manufacturers. As
matters stand now, a poor patentee is generally helpless to turn his
invention into money without the assistance of a capitalist; but to
allow a master, because he is rich enough to use an invention, to
pick the brains of a clever artisan without making him any
acknowledgment, would be to aggravate the plutocratic tendencies
of the age, which most serious thinkers would gladly mitigate as far
as possible. The product of invention and thought is a very difficult
kind of property to protect, but it is not on that account the less
deserving of protection, if any means can be devised for granting it
without too grave an interference with the commercial freedom which
public expediency demands. The subject requires a more searching
investigation than it has yet received. Lord Stanley’s Commission
scarcely touched the root of the matter, and no attempt has even
been made to test the feasibility of such suggestions as the report
contained. It is for those who attack the law to make out a conclusive
case, not merely against the particular system in force, but against
every possible scheme for securing to inventors the benefit of their
own work. And this has certainly not yet been done.
EXTRACTS FROM RECENT CLASS
PERIODICALS.
Along with some true light and sound sense, the shifts to which
advocates of Patent restrictions are put when they venture upon
argument, and the boldness with which advances are being made on
the path of monopoly in the face of attack, may be deduced from the
following extracts picked up at a glance in current periodical class
literature:—
A Good Illustration and Bad Argument.

However absurd it may appear, a valid Patent has been for
fourteen years granted, which gave a monopoly to one person to
make all the pins for all our railways. I should have thought that the
use of wooden trenails to fasten materials together, to have been of
ancient date, but for this Patent. That existing Patent-rights are, to
some extent, obstructive to the “right of way,” is just as true as that
the right to enclose common land is so. The natural remedy, in both
instances, is to reserve “a right of way” to the public, not necessarily
a free right, but one open to all, on payment of a reasonable toll in
the latter, and of a reasonable royalty in the former case. With more
show of justice, might the enclosure of common lands be prohibited
than Patent-rights for inventions be refused, for the common lands
were not only discovered, but in human use before enclosure, which
is more than can be said of any true invention.—Extract from
“English Mechanic,” July 2, 1869.
Growth of Strange Views among Surgeons.

A change in the views of English medical men is perceptible on
the question of the propriety of a surgeon taking out a Patent for an
instrument he has invented. Although we have always felt it the duty
of a physician who subscribed to a fixed code of ethics to abide by
its regulations, and therefore have always opposed, on technical
grounds, the taking Letters Patent on improvements in surgical
appliances, we freely grant that there is no à priori immorality in the
act.... If we read Dr. Chapman’s letter to the British Medical Journal,
we find that he there says: “I have been informed that soon after Dr.
Richardson invented his ether-spray instrument, Her Majesty’s
physician, Dr. Jenner, said, if he were Dr. Richardson, he would
patent the instrument.” And further on we read, “Before I patented
the spine bags, I consulted the President of the College of
Physicians, Sir Thomas Watson, and the head of the Privy Council,
Mr. Simon; and both these gentlemen expressed the opinion that I
was justified in doing so.” Such quotations, in our humble opinion,
show that Dr. Chapman is, in all probability, right, and the majority of
the profession wrong, in objecting to his patenting an instrument
which is by no means mysterious or secret. We shall not be sorry to
see this frank admission gain ground with the profession in this
country, and the prohibition of patenting instruments reconsidered.—
Medical and Surgical Reporter.
What Preliminary Investigation Requires.

... To diminish the period for which he shall be allowed to retain his
exclusive right.... If a gratuitous privilege of five years’ duration be a
sufficient price for John Bull to pay inventors for inducing them to
make their inventions Patent, I know no just reason why he should
pay more in the form of monopoly price for that which he can
purchase for the shorter term.... To enable an efficient preliminary
investigation to be made with facility, either by individuals, or by the
official examiners, I propose to compile a history of inventions,
discoveries, and processes, for one rather more full and modern
than Beckman’s would be required. I have long advocated the
compilation and official publication of this great work, for it is not
nearly enough for this purpose to have only a classified abridgment
of the specifications of English or British Patents. In addition to this,
besides all foreign Patents, a brief classified description of the million
things formerly and now being done and suggested is almost
absolutely necessary to enable either official or private investigators
to arrive at anything like a probable resolution of the question, if a
given thing it is proposed to Patent is new.—Extract from “English
Mechanic,” July 9, 1869.
Hard Pushed for a Defence of Patents.

(Extract from Leading Article in “Engineer” of July 9, 1869.)
In a civilised state, we say, everything is property that is the fruit of
a man’s own intellect, and if the law does not make it property, then
the law, not the principle, is to blame. Advocates for the abolition of
Patent-Laws consider the following as one of their most powerful
arguments: They say that if inventors would restrict themselves to
the initiation of inventions great and good, there might be some plea
for the concession of reward through monopoly or otherwise; but the
fact is otherwise. It suffices to take the most cursory glance at Patent
records, they say, to be made aware that processes great and good
constitute but a very small minority of those on behalf of which
Patent fees are paid and the rights of monopoly claimed.
We readily grant the second clause of the statement. The number
of great and good inventions, by comparison with the obviously trivial
claims, is very small indeed; but we altogether fail to perceive what
legitimate source of grievance this can be to the public. On the
contrary, it seems to us demonstrable that under a competent
system of Patent-Law organisation the fees accruing from these
claims of trivial intrinsic import might be utilised and made to fructify.
The surplus thus accruing might be used in diminution of existing
Patent fees, in establishing a museum of inventions creditable to the
nation and the epoch, and in other ways conducive to the
development of invention in general.... Our own experience points to
many cases like this; wherefore we are assured a proposition of
some not wholly averse to Patents, whereby they would establish
courts of preliminary investigation to determine whether any given
process should be deemed worthy of patenting or not, would be
altogether futile.
According to our way of viewing the case, the registration of
inventive novelties should be encouraged on other grounds than that
already specified. We hold the record of failures to be of, at least,
equal importance to the record of successes. Anybody who has
given much time to promote invention will, we are sure, coincide in
our opinion, that the knowledge of what others have been unable to
accomplish in some particular line of invention is one of the most
likely conditions of his own success. This collateral value of failures
does not seem to have been heeded by those who are most
prominent amongst the advocates of Patent abolition. From matters
of undisputed non-success, we pass now to the consideration of
others confessedly of some value, but the importance of which is
trivial. In respect to such it is argued by Mr. Macfie that they much
embarrass the manufacturer by needlessly stopping the way until
terms can be come to with the inventor. The plausibility of this
reasoning we fail to see. Does not the assumed worthlessness of an
invention of the series contemplated bar the need of coming to terms
with the inventor at all? What manufacturer in his senses would treat
for the use of an invention that he knows to be worthless—such
foreknowledge being a postulate on which the argument is raised,
and on which the objection turns? The national value of a readily-
accessible and classified record of invention must be obvious to all.
Those who would desire to uphold the Patent-Laws, and those who
would wish to abolish them, must alike coincide in this point. We
insist upon this part of the subject all the more strenuously from the
conviction that the upholding the abrogation or modification of the
Patent-Laws will turn, after all, on considerations of public
expediency, not on considerations of right and wrong to individual
inventors. This being so, the collateral value of Patent-Laws, in
establishing a record of inventive progress, cannot be too
prominently kept in view.
PATENT RIGHTS AND PATENT WRONGS.

Sir,—On page 279, in speaking of steel rails, you say: “Could a
better result than that achieved by Mr. Bessemer, and by those who
hold licences under him, have been arrived at under the ‘No-Patent’
system?” Decidedly not, for it has landed them in wealth; but I will
suppose a by no means improbable case. Suppose Belgian
manufacturers had secured Patent-rights in England, and demanded
a royalty preventing English manufacturers from selling their steel
rails, as you state, under 12l. per ton, when without such royalty they
could be sold at 9l. per ton. Now, the case would stand thus: the
Belgian manufacturers could be supplying the world with steel rails
at 9l. per ton, while the English manufacturers were prevented by
their own laws for fourteen years from manufacturing them under
12l. per ton, although all the materials were lying at their doors, and
both masters and men wanting the work. If England wishes to
maintain her position in the trading and manufacturing world,
monopolies and prejudice must be things of the past....
You will say the inventor has a right to the invention. Granted;
there were no laws to prevent him from finding it out, and getting all
the advantage he could out of it, and there ought not then to have
been a law made to prevent any one else finding out the process or
improving upon it. I cannot see the right of giving anyone the power
to block the public highway of thought and enterprise. Necessity is
the mother of all useful inventions, and if steel rails were required,
English manufacturers would have soon found out how to make
them, without a Patent Law to help them.
R. R. S.
—From the English Mechanic.
REPORT OF THE CHAMBER OF
COMMERCE OF COLOGNE ON THE
PATENT QUESTION.
For the following translation I am indebted to the Hon. J. C.
Heustler, of the Legislative Council of Queensland:—
The resolution to abolish Patents on inventions, arrived at by the
Chamber of Commerce of Cologne, at their sitting of the 15th Sept.,
1863, has been confirmed in a report to the Ministry of Commerce,
as follows:—
The Patent is a monopoly, and if it has been said in its favour that
it is justifiable and only temporary, it is, notwithstanding, subject to all
the disadvantages in its consequences which are common to all
monopolies.
Endeavours to compete in the sphere of inventions are suddenly
checked by Patents, while, on the other hand, many a patentee,
instead of continuing to work with zeal, and to advance in the
direction commenced, simply occupies himself to watch with
jealousy possible infringements of others on his monopoly during the
currency of his Patent.
Consumers pay exorbitant prices during a number of years for the
manufacture so patented, or receive the same in a less perfect
condition than would be the case if competition had exercised its
wholesome influence on the manufacture of the article in question. It
may be rejoined, that nobody is forced to buy the patented article, or
to make use of the patented invention; also that the common weal
would profit more by the utilisation of an invention, even if burthened
for a period of from five to fifteen years, than not have it in use at all.
To this it could be replied, with good reason, that with the constant
activity which working minds develop upon all fields of industry, the

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Bernard R. Bendok, MD, FAANS

Jamal McClendon, Jr., MD

IMAGING IN SPINE SURGERY ISBN: 978-0-323-48554-8

Copyright © 2017 by Elsevier. All rights reserved.

Publisher Cataloging-in-Publication Data

International Standard Book Number: 978-0-323-48554-8

Last digit is the print number: 9 8 7 6 5 4 3 2 1

To my parents, wife, and children.

Michael P. Federle, MD, FACR

Donald V. La Barge, III, MD

C. Douglas Phillips, MD, FACR

Art Direction and Design

Normal Anatomy and Techniques

SPINE ANATOMY GENERAL OVERVIEW

7 cervical vertebral bodies

12 thoracic vertebral bodies

5 fused sacral vertebral bodies

C8 root exiting at C7-T1 level

Thoracic intervertebral discs

T12 root exiting at T12-L1 level

Lumbar intervertebral discs

Normal Anatomy and Techniques

(Left) Graphic shows the

(Left) Graphic shows thoracic

(Left) Graphic shows the

(Left) Oblique view of the

(Left) Graphic shows lumbar

Normal Anatomy and Techniques

Medullary branches Posterior spinal arteries

Anterior spinal artery

Ventral branch of segmental

Intercostal artery (segmental

Anterior spinal artery

Subdural potential space

Posterior spinal arteries

– Transverse ligament: Strong horizontal component

Normal Anatomy and Techniques

Apical ligament Opisthion

Anterior longitudinal ligament Posterior longitudinal

Cruciate ligament Transverse ligament

Odontoid anterior to cruciate

Superior articular facet

Normal Anatomy and Techniques

Anterior articular facet for

Superior articular facet

Body Transverse process

Inferior articular facet

Articular facet for posterior

Superior articular facet

Lamina Transverse process

Inferior articular process

C2 bifid spinous process

C2-C3 disc space

Posterior spinolaminar line

Normal Anatomy and Techniques

Basion Occipital condyle

Uncinate process C2-C3 intervertebral disc

C1 lateral mass Odontoid process

C2 body C2-C3 intervertebral disc

Superior cortex of anterior arch C1

Transverse foramen Superior articular facet C1