with a anterior part of the right leg and the dorsomedial aspert

her clinician of the foot down to the big toe. In turther testing, with the
woman visited back and leg. patient lying down in the supine position and her pelvis sta
35-year-oldof severe pain in her lower
her neighbor bilized, the clinician slowly raised the womans right leg by
A
move
complaint how she was helpingwhen
She described
his car, which was stuck
a sharp,
in
shooting
a snowdrift,
pain in her lower
suddenly lifting her heel with the knee extended. This placed tensicn
back. At
the back of on the lumbosacral nerve roots. During this maneuver the
he
she experiencedshe felt a deep, sharp pain down"locked, " and patient experienced severe pain down her leg belcw
the same time, tried to walk but her back felt
She physician knee. Radiographic and computed tomography examinatic
her ight leg. intensitied the pain. When the back as revealed nothingabnormal. However, a magnetic resonance
to move
any attempt hurt, the woman pointed to her lower disc between the fou
it the imaging study showed a herniated
asked where pain and then ran her finger down and fifth lumbar vertebrae. A protruding nucleus pulpcsus
the site of maximum side of her right leg. root, would explain the
thigh and the outer pressing on the fifth lumbar nerve
back of her
the physician noted decreased
On physical examination, region of the spine. woman's symptoms and signs. complaint in clinical practica
range of motion in the lumbosacral
patient was reluctant to put her Lowback pain is a common
spectrum of diseases. The anat
When asked to walk, the pain worsened when sittingin
and may be caused by a wide
weight on the involved leg. The omy of the region is complex, and many structures have the
revealed weakness cause pain. The clinician can identity the cause
and coughing. Further examination weakness in dor potential to
extension of the rightMusclebig toe and slight in both and start treatment only by having a sound knowledge of the
reflexes were normal
sifiexion of the foot.
was present over the anatomy and the pathologic processes involing the area.
lower limbs. A slight sensory deticit

CHAPTER OUTLINE
Deep Fascia (Thoracolumbar Radiographic Anatomy
Overview Vertebral Column
Vertebral Column Fascia) Spinal Subarachnoid Space
Back Blood Supply
Composition Arteries Computed Tomography and Magnetic
Vertebrae
Veins
Resonance lmaging Studies
Vertebral Column Joints
Vertebral Joint Nerve Supply Surface Anatomy
Vertebral Column Movement Lymph Dralnage
Spinal Cord Midline Structures
Back Muscles Spinal Nerves Upper Lateral Part ofof Thorax
Back
Deep Muscles (Postvertebral SpinalCord Blood Supply Lower Lateral Part
Spinal Cord Meninges lliac Crests
Muscles) Spac
Back Muscle Nerve Supply Cerebrospinal Fluid Spinal Cord and Subarachnoid
Muscular Triangles Back Symmetry
 Vertebral Column 45

LEARNING OBJECTIVES of lesions

the baslc anatomy Predict the functional consequences of the
The purpose of this chapter is to review of specific motor nerves and paralysis
and related soft tissue structures
of the vertebral column assoclated muscles.
back Injurles, major contents
in order to understand the basis for common 9. Describe the boundaries and suboccipital
congenital defects, medical
back pain, motor defcits, examination. of the auscultatory, lumbar, and
imaging, and general surface triangles. lymphatic
and thelr major 10. Describe the blood supply and topography and
1. ldentity the bones of the back the
drainage of the back. Note vertebral venous
features. Describe the functional aspects of these major anastomoses of the of the venous
structures.
column, plexuses. Explain the significanceand spread of
2. Identify the regions of the vertebral
and the network in collateral circulation
giving the number of vertebraeatypical vertebrae disease.
features of the spinal
characteristics of typical and 11. ldentify the major external supply of the spinal
in each region.
of the vertebral cord. Describe the vascular
3. Describe the normal curvatures cord.
conditions. Describe
column in pre- and postnatalsignificance of the of a typical spinal cord
12. Describe the components
the features and the clinical segment, including the formation of a typical
the vertebral of a typical
major abnormal curvatures of spinal nerve. Trace the distribution
column. spinal nerve.
a typical embryonic the spaces between
4. Identify the componentsinofeach region of the adult 13. Identify the spinal meninges, of each space.
vertebra and their fate
basis them, and the major contents signiicance of
vertebral column. Describe the embryonic
bifida.
Describe the functions and clínical
of accessory ribs and spina each.
joints and the major of the spinal cord in
5. Identify the intervertebral 14. Describe the development column. Compare
ligaments related to each joint. Identify the relation to that of the vertebral spinal cord, the
movements allowed in each
case.
and contrast the length of theand the relationship
of the intervertebral location of spinal segments,to the intervertebral
6. Describe the components of each.
disc and the functional significance herniated of spinal roots and nerves states.
spaces in pre- and postnatal
of a
Describe the anatomical basis basis for and clinical
("slipped") disc. 15. Describe the anatomical
7. Identify the major forms
of fracture and lumbar puncture (spinal tap)
significance of a anesthesia.
column and the
dislocation of the vertebral versus a caudal
of the vertebral
functional consequences of each. 16. ldentify the major features images.
of the back according column in standard radiographic
8. Identify the muscles Describe their features of the back in a
to their general topography. 17. Identify the majoranatomy examination.
innervation and major actions. Differentiate standardsurface
muscles of the back.
the extrinsic and intrinsic

body weight to the lower limbs.

pelvic girdle, transmits
the roots of the spinal nerves, and the
The spinal cord, the verte
OVERVIEW covering meninges lie within the cavity of to those
the skull to the tip of the great protection
The back, which extends from of the bral column, which provides
can be defined as the posterior surface con structures.
coccyx, and the muscles thaton the
trunk (Fig. 2.1). The scapulae
nect the scapulae to the trunk are superimposed Composition 2.1) is
upper part of the
back. column (Fig. 2.2; also see Fig.
regions-7
The vertebral vertebrae organized in five
33
composed12ofthoracic, 5 lumbar, 5 sacral
(fused to form
VERTEBRAL COLUMN cervical, com
(the lower 3 are many
is the central, longitudinal bony and -4 coccygeal
the sacrum), Numerous joints connect these
The vertebral columnsupports the skull, pectoral girdle, monly fused).
pillar of the body. It and, by way theof
cage
upper limbs, and thoracic