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Intercostal Vessels and Nerve, Posterior
Intercostal nerve
Posterior intercostal artery
Costovertebral joint
Origin of right and left
arteries from aorta
Posterior thoracic wall showing origin of posterior intercostal arteries (Atlas of
Human Anatomy, 4th edition, Plate 172)
The intercostal neurovascular bundle usually traverses the
subcostal groove under the superior rib of the intercostal space. When a
surgical incision or procedure (thoracotomy, thoracocentesis) is performed,
the superior aspect of the intercostal space is avoided.
Clinical Note
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Intercostal Vessels and Nerve, Posterior
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Posterior intercostal
vein
Posterior intercostal
artery
Intercostal nerves
Costovertebral joint
Curved coronal 10 mm slab, volume rendered display, CE CT of the chest
• The intercostal nerves and vessels traverse the potential space between the
internal and innermost intercostal muscles.
• From superior to inferior the typical order of structures in an intercostal space
is vein, artery, and nerve (VAN).
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Vertebral Venous Plexuses
Inferior facet
Vertebral body
Spinous process
Intervertebral disk
Vertebral venous
plexuses
Veins of the spinal cord and vertebral column (Atlas of Human Anatomy, 4th edition,
Plate 173)
Dilation of the internal (Batson’s) venous plexus within the
lumbar epidural space, associated with an epidural varix, can compress the
thecal sac or nerve roots, causing lumbar radiculopathy.
Clinical Note
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Vertebral Venous Plexuses
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Liver
Kidney
Vertebral venous
plexuses
Coronal CE FS T1 MRI of the posterior abdomen
• The internal vertebral venous plexus (Batson’s) is within the spinal canal
whereas the external surrounds the vertebrae.
• The veins of these plexuses are valveless and connect to segmental
intervertebral veins and to the cerebral venous sinuses.
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Deep Muscles of the Back
Rotatores cervicis muscles
Semispinalis thoracis muscles
Spinous processes
Quadratus lumborum muscle
Multifidus muscles
Multifidus, rotatores, and other deep back muscles (Atlas of Human Anatomy, 4th
edition, Plate 176)
Although often not considered important clinically, spasms in
the deep back muscles (especially multifidus) may be associated with
radiculopathy and pain.
Clinical Note
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Deep Muscles of the Back
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Rotatores cervicis muscles
Spinous processes
Multifidus muscles
Quadratus lumborum muscle
Sacrum
Coronal T1 MRI of the back
• The deep back muscles are primarily responsible for delicate adjustments
between individual vertebrae that correlate with changes in posture.
• The three components of the transversospinalis muscle group are semispinalis,
multifidus, and rotatores, but they are not equally developed in all regions
(multifidus is best developed in the lumbar region).
• The deep back muscles are all innervated by segmental dorsal rami.
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Suboccipital Triangle
Rectus capitis
posterior minor muscle
Rectus capitis
posterior major muscle
Vertebral artery
Obliquus capitis
inferior muscle
Trapezius muscle
Superficial and deep muscles of the posterior neck (Atlas of Human Anatomy, 4th
edition, Plate 178)
The rectus posterior muscles may play a role in cervicogenic
headaches via a dense fascial connection between these muscles and the
cervical dura.
Clinical Note
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Suboccipital Triangle
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Rectus capitis
posterior major
muscle
Rectus capitis
posterior minor
muscle
Vertebral artery
Obliquus capitis
inferior muscle
Trapezius muscle
Curved 15 mm slab, volume rendered display, cervical spine CT
• The rectus posterior muscles function in lateral rotation and extension of the
head.
• All the muscles of the suboccipital triangle are innervated by the suboccipital
nerve (dorsal ramus of C1).
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