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2 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 Q 140 Ch002-X5619.indd 140 Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT 2008/2/14 05:14:06 Intercostal Vessels and Nerve, Posterior 2 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). Q Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT Ch002-X5619.indd 141 141 2008/2/14 05:14:10 2 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 Q 142 Ch002-X5619.indd 142 Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT 2008/2/14 05:14:13 Vertebral Venous Plexuses 2 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. Q Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT Ch002-X5619.indd 143 143 2008/2/14 05:14:18 2 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 Q 146 Ch002-X5619.indd 146 Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT 2008/2/14 05:14:21 Deep Muscles of the Back 2 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. Q Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT Ch002-X5619.indd 147 147 2008/2/14 05:14:24 2 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 Q 150 Ch002-X5619.indd 150 Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT 2008/2/14 05:14:29 Suboccipital Triangle 2 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). Q Back and Spinal Cord Advance Sample Chapter -- NOT FINAL PRODUCT Ch002-X5619.indd 151 151 2008/2/14 05:14:33