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MindMap Gallery Regional anatomy spinal region
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Regional anatomy spinal region
It is very important for medical professionals to have a deep understanding of the anatomy and functional characteristics of the spinal region. Drawing is not easy, welcome to like and collect~
Edited at 2024-03-06 18:28:55
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Regional anatomy spinal region
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- Outline
spinal area
Overview
Boundaries and divisions
realm
Upper limit: external occipital protuberance and superior nuchal line
Lower bound: tip of coccyx
Lateral boundary: the anterior edge of the trapezius muscle, the upper part of the posterior edge of the deltoid muscle, the posterior axillary fold, the posterior axillary line, the posterior part of the iliac crest, the line connecting the posterior superior iliac spine and the tip of the coccyx
Partition
Xiang District
Upper limit: external occipital protuberance and superior nuchal line
Lower bound: the line connecting the spinous process of the 7th cervical vertebra to the acromions on both sides
thoracodorsal area
Upper bound: the lower bound of the nuchal area
Lower bound: the line connecting the spinous process of the 12th thoracic vertebra and the front edge of the 12th rib to the front of the 11th rib
waist area
Upper bound: the lower bound of the thoracodorsal region
Lower bound: the line connecting the posterior portions of the two iliac crests and the two posterior superior iliac spines
Sacrococcygeal area
Upper bound: the lower bound of the waist area
Lower bound: the triangle formed by three points between the two posterior superior iliac spines and the tip of the coccyx
surface anatomy
shoulder blade
The line connecting the medial ends of the scapular spines on both sides is level with the spinous process of the third thoracic vertebra (T3).
The line connecting the lower corners of the scapula on both sides is level with the spinous process of the seventh thoracic vertebra (T7)
The inferior angle of the scapula can be palpated on the body surface
spinous process
The spinous process of the seventh cervical vertebra (C7) can be touched on the body surface and is often used as a marker to identify the number of vertebrae.
The highest point of the iliac crest on both sides of the spinous process of the fourth lumbar vertebra (L4)
sacrum
Sacral hiatus: The notch on the back of the 4th and 5th sacral vertebrae is bounded by the coccyx and is the lower opening of the spinal canal.
Sacral angle: The downward protrusions on both sides of the sacral canal hole, which are easily palpable on the body surface and are often used as needle positioning marks for sacral canal anesthesia.
Lateral sacral ridge: the ridge lateral to the median sacral ridge, which is the symbol for sacral nerve block anesthesia through the posterior sacral foramen.
coccyx
The tip of the coccyx can be palpated in the gluteal groove 2.5cm behind the anus.
iliac crest and posterior superior iliac spine
The line connecting the two posterior superior iliac spines is level with the spinous process of the second sacral vertebra (S2).
The left and right posterior superior iliac spines, the spinous process of the fifth lumbar vertebra (T5) and the tip of the coccyx form a diamond-shaped area.
rib 12
This rib can be palpated lateral to the erector spinae muscles
chirocostal angle
The angle between the lateral edge of the erector spinae muscle and the 12th rib. The kidney is located deep in this angle.
In kidney diseases, there is often percussion pain or tenderness in this area, which is also a commonly used needle insertion site for renal capsule sealing.
Hierarchy
shallow structure
skin
superficial fascia
The superficial fascia in the upper part of the nuchal area contains more fibers, so it is particularly tough. The superficial fascia in the waist area contains more fat.
cutaneous nerve
all come from the posterior rami of spinal nerves
Xiang District
Greater occipital nerve
2nd posterior cervical nerve branch
3rd occipital nerve
Posterior branch of 3rd cervical nerve
The thicker cutaneous branch of the posterior cervical nerve
Chest and back area and lumbar area
gluteal epithelial nerve
It is composed of 1 to 3 posterior branches of the lumbar nerve. It passes through the lumbar area, penetrates the thoracolumbar fascia, crosses the iliac crest, and distributes to the upper gluteal area.
When the waist is sharply twisted, this nerve is easily damaged and is one of the common causes of low back and leg pain.
The branches of the posterior rami of the 12th thoracic nerve distribute to the gluteal region
Sacrococcygeal area
The cutaneous branches of the posterior divisions of the 1st to 3rd sacral nerves form the middle gluteal cutaneous nerve.
Superficial vessels
Xiang District
occipital artery
superficial cervical artery
Branches of dorsal scapular artery etc.
thoracodorsal area
posterior intercostal artery
dorsal scapular artery
branches of thoracodorsal artery etc.
waist area
branches of lumbar artery
Sacrococcygeal area
Branches of superior and inferior gluteal arteries
deep fascia
thoracolumbar fascia
back layer
Covers the back of the erector spinae muscle, joins with the latissimus dorsi muscle and serratus posterior inferior aponeurosis, and attaches downward to the iliac crest
Medially attached to lumbar spinous process and supraspinal ligament
The lateral edge of the erector spinae muscle unites with the middle layer to form the erector spinae sheath.
middle level
Located between the erector spinae and quadratus lumborum muscles
Medially attached to the lumbar transverse process apex and transverse process apex ligament
The lateral edge of the quadratus lumborum muscle unites with the anterior layer to form the quadratus lumborum sheath.
As the aponeurosis of the origin of the transverse abdominis muscle, it is attached upward to the lower edge of the 12th rib and downward to the iliac crest
The upper part stretches between the 12th rib and the transverse process of the first lumbar vertebra, and thickens to form the lumbocostal ligament.
front floor
Located in front of the quadratus lumborum muscle, also known as the quadratus lumborum fascia
Medially attached to the tip of the transverse process of the lumbar vertebrae
Attaches downward to the iliolumbar ligament and posterior part of the iliac crest
The upper part thickens to form the medial and lateral arcuate ligaments.
Muscle layer
Superficial muscles
trapezius muscle
innervated by accessory nerve
blood supply
main
superficial cervical artery
dorsal scapular artery
Secondly
occipital artery
segmental posterior intercostal artery
Available for muscle flap or myocutaneous flap transplantation
latissimus dorsi
innervated by thoracodorsal nerve
blood supply
Bounded by scapular line
Lateral: thoracodorsal nerve
Medial: segmental posterior intercostal artery
The thoracodorsal artery can be used as a pedicle to make a transferred or free muscle flap or a myocutaneous flap.
posterior external oblique muscle
middle muscle
levator scapulae
rhomboids
Serratus posterior superioris
serratus posterior inferior
deep muscle
splenius
Erector spinae
Lateral iliocostalis
longissimus intermedius
medial spinalis muscle
erector spinae
Transversospinalis muscle
From shallow to deep
semispinalis muscle
deep neck
rectus capitis major muscle
Rectus capitis posterior minor
oblique capitis muscle
oblique capitis inferior muscle
suboccipital muscle
multifidus
rotators
important triangle
suboccipital triangle
Surrounded by suboccipital muscles
Medial superior boundary: Rectus capitis major posterior muscle
Upper outer boundary: oblique capitis muscle
Inferior outer boundary: oblique capitis inferior muscle
Base: Posterior atlanto-occipital membrane and posterior arch of atlas
The vertebral artery and suboccipital nerve pass through the triangle.
auscultation triangle
Also known as the parascapular triangle, it is located outside and below the trapezius muscle and in the muscle space inside the lower corner of the scapula.
Upper inner boundary: outer lower edge of trapezius muscle
Lateral boundary: spinal border of scapula
Lower bound: upper edge of latissimus dorsi muscle
Bottom: thin layer of adipose tissue, deep fascia and 6th intercostal space
Surface covered with skin and superficial fascia
Meaning: Auscultate the part of the back where breath sounds are clearest. To facilitate auscultation, the scapula can be pulled outward to expand the scope of the triangle.
triangle above waist
Located deep to the latissimus dorsi muscle, below the 12th rib
Medial boundary: lateral border of erector spinae muscle
Lower outer boundary: posterior edge of internal oblique muscle
Upper bound: 12th rib
Base: Aponeurosis of the origin of the transversus abdominis muscle
There are three nerves parallel to the 12th rib deep in the aponeurosis.
subcostal nerve
iliohypogastric nerve
ilioinguinal nerve
top down
In front of the aponeurosis are the kidneys and quadratus lumborum muscle
The extraperitoneal approach for renal surgery must pass through this triangle
Significance: One of the weak areas of the posterior abdominal wall. If the abdominal organs protrude backward through this triangle, lumbar hernia will form.
triangle below waist
Depend on
iliac crest
Lower edge of latissimus dorsi
posterior edge of external oblique muscle
surrounded
Bottom: Internal oblique muscle
Surface covered only by skin and superficial fascia
Significance: Lumbar hernia can also occur in another weak area of the posterior abdominal wall. In retrocecal appendicitis, there is obvious tenderness in this triangular area.
Deep blood vessels and nerves
artery
occipital artery
dorsal scapular artery
vertebral artery
Divided into 4 sections
Section 1: from the starting point to before entering the transverse process foramen of the 6th cervical vertebra
Section 2: Passing through the transverse process foramen of the 6th to 1st cervical vertebrae
Segment 3: Enters the skull through the vertebral artery groove of the suboccipital triangle and the foramen magnum
Segment 4: Intracranial segment
Significance: Cervical bone hyperplasia can cause compression of the second segment of the vertebral artery, causing insufficient intracranial blood supply, which is the so-called vertebral artery cervical spondylosis.
thoracodorsal artery
vein
nerve
31 pairs of posterior branches of spinal nerves
lumbar nerve posterior rami fibrous foramen
Upper lateral boundary: medial edge of the intertransverse process ligament
Inferior boundary: the upper edge of the transverse process of the lower vertebra
Medial boundary: lateral edge of the inferior vertebral articular process
Posterolateral to the intervertebral foramen
posteromedial branch of lumbar nerve osteofibrous canal
Anterior wall: intermastoid paraprocess groove
Posterior wall: superior articular process ligament
Upper wall: mastoid process
Inferior wall: accessory process
Located in the bony groove between the mastoid process and accessory process of the lumbar vertebrae
These channels will deform and narrow, compressing blood vessels and nerves, which is one of the common extraspinal causes of low back and leg pain.
accessory nerve
thoracodorsal nerve
dorsal scapular nerve
spine
Vertebrae and their connections
Uncinate joint (Luschka joint)
Composed of vertebral hooks (C3~C7) and lips (C2~C6)
adjacent to
Rear adjacent to the cervical segment of the spinal cord and spinal canal
Lateral adjacent vertebrae arteries and veins, transverse process foramen
posterolateral adjacent spinal nerve, intervertebral foramen
intervertebral disc
ligamentum flavum
Lumbar puncture or epidural anesthesia needs to be passed through this ligament to reach the spinal canal
intervertebral foramen
adjacent to
Superior wall: superior subpedicular notch
Inferior wall: suprapedicle notch
anteromedial wall
intervertebral disc
vertebral body
vertebral body hook
posterolateral wall
facet joint
ligamentum flavum
spinal canal
adjacent to
front wall
intervertebral disc
vertebral body
posterior longitudinal ligament
back wall
lamina
ligamentum flavum
facet joint
side wall
pedicle
lamina
It can be divided into
central spinal canal
The location of the spinal cord and its capsule
neural spinal canal
The area occupied by the spinal nerve roots in the lateral part of the spinal canal, also known as the lateral recess clinically
spinal canal contents
Spinal capsule and meningeal cavity
membrane
dura mater
Upper: Attached to the edge of the foramen magnum
Bottom: forming a blind end at the height of the 2nd sacral vertebra
arachnoid membrane
Top: Continuous with the cerebral arachnoid membrane
Bottom: The level of the second sacral vertebra forms a blind end.
Pia mater
On both sides of the spinal cord, the pia mater thickens and protrudes outward to form the dentate ligament
spinal cavity
epidural space
Epidural anesthesia
subdural space
subarachnoid space
filled with cerebrospinal fluid
It expands from the first lumbar vertebra to the second sacral vertebra to form the terminal cistern.
filum terminale
ponytail
Perform lumbar puncture or anesthesia between the 3rd to 4th or 4th to 5th lumbar vertebrae
cisterna magna
Puncture site: On the midline of the nuchal area, insert the needle from below the occipital bone or above the spinous process of the second cervical vertebra
Needle insertion stroke: skin, superficial fascia, deep fascia, nuchal ligament, retroatlanto-occipital membrane, dura mater and arachnoid mater
spinal nerve root
Subarachnoid space segment: a segment within the dural sac
Epidural segment: the segment that penetrates the dural sac
spinal cord blood vessels and spinal nerves
artery
anterior spinal artery
posterior spinal artery
Follow the artery
vein
Meningeal branches of spinal nerves (sinovertebral nerves)
Irritation can cause reflex spasms in the waist and hamstring muscles and pain in the lower back and legs.
Cutting off the spinal branches can cause the loss of proprioception of the intervertebral disc, posterior longitudinal ligament, and dura mater.
vertebral venous plexus
intravertebral venous plexus
Distributed between the vertebral periosteum and dura mater
external vertebral venous plexus
Hair distributed outside the spinal canal
intrinsic spinal muscles
During renal surgery, cutting this ligament can increase the width of the 12th rib and facilitate exposure of the kidney.