Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS - G. Cramer, S. Darby (Mosby, 1995) WW

450 Pages·1995·66.23 MB·English

BASIC AND CLINICAL ANATOMY OF THE

SPINE, SPINAL CORD,

ANDANS

BASIC AND CLINICAL ANATOMY OF THE

SPINE, SPINAL CORD,
ANDANS

GREGORY D. CRAMER, D.C., Ph.D.

Professor, Department of Anatomy

Dean of Research,

The National CoUege of Chiropractic

SUSAN A. DARBY, Ph.D.

Associate Professor

Department of Anatomy

Assistant Academic Dean

The National College of Chiropractic

Illustrator'

ALLY A. CUMMINGS
M . .

PhotograjJher

RON MEN CHIN

with 293 illustrations

T� Mosby

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Composition by Graphic World, Inc.

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Ubrary of Congress Cataloging in Publication Data

Cramer, Gregory D.

Basic and clinical anatomy of the spine, spinal cord, and ANS /

Gregory D. Cramer, Susan A. Darby; iUustrator, SaUy A. Cummings;

photographer, Ron Mensching.

p.
cm.

Includes bibliographical references and index

ISBN 0-8016-6467-5

1.
Spinal cord-Anatomy.
2.
Spine-Anatomy.
3.
Autonomic nervous

system-AnalOmy.
I.
Darby, Susan A.
11.
Title.

[DNlM:
I.
Spinal Cord-anatomy & histology.
2.
Autonomic Nervous

System-anatomy & histology.
WL
400
C889b
1995)

QM465.C73
1995

611 '.82-dc20

DNlM!DlC

for Library of Congress

98
99
00
01
02
/
9
8
7
6
5
4
3
2

94-30169

C1P

Contriblltors

WIL.LL\;\( E. BACIIOP, Ph.D.

Professor

Department of Anatomy

The National CoUege of Chiropractic

8\ {L\\ \". BAKKUM, D .
.. , ph.D.

Assistant Professor

Department of Anatomy

The National College of Chiropractic

DARRYL L D\LEY, Ph.D.

Assistant Professor

Division of Natural Science and Mathematics

Snow College

CJl-\E-SO, 'G RO. M.D., Ph.D.

Associate Professor

Department of Anatomy

The National College of Chiropractic

PETER C. SlATHOPOl LOS, M.Ed ..
.. D.C.

Professor

Department of Anatomy

The National College of Chiropractic

v

To

Chris and David

Dave, Katherine, and Jason

Thank you for your invaluable support, patience, and encouragement

throughout the writing of this text.

Forewords

Drs. Cramer and Darby, with the able assistance of col­

leagues in Anatomy and Physiology at the National

College of Chiropractic, have created a remarkable re­

source for both clinicians and students.

Basic and Clinical Anatomy of the Spine, Spinal

Cord, and ANS is designed to facilitate a learner's un­

derstanding of important anatomic concepts and their

relationship to clinical practice. The most important as­

pects of this book include comprehensive coverage of

spinal anatomy and related neuroanatomy with clear ex­

planations of structural relationships; the extensive use

of iUustrations and photographs to enhance anatomic

detail; and numerous well-referenced clinical pearls that

relate anatomy to clinical care.

Anatomy faculty and students will find that this book

goes beyond a mere description of the structure of the

spine and nervolls system. It sets out to explain how a

structure developed, to uncover patterns of distribution,

and to foster an appreciation of the morphologic basis of

variation. Anatomic facts are presented within the con­

text of their mutual relationships and clinical relevance.

viii

This inevitably leads to comprehension of the underly­

ing principles involved and facilitates anatomic reason­

ing and easier acquisition of additional morphologic

facts and concepts.

For the cliniCian, this book provides essential back­

ground knowledge for the safe and appropriate care of

patients with neuromusculoskeletal disorders of the

spine. Valuable chapters have been included on the sur­

face anatomy of the back, muscles that influence the

spine,
pain
of
spinal
origin,
and
the microscopic

anatomy of the zygapophyseal joints and intervertebral

discs. Special emphasis is placed on stnlCtures that may

be affected by manual spinal techniques. Each chapter is

extensively referenced. I highly recommend this invalu­

able resource to all students and practitioners who reg­

ularly care for patients with spinal disorders.

Alan H. Adams, D.C.

Vice President for Professional Affairs

Los Angeles CoUege of Chiropractic

Whittier, California

Medical textbooks are usuaLly targeted at the interests

anel needs of undergraduate medical students. While on

one hand this helps provide a common language among

health care providers, it frequently does not do justice to

several special areas of concern to those students and

practitioners interested in neuromusculoskeletal func­

tion. Nowhere is that deficiency more apparent than in

the anatomy of the spine and of the autonomic nervous

system, two areas that are of particular relevance to clin­

ical practice. This has placed a burden on those involved

in the teaching of anatomy, as well as on those desiring

to extend their knowledge beyond the rather terse de­

scriptions of these topics available in most anatomy

texts.

Therefore I received with enthusiasm the news that

Drs. Cramer and Darby were embarking on a project to

create a text that would remediate many of the deficien­

cies in existing anatomic textbooks. Some of my excite­

ment came from the fact that I have known these au­

thors for many years and have recognized their commit­

ment to undergraduate and graduate education.
My

optimism was based on the knowledge that their teach­

ing methods and style of exposition had been "field

tested" on literally thousands of students over more

than a decade. I am pleased to say that the product does

not disappoint. The authors present difficult concepts

clearly and concisely. The selection of material is appro­

priate for both the undergraduate student and for any­

one in the field wishing to solidify their foundations or

"brush up" for examinations.

In recognition of the highly visual nature of anatomy,

the text is supplemented with detailed illustrations,

many in full color. In addition, many high-quality pho­

tographs taken of careful cadaver dissections reinforce

further important concepts in the anatomy of spinal re­

gions. I believe that this is particularly helpful to the stu­

dent of anatomy who is asked to dissect the spinal re­

gion aided only by atlases, which do not do justice to the

region. Finally, I am very pleased by the addition of ra­

diographs, computed tomograms, and magnetic reso­

nance images. With the proliferation of diagnostic imag­

ing technology in clinical practice comes a special im­

portance
in
presenting
radiographiC
anatomy
in
a

manner that supports further study of radiographic

pathology. In short, I believe that this text fills an im­

portant deficiency in modern medical anatomy text­

books and will be a valuable addition to any library.

Rand S. Swenson. D.C.. M.D., PIl.D.

Department of Anatomy and Section of Neurology

Dartmouth Medical School and Dartmoutll-Hirchcock Medical Center

Editor, Journal of tbe Nellromllsculoskeletal !»stem

ix

Preface

Current anatomy texts that describe the spine, spinal

cord, and autonomic nervous system frequently discuss

this material in a rather general way. Often the pages de­

voted to these topics are scattered throughout the text,

deemphasized, or relegated to later chapters. At the

other end of the spectrum, several highly specialized

texts on spinal anatomy describe a single region of the

spine. In some instances even subregions of the verte­

bral column, such as the intervertebral discs or interver­

tebral foramina, become the sole topic of the text. These

general and specialized texts both serve important pur­

poses. However, we felt that a need existed for a cohe­

sive, well-illustrated text covering spinal anatomy, which

included the neuroanatomy of the spinal cord and the

autonomic nervous system as well.

The purpose of this book is threefold:

• To provide an accurate and complete text for stu­

dents studying the spine, spinal cord, and auto­

nomic nervous system.

• To serve as a reliable reference to spinal anatomy

and related neuroanatomy for clinicians and re­

searchers.

• To help bridge the gap between the basic science

of anatomy and the applied anatomy of clinical

practice.

To accomplish the first purpose the anatomy of the

spine, spinal cord, and autonomic nervous system is or­

ganized with both the student and the clinician in mind.

The first chapter on surface anatomy provides both the

neophyte and the seasoned clinician with a valuable re­

source-a comprehensive view of surface landmarks

and the vertebral levels of clinically relevant structures.

General concepts also are emphasized throughout the

book through many illustrations and photographs to

help the reader establish a three-dimensional image of

the spine, spinal cord, and autonomic nervous system.

The second purpose of the text was accomplished

with a thorough search of the current literature in spinal

anatomy, with the results of many of these clinically

relevant studies included in the text. Even though the

science of anatomy is very old, a surprisingly large num­

ber of studies related to spinal anatomy continue to

appear in the scielltific literature. The past 15 years

have also seen an explOSion of new neuroanatomic

information.

Including the results of recent investigative studies

also provided a means by which the third objective of

this book was attained. This objective was to serve as a

bridge between the basic science of anatomy and the ap­

plied anatomy of clinical practice. Throughout the text

the results of clinically relevant research have been pre­

sented with a red nile running beside, thus providing a

rapid reference to this clinically applicable information.

III addition, a chapter on pain generators and pain path­

ways of the back has been included (Chapter 11). This

chapter focuses on those stnICtures that can be a source

of back pain and details the manner by which the re­

sulting nociceptive stin1uli are transmitted and perceived

by the patient.

Numerous magnetic resonance imaging scans have

been included throughout this text. The purpose of

these scans is not only to demonstrate clinically relevant

anatomy, but also to aid the tmfamiliar reader beginning

the exciting process of learning cross-sectional spinal

anatomy, which is often clearly demonstrated on these

scans.

xi

xii
PREFACE

This book is designed to serve the needs and interests

of many groups. The basic anatomy and concepts should

be an aid to the beginning student of spinal anatomy

whether they be allopathic, osteopathic, chiropractic, or

physical therapy students. The text should also provide

a ready source for those in clinical practice desiring a

rapid reference on a specific topic related to the spine,

since the book is arranged topically and exhaustively

indexed. Finally, the inclusion of the results of recent re­

search studies, as well as discussions on clinically related

topics, will hopefully spark interest and highlight the im­

portance of the spine for the new students, as well as the

experienced individual.

Gregory D. Cramer
Susan A. Darby