LECTURE02

*Gross Anatomy
Blood s u p p l y o f t h e
spinal cord

BY
Dr Farooq KhanAurakzai

Date: 02.02.2022
 GROSS FEATURES o f Spinal cord
The spinal cord begins as the continuation of the
medulla oblongata of the brain at the level of the
foramen magnum in the skull.
Cylindrical in shape.

Ends at L1/L2 (adult)

L3 (Newborn).

It occupies upper 3rd of the vertebral canal.

Surrounded by 03 layers ofmeninges:

Dura matter.
Arachnoid Mater.
Pia Mater.

CSF in subarachnoid space.

 GROSS FEATURES o f S p i n a l c o r d … … c o n ’ t

Along its course, the spinal cord

gives rise to 31 pairs of the spinal
nerves.

08 Cervical
12 Thoracic
05 Lumber
05 Sacral and
01 Coccygeal.
 GROSS FEATURES 0 f S p i n a l c o r d … . c o n ’ t
Enlargements:
Limbs form the appendages of the trunk.
Their muscles have to be supplied by
neurons of spinal cord.
Neurons at appropriate levels form
enlargements to be able to supply
increased musculature.

Spinal cord presents:

Cervical enlargement for supply of

upper limb muscles.
Extends from C4 toT2.

Lumber enlargement for supply of

lower limb muscles.
Extends from L2 to S3.
 Main F e a t u r e s o f t h e S p i n a l c o r d

Conus medullaris
Tapering end of spinal cord.
It occurs near lumbar vertebral levels (L1)
and (L2), occasionally lower.

Corda Equina:
Horse tail shape structure.
Contain nerves from L2 to L5.
S1 to S5.
Coccyx.
 Main f e a t u r e s o f t h e s p i n a l cord……con’t

FilumTerminale.
Tip of the conus medullaris of spinal
cord at lower border of L1.
Pierce the dura and arachnoid – at the
level of S2, then leaves sacral Hiatus.
Periosteum of posterior surafce of first
coccygeal vertebra.

Denticulate Ligaments:

Between the nerve roots, the piamater

thickens to form the denticulate
ligaments.
 Comparison o f s p i n a l segment a n d
vertebral level

As the spinal cord is much shorter

than the length of the vertebral
column, the spinal segment do not
lie opposite the corresponding
vertebrae.

In estimating the position of a spinal

segment in relation to the surface of
the body.

It is important to remember that

the vertebral spine is always lower
than the corresponding spinal
segment.
 Comparison o f s p i n a l segMent an d v e r t e b r a l l evel …. co n ’ t

The level of spinal segment with

their vertebral level are as follows.

Spinal Segments Vertebral Level

C1-C3 C1- C3
C4-C8 C4-C7
T1-T6 T1-T4.
T7-T12 T5-T9
L1-L5 T10-T11
S1-S5 and Co1 T12-L2
Comparison o f s p i n a l segment a n d v e r t e b r a l
level….con’t
 EXTERNAL FEATURES OFSPINAL CORD
Anteriorly:
The spinal cord reveals a deep anterior
median fissure lodging the anterior spinal
artery.
Posteriorly:
Median sulcus is a thin longitudinal groove
from which a septum runs in the depth of
spinal cord.
Each half is subdivided into anterior, lateral and
posterior regions by anterolateral and
posterolateral sulci.

Ventral and motor nerve roots emerges from

the anterolateral sulcus.

Dorsal or sensory nerve roots enter spinal

cord from posterolateral sulcus.
 Internal structure

White Matter:
Nerve fibers lie outside and gray
matter lies inside.

GREYMATTER:
In the centre of grey matter is the
central canal* containing CSF.

The grey matter is in the form of “H”

shape with a grey commissure joining
the grey matter of right and left sides.
 GREY MATTER….con’t
The Grey matter comprises of one
posterior horn and one anterior horn
on each side in the entire extent of the
cord.
Only in T1-L1 and S2-S4 segments,
there is an additional lateral horn for
the supply 0f viscera.
This is a part of autonomic Nervous
system.
Shape and size of the horns differ in
different segments due to functional
reasons.

Amount of grey matter related to the

amount of muscles innervated.
 BLOOD SUPPLY OF SPINAL CORD
 The spinal cord is supplied with blood by
three arteries that run along its length
starting in the brain, and many arteries that
approach it through the sides of the spinal
column.
 The three longitudinal arteries are called
the
 Anterior spinal artery, and
 Right and Left posterior spinal arteries.

 These travel in the subarachnoid space

and send branches into the spinal cord.
 blood supply o f spinal cord….con’t

 They form anastomoses via the

anterior and posterior segmental
medullary arteries.
 The segmental arteries arises from
outside the vertebral column and
enter the vertebral canal through the
intervertebral foramina.

 These vessels anastomoses on the

surface of the cord and send
branches to the substances of the
white and grey matter.
 A n t e r i o r Spinal A r t e r i e s

It supplies the anterior portion of

the spinal cord.
It is formed by the union of the
two vertebral arteries inside
the skull.

It then descends on the anterior

surface of the spinal cord within
the anterior median fissure.

It supplies almost 2/3rd of the

spinal cord surface.
 A n t e r i o r spinal arteries…..con’t

On its course the artery takes several small

branches (i.e. anterior segmental medullary
arteries), which enter the vertebral
canal through the intervertebral foramina.

These branches are derived from

the vertebral artery,
The ascending cervical artery,
A branch of the inferior thyroid artery in
the neck.
The intercostal arteries in the thorax, and

From the lumbar artery iliolumbar

Artery in the abdomen and

Lateral sacral arteries in

the pelvis.
 a n t e r i o r s p i n a l a r t e r i e s … . .c o n’t

The intercostal,
lumbar and
sacral radicular arteries

 They arise from the aorta,

provide major anastomoses
and supplement blood flow to
the spinal cord.
 Artery of Adamkiewicz.

It is the largest anterior segmental

medullary artery.

Typically arises from a

left posterior intercostal artery at
the level of the T9 to L1 level,
which branches from the aorta.

It supplies the lower two thirds of

the spinal cord via the anterior
spinal artery.
 Segmental spinal artery

They are the feeder arteries that enter the

intervertebral foramina at every level.
So there are 31 pairs of segmental arteries.
 They arise predominantly from the
vertebral and deep cervical arteries in the
neck,
 The posterior intercostal arteries in the
thorax, and

 The lumbar arteries in the abdomen.

 They give rise to

 Anterior and Posterior
 Radicular arteries and
 Segmental medullary arteries.
 Radicular Arteries
 At spinal cord regions below upper cervical
levels, the anterior and posterior spinal
arteries narrow and form an anastomotic
network with radicular arteries.

 The radicular arteries are branches of the

segmental arteries.

 The radicular arteries supply most of the

lower levels of the spinal cord.

 There are approximately 6 to 8 pairs of

radicular arteries supplying the anterior and
posterior spinal cord
 P o s t e r i o r Spi nal A r t e r i e s

 The posterior spinal arteries are paired and

form an anastomotic chain over the posterior
aspect of the spinal cord.
 Arises directly from the vertebral arteries
inside the skull or indirectly from the
posterior inferior cerebellar arteries.
 Aplexus of small arteries, the arterial
vasocorona, on the surface of the cord
constitutes an anastomotic connection
between the anterior and posterior spinal
arteries.
 This arrangement provides uninterrupted
blood supplies along the entire length of the
spinal cord.
 In summary
The spinal cord is supplied by three
longitudinal arteries:

 Single anterior spinal artery - supplies

the anterior two-thirds of the spinal
cord

 Paired posterior spinal arteries -

supply the posterior one-third of the
spinal cord
 Anastomoses between the spinal
arteries, called arterial vasocorona,
supply the peripheral lateral aspect of
the spinal cord (lateral columns)
 summary…..con’t

These have their origin at or near the

cervico-occipital junction and are
small calibre, often appearing
discontinuous.

Thus they require reinforcement by

segmental (radicular) arteries, which
are branches of:

 Ascending cervical artery

 Deep cervical artery
 Intercostal arteries
 Lumbar arteries
 Sacral arteries
 Venous d r a i n a g e
 Venous drainage largely follows arterial
supply.
 That is, there are anterior and posterior
spinal veins and anterior and posterior
radicular veins, which freely
communicate with the internal
vertebral plexus in the epidural space.

 This is in turn drains to the cerebral

dural venous sinuses and cerberal veins
as well as the external vertebral plexus.

 The veins of the spinal cord and

vertebral column are valveless.
Venous Drainage of the Spinal Cord
The Blood Supply of the Spinal Cord

 If any of the medullary arteries are obstructed or damaged (during abdominal

surgery, for example), the blood supply to specific parts of the spinal cord may be
compromised.

 The pattern of resulting neurological damage differs according to whether the

supply to the posterior or anterior artery is interrupted.

 Asmight be expected from the arrangement of ascending and descending neural

pathways in the spinal cord, loss of the posterior supply generally leads to loss of
sensory functions, whereas loss of the anterior supply more often causes motor
deficits.
Blood supply of Vertebrae
THANK YOU…..