Spinal Cord and Meninges

Clinical Anatomy II
Spring
Gray’s pp. 101-110
 Vertebral Canal
Notice the venous
plexus surrounding
the spinal cord

Can you describe

the extradural
space to your
neighbor? Lies
between ______
and __________
Why extradural fat?
(What lies within
the extradural fat?
___

Label the spinal

root ganglion,
posterior ramus
and anterior ramus

Which level are

these vertebral
bodies?

Gray’s Fig 2.8, p. 62

 Vertebral Canal
Boundaries:
Anterior – vertebral bodies,
intervertebral discs, posterior
longitudinal ligament

Posterior – vertebral arch, laminae (in

midline -spinous process and
interspinous ligaments), ligamenta flava

Contents: Spinal cord, meninges,

epidural fat, epidural venous
plexus, arteries and nerves
Notice vertebral venous
plexus surrounding the
Vertebral Canal
entire vertebral canal
Great picture to know! Which vertebral area?

Gilroy Fig 4.8, p. 40

cervical spine, axial section image at seventh cervical vertebral body showing caudal
migrated posterolateral fragment causing formation of an intraspinal large mass
producing severe canal stenosis (large arrow head) 
Dural Sac
AKA: Thecal Sac
Membranous sheath
or tube surrounding
SC and Cauda
equina.

What lies inside?

CerebroSpinal
Fluid(CSF)

SC moves inside of
Dural Sac. If not fee
to move within sac,
due to abnormal
tissue attachments,
One can have
Tethered spinal cord
syndrome.
 Spinal Cord
• 31 Pairs of nerves
exiting vertebral canal
• Ends at spinal level L1-
L2
• Enlargements in cervical
and lumbosacral regions
• Caudal end – conus
medullaris

Gray’s Fig 2.11, p. 65

Gilroy Fig 4.13A, p. 42
Spinal Cord and Meninges - Cervical

In what 2
areas of the
spinal cord is
enlargement
noted?

Gilroy Fig 4.6, p. 40

Note C1 nerve root
exits above as do
all C nerve roots

Thoracic- lumbar
nerve roots exits
BELOW
Spinal Cord and
Meninges -
Lumbosacral

Gilroy Fig 4.6, p. 40

Spinal Cord
Features
Which structures
project into the
dorsal root
ganglion?
___________
___________

Gray’s Fig 2.48, p.

Vertebral Canal
Cauda Equina

Gilroy Fig 4.10, p. 41

Which artery lies
in the anterior Spinal Meninges “Tender mother”
median fissure?

“Spider web”

“Tough mother”
Gray’s Fig 2.51, p. 105
Spinal Cord and Meninges

Purpose of
denticulate
ligament?
_________________

Lundy-Ekman Fig 12.1

 Conus Medullaris
Cauda Equina
Filum Terminale
Caudal End of Dural Sac
(S2)

Lundy-Eckman Fig 12.3

Conus Medullaris
Cauda Equina
Dural Sac

Gilroy Fig 4.9, p. 41

 Arterial Blood Supply
Spinal Cord

Which artery
arises off of the
aorta to supply
the spinal cord?

Gray’s Fig 2.49B, p. 103 Gilroy Fig 4.15C, p. 44

Anterior and
Posterior
Spinal AA.
From where does the
blood supply arise for the
cervical vertebral canal?

Blood supply from the

heart?
Aorta----Subclavian---
Vertebral artery------
_______________

Gilroy Fig 4.15C, p. 44

 Blood Supply to
Spinal Cord

Spinal Cord also receives blood

from small segmental a.
branches at each spinal level
- supply BOTH spinal and
extraspinal tissues

Cervical – branches of
vertebral artery and other
branches in cervical region

Gilroy Fig 4.15C, p. 44

Blood supply
Blood Supply to
Spinal Cord

Thoracic – segmental
spinal branches from
posterior intercostal
aa. (from aorta)

Gilroy Fig 4.15C, p. 44

 Blood Supply to
Spinal Cord

Lumbar – branches
of lumbar aa.

Gilroy Fig 4.15C, p. 44

Blood Supply to Spinal Cord
-Segmental Spinal Arteries
Be able to trace blood
supply to spinal cord
from thoracic aorta---
posterior intercostal a----
posterior branch--
segmental spinal a-----
Posterior /ant radicular a

Gilroy Fig 40.11B

Gilroy Fig 4.15B, p. 44
Gilroy Fig 4.15B, p. 44
 Amazing blood flow
• Segmental arteries
branch profusely at
intervertebral foramen
and anastomosis occurs
within spinal canal in
extradural region.
• Rich network of vessels
 Segmental Medullary Aa.
• 8 – 10 segmental spinal arteries also give off a
larger branch which goes directly to anterior
or posterior spinal aa. (or both) to supplement
blood supply of these arteries
• Largest is found in lower thoracic or upper
lumbar region
• Least in midthoracic region(T4-T9)
 Spinal Cord Arterial Supply Segmental spinal
a---segmental
medullary a—
Goes to ant /post
spinal a

Gray’s Fig 2.49B, p. 103

 Arterial Supply
Segmental
Medullary
Arteries

Gilroy Fig 4.15A, p. 44

 Venous Drainage of Spinal Cord

Spinal vv.

Gilroy Fig 4.16B, p. 45

 Innervation of Vertebral Canal
Each spinal nerve gives off 2-4 small branches
which turn back and enter the intervertebral
foramen to supply the meninges, vertebral
bodies and intervertebral discs
Recurrent meningeal nn. Also known as sinu-
vertebral nerves.
Application: Is it possible for a pt to have pain at
L4 that comes from L1?
Innervation of Vertebral Canal

Gray’s Fig 2.51, p. 105

Recurrent Meningeal (Sinuvertebral)
Nerves

Sensory innervation of:

-meninges
-PLL
-posterior vertebral bodies
-posterior discs
-blood vessels
-atlanto-axial joint (dens)
Gray’s Anatomy, Fig 43.7
Epidural Space

• Fat
• Nerves
• Arteries
• Internal vertebral
venous plexus Gray’s Fig 2.9
Arterial Blood Supply to Vertebrae

Gray’s Anatomy, Fig 42.12

 Internal Vertebral Venous Plexus
AMAZING

Gilroy Fig 40.12C

Venous Drainage of
Vertebral Canal
Trace vein supply from Ext /Int
Iliac v ------ascending lumbar v

Gilroy Fig 40.12D

Venous Drainage of
Spinal Region
Note Azygos vein
Hemiazygous vein

Gilroy Fig
40.12A
 Questions
• Differentiate all the coverings of the spinal cord
– Dura, Arachnoid, Pia ; also denticulate ligament_ not true covering
• What is the purpose of the denticulate ligament?
– Stabilizes SC within vertebral canal
• What is the difference of viewing the spinal cord cranially @
cervical region compared to L5 region?
• C5 nerve root travels
– a. above C5 vertebra
– b. below C 5 vertebrae c. neither
• Where does the conus medullaris end? L1-2 ( in adults)
• Where is the end of the dural sac? S2 ( in adults)
• Describe the arterial supply to the spinal cord at the cervical vertebrae. Also
describe at the thoracic region and lumbar region. Segmental spinal a---
segmental medullary a—Goes to ant /post spinal a
• Which nerve would supply the posterior disc in someone with a lateral HNP at
L4( disc between L4 and L5)?
– Sinuvertebral n. goes to tissues within vertebral canal
– Posterior Lumbar spinal plexus/ n.- L4 goes above disc; L 5 would be irritated.