SPINAL CORD

BY:DR.APARNA DIXIT
 Spinal cord
• Both the brain and the spinal cord:
– Receive sensory input from receptors
– Contain reflex centers
– Send motor output to effectors
Reflex
• Rapid,
• automatic response triggered by specific stimuli
Spinal reflexes
• Controlled in the spinal cord
• Function without input from the brain
The spinal cord can function independently from the
brain
The main pathway for information connecting the brain and
peripheral nervous system- SPINAL CORD
 Spinal cord
Elongated, cylindrical, suspended in the vertebral
canal and protected by vertebrae.
• Continuation of medulla oblongata from foramen
magnum up to lower border of L1 vertebra.
cord tissue ends between vertebrae L1 and L2.
At birth, cord and vertebrae are about the same size
but cord stops elongating at around age 4.
Ends conus medularis and here give rise cauda
equina & filum terminale.
Gives rise 31 pairs of spinal nerves
which emerge out of inter-
vertebral foramina
 Spinal cord
• Covered in all three meninges:-
1. Dura, 2. Arachnoid & 3. Pia.
• Has cerebrospinal fluid (CSF) within subarachnoid
space. Lies within vertebral foramina.
• MEASUREMENT:
• About 18 inches (45 cm) long.
• 1/2 inch (14 mm) wide.
• FUNCTION:
• Execution of simple reflexes.
• Transmission of impulses to and from the brain.
SPINAL MENINGES
• Spinal meninges:
– protect spinal cord
– carry blood supply
– continuous with cranial
meninges

• Dura mater :
– outer layer
• Arachnoid mater :
middle layer
• Pia mater :
Inner layer
 The Spinal Dura Mater
• Are tough and fibrous

Cranially:
 fuses with periosteum of occipital bone
 continuous with cranial dura mater

Caudally:
 tapers to dense cord of collagen fibers
 joins filum terminale in coccygeal ligament (for
longitudinal stability)
 The Epidural Space
 Between spinal dura mater and walls of
vertebral canal (above the dura)
 No such space in the brain
 Contains loose connective and adipose tissue
 For Anaesthetic injection site
 Inter-Layer Spaces – just like in the brain
 Subdural space:
 between arachnoid mater and dura mater
 Filled with tissue fluid.

 Subarachnoid space:
 between arachnoid mater and pia mater
 filled with cerebrospinal fluid (CSF)
 Spinal cord
• The lumbosacral nerve
roots elongate and extend
past the caudal end of the
spinal cord to form what is
known as the cauda equina.
• The caudal end of the spinal
cord tapers off into the
cone-shaped conus
medullaris, which continues
distally as the filum
terminale.
 Spinal cord
• The filum terminale is a
caudal prolongation of
the spinal pia mater that
courses along with the
cauda equina to
terminate on the dorsal
surface of the coccyx.
 Processes of the pia mater
• 1. Filum terminale :It is a delicate, glistening
white thread-like structure extending from tip of
conus medullaris to the first coccygeal vertebra
(dorsal aspect).
• The filum terminale is about 20 cm long .
• Mainly composed of non-nervous fibrous tissue
(pia), but few nerve fibres are found embedded in
its upper part.
• The central canal of spinal cord extends into the
upper part of the filum terminale for about 5 mm.
 Processes of the pia mater cont….
The filum terminale consists of 2
parts:
• (a) filum terminale internum,
• (b) filum terminale externum.
• The filum terminale internum is
about 15 cm in length and lies
within the dural sac.
• The filum terminale externum is
about 5 cm in length and lies
outside the dural sac, i. e. below
the level of second sacral
vertebra.
 CONT..
• 2. Subarachnoid septum: It is a mid-sagittal
fenestrated pial septum which connects the dorsal
surface of the spinal cord with the arachnoid
mater.
• 3 .Linea splendens: The pia gives off a septum into
the anterior median fissure. Where this process is
given off, the pia mater presents a thickening,
called linea splendens.
 CONT..
• 4. Ligamenta denticulata: These are two
transparent ribbon-like thickened bands of pia
mater (one on each side) extending laterally
between posterior and anterior nerve roots from
pia mater covering the cord.
• The lateral margin of each band presents 21 tooth-
like processes which pierce the arachnoid, to be
attached to the inner surface of the dura mater
between the points of emergence of the spinal
nerves.
 CONT..
• 4. Ligamenta denticulata:
• The ligamenta denticulata help to anchor the spinal
cord in the middle of subarachnoid space.
• The first teeth of ligamentum denticulatum lies at
the level of foramen magnum while the last
between T12 and LI spinal nerves.
 EXTERNAL FEATURES OF THE SPINAL CORD
• The external features of the spinal cord are:
• 1.FISSURES AND SULCI
• 2.ATTACHMENT OF SPINAL NERVES
• 3.ENLARGEMENTS
• 4.CAUDA EQUINA
 Fissures and Sulci
• The anterior aspect of the spinal cord presents:
• Anterior median fissure,
• Two antero lateral sulci
• While the posterior aspect presents:
• Postero median sulcus,
• Two postero-lateral (dorsolateral sulcus)
• Two postero-intermediate sulci (ventrolateral
sulcus).
 CONT..
• The anterior median fissure
is deep and extends along
the entire length of the cord.
• The anterior spinal artery
runs in it.
• The posterior median sulcus
is a faint longitudinal groove.
• From its floor, a septum of
neuroglial tissue (posterior
median septum) extends into
the substance of the cord to
a variable extent.
 CONT..
• The surface of the cord is divided into two
symmetrical halves by :-an anterior median fissure
and a posterior median sulcus.
• Each half of the cord is further subdivided into:
posterior, lateral and anterior regions by
anterolateral and pos-terolateral sulci.
• Through anterolateral sulcus emerge the ventral
root fibres and through posterolateral sulcus enter
the dorsal root fibres of the spinal nerves.
ENLARGEMENT AND SPINAL SEGMENT
• The bundle of spinal nerves extending inferiorly from
lumbosacral enlargement and conus medullaris surround the
filum terminale and form cauda equina.
• Segmented:
• 8 Cervical
• 12 Thoracic
• 5 Lumbar
• 5 Sacral
• 1 Coccygeal
• Has two enlargements:
• Cervical Enlargement.
• Lumbo-sacral Enlargement.
 INTRODUCTIONOF SPINAL NERVE
• In the human body, every spinal nerve has
essentially the same construction and components.
• The anatomy of one spinal nerve, you can
understand the anatomy of all spinal nerves.
• a. Parts of a "Typical" Spinal Nerve. Like a tree, a 
typical spinal nerve has roots, a trunk, and branches
(rami).
SPINAL NERVE
 CAUDA EQUINA
• The cord is shorter than the vertebral column,
• length and obliquity of spinal nerve roots increase
progressively from above downwards, so that spinal nerves
may emerge through their respective inter-vertebral
foramina.
 CAUDA EQUINA
• As a result the nerve roots of lumbar, sacral and
coccygeal nerves from the caudal part of the cord
takes more or less a vertical course and form a
bunch of nerve fibres around the filum terminale
called cauda equina because of its fancied
resemblance to the tail of a horse (cauda – tail;
equina – horse).
• The cauda equina
consists of the roots
of the lower four
pairs of lumbar, five
pairs of sacral and
one pair of coccygeal
nerves
 BLOOD SUPPLY OF SPINAL CORD
• The spinal cord is supplied by the following
arteries:
1. Anterior spinal artery.
2. Two posterior spinal arteries .
3. Segmental arteries.

The anterior spinal artery supplies the anterior two-

third of the spinal cord while the posterior spinal
arteries together supplies the posterior one-third of
the spinal cord.
 BLOOD SUPPLY OF
SPINAL CORD
- The anterior spinal artery
is formed by the union of
two small spinal
branches of right and
left vertebral arteries in
the upper cervical canal .
- It runs caudally in the
anterior median fissure
of the spinal cord and
terminates along the
filum terminale.
 BLOOD SUPPLY OF SPINAL
CORD
- There are two posterior spinal arteries
each arising as a small branch from
either the vertebral or the posterior
inferior cerebellar artery.
- Each posterior spinal artery runs down
on the posterolateral aspect of the cord
in the posterolateral sulcus along the
line of attachment of the posterior nerve
roots and usually divides into two
collateral collateral arteries along the
medial and lateral sides of posterior
nerve roots . Thus there are five
longitudinal arteries around the spinal
cord.
 Cont..
• Segmental arteries :The segmental arteries are the spinal
branches of deep cervical, ascending cervical , posterior
intercostal , lumbar and lateral sacral arteries.
• They reach the spinal cord as the anterior and posterior radicular
arteries along the corresponding roots of the spinal nerves
respectively and nourish the nerve roots.

• There are 8 anterior and 12 posterior radicular arteries which

reaches the spinal cord and they reinforces the anterior and
posterior spinal arteries to form five longitudinal arterial trunks
and these arterial trunks communicates around the spinal cord
forming a pial plexus called as arterial vaso-corona or arteriae
coronae and by the peripheral branches they supply the
superficial regions of the spinal cord.
 Segmental arteries Cont..
• The anterior artery at the
11th thoracic segmental
level is very large and
termed as arteria
radicularis magna
(artery of Adamkiewick).
• Radicular ( segmental)
arteries are the end
arteries and therefore if
any of them is blocked ,
the area supplied by that
particular area will be
damaged.
 Venous drainage
• The veins draining the cord forms six longitudinal
venous channels around the cord :
• Two median longitudinal
• Two anterolateral
• Two posterolateral
• These longitudinal venous channels communicates
with the internal vertebral venous plexus and
drained by veins which leaves through the
intervertebral foramina to empty into the vertebral
, posterior intercostal , lumbar and lateral sacral
veins.
APPLIED ANATOMY OF SPINAL CORD
 Lumbar puncture
• Lumbar puncture is done to withdraw cerebrospinal
fluid for various diagnostic and therapeutic purposes.
• The puncture should be done well below the
termination of the cord, i.e. lower border of LI.
• A horizontal line joining the highest points of the
iliac crests passes through the spine of the fourth
lumbar vertebra. Therefore, the interspinous spaces
immediately above and below this landmark can be
used with safety.
• The interspinous space between L3 and L4 is the
most preferred site.
Clinical significance of ligamenta denticulata
• The ligamenta denticulata serve as a guide to neuro-
surgeons during cordotomy operation.
• When sensory tract requires section to relieve pain, the
knife is put in front of the ligament, and if the section of
motor tract (viz. pyramidal tract) is desired,the knife is
placed behind the ligament.
• The lowest tooth is forked, and the posterior root of the
first lumbar nerve lies on the outer prong of the fork .
• In the lower region of the spinal cord, it is the surgeon's
guide to the first lumbar nerve and gives him a nerve root
of known number from which he can determine the
position of whatever nerve roots he is in search of.
Posterior view of a part of spinal cord showing forked lowest tooth of ligamentum denticulatum.
 Cauda equina syndrome
• It occurs due to compression of cauda equina by
extradural tumor prolapsed intervertebral disc or spinal
canal stenosis.
• The characteristic features of this syndrome are as follows:
-Areflexia (absence of deep tendon reflex) lower motor
neuron type of paralysis
-saddle shaped anesthesia(restricted to the area of buttocks
,perineum, and inner surface of thighs)
-severe root pain
-late urinary and bowel retention
-sexual dysfunction less frequent
 Anterior spinal artery syndrome
• It occurs due to occlusion (thrombosis or compression
of the anterior spinal artery).
• Many of these radicular arteries are small and end by
supplying the spinal nerve roots.
• The anterior spinal artery supplies anterior two-third
of the cord, the occlusion of this artery will therefore
result in:
• (a) motor symptoms, due to involvement of
corticospinal tracts and anterior grey columns, and
• (b) bilateral loss of pain and temperature sensation
due to ischaemia of spinothalamic tracts
 Artery of adamkiewicz
• The artery of T11 spinal segment is remarkably large
and supplies several segments of the cord upwards
and downwards.
• A fracture of vertebra involving this artery leads to
softening of several segments of the cord.
• The artery at the level of T1 segment anastomoses
with the other arteries in such a fashion (valvular
fashion) that its supply is directed only downwards.
Therefore, if this segmental artery is involved, the
C8 segment is most affected.
 Syringomyelia
• In this condition, a fluid cavity (or cavities) develops
near the centre of the spinal cord usually in the
cervical segments. This leads to the destruction of the
cord involving central canal and its surrounding area.

The site of lesion in syringomyeli.

• This lesion involves the decussating spinothalamic
fibres in the anterior white commissure . so that
there is bilateral loss of pain and temperature
sensations below the lesion but other sensations
are preserved in the uncrossed tracts of posterior
columns. Thus, this condition results in what is
called dissociated sensory loss.
 Tabes dorsalis
• It is a syphilitic degenerative lesion of the posterior
white columns and posterior nerve roots
• It is characterised by impairment of propriocep-tive
sensibility.
• The patient loses the sense of tactile discrimination,
vibration, passive movement and appreciation of
posture.
• The patient becomes ataxic, particularly if he closes
his eyes, because he has lost his position sense for
which he can partially compensate by visual
knowledge of his spatial relationship (Romberg's sign).
 Hemi section of the spinal cord
(Brown-Sequard syndrome)
• Effects of the hemi section of the spinal cord are as
follows:
• – Ipsilateral upper motor neuron type of (spastic)
paralysis below the level of hemi section (due to
involvement of pyramidal tract).
• – Ipsilateral loss of proprioceptive sensations (sense of
position, posture, passive movement and vibrations) and
fine touch/discrimination (due to involvement of
posterior columns).
• – Contralateral loss of pain and temperature sensations
below the level of lesion (due to involvement of
spinothalamic tract).
Brown-Sequard syndrome, due to hemisection of
spinal cord on the left side at the level of T10
segment.
 Posterior rhizotomy or cordotomy
• Chordotomy, rhizotomy and neurectomy are various
procedures in which the nerves are cut or damaged
to relieve pain.
• In chordotomy, a part of the spinal cord is cut;
• In rhizotomy, a dorsal nerve root is cut, while
• In neurectomy, a peripheral nerve is cut
 Posterior rhizotomy or cordotomy
• The intractable pain can be treated in selected cases
by cutting the appropriate posterior nerve roots
(posterior rhizotomy) or by division of the
spinothalamic tract on the side opposite to the pain
(cordotomy).
• A knife is passed 3 mm deep into the cord, anterior
to the denticulate ligament, and then swept
forward.
• It severs the lateral spinothalamic tract but
preserves the pyramidal tract lying immediately
behind it.
Thank you