Anatomy of Vertebral

column and spinal cord and

applied importance in
central neuro axial
blockade.
Dr. Melvin Cyriac
Vertebrae Anatomy
Spinal Cord
 Extends from foramen magnum to
 Adult : lower border of L1 in /upper border of L2
 Infants/children : L3
 It is about 45 cm long
 Duramater, Subarachnoid space & subdural space: S2 in adults( S3 in
children)

 S. C gives 31 pairs of spinal nerve

 An extension of piamater , the FILUM TERMINALE penetrate the dura and

attach the terminal end of spinal cord [conus medullaris]to the periosteum of
the coccyx.
 Adult : L3-L4 or L4-L5 ( or even L2-L3)
 Infant : L4-L5
 A line drawn b/w the highest pt. of iliac crests (Tuffier’s line)
usually cross either body of L4 or the L4-L5 interspace

 Position
 Sitting
 lateral
 Prone(anorectal procedure, hypobaric solution, jackknife position)
SURFACE ANATOMY
Dermatomes
Important Facts
 Cardiac accelerator fibre: T1-T4(Bradycardia & ↓ contractility)

 Vasomotor fibre : T5-L1( Determine vasomotor tone)(vasodilation

on blockade)

 Sympathetic outflow arise from T5-L1(Block ↑vagal tone, small

contacted gut with active peristalsis)

 Most dependent part in supine position is T4-T8 (imp. For

hyperbaric solution)
Spinal Anesthesia
Spinal Anesthesia
Spinal Approches
Epidural Anaesthesia
 Epidural space – from base of the skull to the coccyx.

 Distance from the skin to epidural space is 4-5 cm

 Epidural space contains loose aeriolar tissue, fat, arterial and venous
networks, lymphatics, spinal nerve roots

 Because epidural anaesthesia is diffusion dependent relatively large volumes

of LA are needed to achieve a block that spans several dermatomes

 It is differential blockade
 Selective blockade possible because it can
be performed at any level of spine

 Cervical epidural
 Thoracic epidural
 Lumbar epidural
 Caudal epidural