SPINAL NERVE

Dr. Muhallil (1st Year PG )

Moderator :- Dr. Shamima Banoo

(Assistant Professor)

Department of Anatomy

GMC Srinagar
Learning Objectives
• Brief introduction of Nervous System.
• Definition of Spinal Nerve .
• Vertebral levels of spinal segments.
• Spinal roots and ganglia.
• Spinal nerve proper.
• Exit of spinal nerve.
• Distribution of sympathetic fibres.
• Variation in size of spinal nerves.
• Plexus.
Nervous System
 Nervous System

Central nervous system Peripheral Nervous System

Central Nervous System

• Brain
• Spinal Cord
Peripheral nervous system

• Cranial Nerves
• Spinal Nerves
• Ganglia

 Enteric Nervous System is often considered as the 3rd Division

of the Nervous Systems
 Spinal Nerves
• Spinal nerves are united
ventral and dorsal spinal roots,
attached in series to the sides
of the spinal cord.
• The region of the spinal cord
associated with emergence of
a pair of nerves is known as
spinal segment.

Spinal segment
• There are 31 pairs of spinal
nerves which arise from the
spinal cord within vertebral
canal and come out of it
through intervertebral
foramina
31 pairs of spinal nerves are as follows:-

• 8 pairs of Cervical nerves (C1-C8)

• 12 pairs of Thoracic nerves (T1-T12)
• 5 pairs of Lumbar nerves (L1-L5)
• 5 pairs of Sacral nerves (S1-S5)
• One pair of Coccygeal nerve
 Vertebral levels of spinal segments
• The length of spinal cord (45cm) is smaller than that of vertebral
column (65cm), the spinal segments are short and crowded, more in
the lower part of the cord.
• Thus the spinal segments and vertebral spines do not lie at the same
level.
Region General Rule Spinal Segment Vertebral Spine
Upper Cervical Same Level C2 C2
Lower Cervical Difference of one vertebra C6 C5
Upper Thoracic Difference of two vertebra T5 T3
Lower Thoracic Difference of three vertebra T10 T7
Lumbar Difference of 3 to 5 vertebra L1-L5 T10-T7
Sacral & Coccygeal Difference of 6 to 10 vertebra S1-S5 and coccygeal segment T12-T11
Development
• In early foetal life (3rd month) the spinal cord
is as long as the vertebral canal and each
spinal nerve arises from the cord at the level
of the corresponding intervertebral foramen.
• In subsequent development the spinal cord
does not grow as much as the vertebral
column and its lower end gradually ascends
to reach the level of the third lumbar vertebra
at the time of birth and to the lower border of
the first lumbar vertebra in the adult.
• As a result of this upward migration of
the cord, the root the spinal nerves
have to follow an oblique downward
course to reach the appropriate
intervertebral foramen. This also
makes the roots longer. The obliquity
and length of the roots is most
marked in the lower nerves and many
of these roots occupy the vertebral
canal below the level of the spinal
cord. These roots constitute the
Cauda Equina.
Clinical Aspect
• Hangman’s Fracture :-

When a person is hanged, the

second cervical vertebra is fractured
and the spinal segment damaged is
C2. This disconnects the respiratory
centers of medulla oblongata from
C3,C4 and C5 segments of phrenic
nerves. This causes respiratory
arrest and death.
• Quadriplegia:-

Damage to spinal segment C5

(due to disease between C4 and
C5), results in paralysis of both
upper and lower limbs, known
as quadriplegia.

 Lower limbs will show signs of

upper motor neuron lesions.

 Upper limbs will show signs of

lower motor neuron lesions.
Cauda Equina Syndrome
• It signifies an injury of multiple
lumbosacral nerve roots within the
spinal canal distal to the termination of
the spinal cord at L1-L2.
• Symptoms :-
Low back pain
Weakness
Areflexia in the legs
Saddle anaesthesia, or loss of
bladder function (can present as a late
feature).
Spinal Roots and Ganglia
• Paired dorsal and ventral roots of
spinal nerve are continuous with
spinal cord. They cross the sub
arachnoid space and traverse the
dura-mater separately, uniting in
close to their intervertebral
foramina to form spinal nerves
Ventral (Anterior) Roots Ventral roots

It contains
• Axons of neurons in the ventral
(anterior) and lateral spinal
gray columns.
• Efferent somatic neurons
• At some levels, preganglionic
neurons
Dorsal (Posterior) Roots Dorsal Roots

• Dorsal roots are usually said to

contain only afferent axons (both
somatic and visceral), which are
central processes of pseudo-
unipolar neurons in spinal root
ganglia.
Dorsal Root Ganglia
• Dorsal root ganglion are large group of
neurons on dorsal spinal roots. Dorsal Root Ganglion
• Ganglia are usually sited in the
intervertebral foramina immediately
lateral to perforation of dura mater by
roots.
However, the first cervical ganglion lies on the
vertebral arch of atlas, second lies behind lateral
atlanto-axial joint
Sacral ganglion lies inside vertebral canal
Coccygeal ganglion lies within Dura Mater
• Medial branch is known as AXON Medial branch (Axon)

Lateral branch (Dendrite)

• Lateral branch is an elongated
DENDRITE
Clinical Aspect

Varicella zoster virus remains latent in the dorsal root ganglia

after an initial episode of chicken pox resolves
Spinal Nerve Proper
• The term “spinal
nerve proper”
strictly applies only
to short segment
after union of roots
and before
branching occurs.
Spinal Nerve proper
• Spinal nerve proper divides into Dorsal and
Ventral Rami, both of which receive fibers from
both roots.

• At all the levels, above the sacral vertebra this

division occurs within intervertebral foramina
• Dorsal ramus passes
back and lateral to the
articular process of
vertebrae and divides
into medial and lateral
branches that
penetrate the deeper
muscles of the back
Dorsal Ramus
• Both medial and lateral
branches of the dorsal ramus
innervate the muscles and
supply a band of skin from the
posterior median line to the
lateral border of scapula
In a typical spinal nerve Ventral
ramus
• Ventral Ramus innervates pre-
vertebral muscles of the trunk
• Near the mid-axillary line , it
gives off a lateral branch that
pierces the muscles and divides
into anterior and posterior
cutaneous branches
• The main nerve advances in the
body wall where it supplies the
ventral muscles and terminates
in the branches to the skin.
• At or distal to the origin, each ventral ramus
gives off Recurrent meningeal branch
(sinuvertebral branches.)
• Recurrent meningeal (or sinuvertebral) nerves
occur at all vertebral levels.
• They are mixed sensory and sympathetic nerves.
• Each nerve pursues a recurrent course through
the intervertebral foramen, passing ventral to the
spinal nerve, to enter the vertebral canal, where it
divides into ascending, descending and
transverse branches.
• Meningeal branches form a plexus on the ventral
and lateral surface of the Dural sac; the posterior
paramedian dura is devoid of nerve endings.
• Skeletal branches are distributed to the posterior
longitudinal ligament, the periosteum of the
vertebral bodies, and to the posterior and
posterolateral aspects of the intervertebral discs
Exit of Spinal Nerves
• Each spinal nerve emerges through the
intervertebral foramen.
• The cervical nerves leave the vertebral
canal above the corresponding vertebra
with exception of 8th spinal nerve,
which emerges between 7th cervical
and 1st thoracic vertebrae.

 Rest of the spinal nerves emerge

below the corresponding vertebrae
Functional components in a Spinal Nerve
• Efferent Neurons
These are the neurons supplying the
skeletal muscle and smooth muscle
Neurons supplying typical skeletal
muscle
In the spinal cord the cell bodies of
neurons supplying most skeletal muscle lie in the
ventral gray column.

These neurons are called as Somatic

efferent neurons
Neurons supplying smooth
muscle
The pathway for supply of
smooth muscle consists of two neurons
that synapse in a ganglion.
1)Preganglionic Neuron
2)Postganglionic Neuron

Neurons innervating smooth

muscle are General Visceral efferent
neurons
• Afferent Neuron

The cell bodies of neurons that

give rise to afferent fibres are located
outside the CNS.

In case of spinal nerves , they

lie in the dorsal root ganglion.
Distribution of Sympathetic Fibers through
Spinal nerves
• Soon after its formation, ventral ramus
receives a bundle of unmyelinated
fibers, the gray ramus communicans,
from the corresponding sympathetic
ganglion of sympathetic trunk.
• They supply smooth muscle of blood
vessel and muscle associated with hair
and sweat glands.
• The ventral rami of each thoracic and
upper 2 lumbar spinal nerves are also
connected with corresponding
sympathetic ganglia by another bundle
of myelinated fibers called the white
rami communicans.
 Horner’s syndrome
• It is due to disturbance of the
sympathetic nerve supply to the dilator
papillae muscle, muller’s muscle of
the lids and the sweat glands.
• Pathway :-

 The sympathetic fibers start from the posterior

hypothalamus.
 Descending fibers reach the cilio-spinal center
of budge(C8-T2).
 The fibers then travel to the superior cervical
ganglion in the neck.
 The post ganglionic fibers join the ophthalmic
branch of trigeminal nerve and reach the
dilator pupillae via the long ciliary nerves.
Clinical Features
• Ptosis (drooping of the upper eyelid):-
It is due to the paralysis of superior tarsal muscle (part of
muller’s muscle) and unopposed overactivity of the
orbicularis muscle.
• Enophthalmos(sunken globe):-
It is due to the paralysis of the orbitalis muscle.
• Miosis(paralysed contracted pupil):-
Occurs as the dilator pupillae is paralysed and sphincter
pupillae is unopposed.
• Vasodilation:-
It occurs due to lesion in T1 vasoconstrictive fibers.
• Anhidrosis(lack of thermal sweating)
• Loss of ciliospinal reflex:-
The ciliospinal reflex is a pupillary skin reflex which consists
of dilation of the ipsilateral pupil in response to pain Anhidrosis
applied to the neck, face and upper limb. Ptosis Miosis
Variation in size of spinal nerves
• Cervical spinal nerves enlarge from the first to the sixth
nerve.
• The seventh and eighth cervical and the first thoracic
nerve are similar in size to the sixth cervical nerve.
• The remaining thoracic nerves are relatively small.
• Lumbar nerves are large, increasing in size from the first
to the fifth.
• The first sacral is the largest spinal nerve; thereafter the
sacral nerves decrease in size.
• The coccygeal nerves are the smallest spinal nerves.
• The size of the spinal nerve and its associated structures
within the intervertebral foramen is not in direct relation
to the size of the foramen.
• At lumbar levels, though L5 is the largest nerve, its
foramen is smaller than those of L1–L4, which renders this
nerve particularly liable to compression.
Formation of spinal nerve
Ventral Root Dosral Root
(Motor fibres) (Sensory fibres)

Trunk of spinal nerve

(Mixed nerve fibres)

Ventral ramus Dorsal ramus

(Mixed fibers) (Mixed Fibers)

Supply muscles and skin Supply deep muscles of the

over anterolateral body back and skin of the back
wall and muscles and skin
of limbs
Plexus :-

• It is a network of intersecting nerves and is formed by subdivisions of

ventral rami of spinal nerves except the thoracic spinal nerves.
Major nerve plexus :-
• Cervical plexus

• Brachial plexus

• Lumbosacral plexus:
1)Lumbar plexus
2)Sacral plexus

• Coccygeal plexus
 Cervical Plexus
 It is formed by the
ventral rami of upper 4
cervical spinal nerves
(C1-C4).

 Each ramus except the

first, divides into
ascending and
descending parts
which unite in the
communicating loops
From the first loop(C2-C3):
Superficial branches of the head arise

Lesser occipital nerve(C2)

supplies the skin of the scalp
Great auricular nerve(C2-C3)
supplies the skin on the angle of mandible
Transverse cervical nerve(C2-C3)
supplies skin on the anterior triangle of the
neck.

From the second loop (C3-C4):

Cutaneous nerves of shoulder and chest arise.

Supraclavicular nerve(C3-C4)
which divides into anterior, middle and
lateral branches to supply the skin over
clavicle and the shoulder.
 Brachial Plexus
• It is formed by the ventral rami of lower 4
cervical (C5-C8) and first thoracic (T1) spinal
nerves.
• The brachial plexus consists of 4 components :
1)Roots 2)Trunks 3)Divisions 4)Cords
• The major branches arising from the brachial
plexus include :-
Musculocutaneous nerve – supplies
corachobrachialis,biceps brachi and brachialis.
Axillary nerve – supplies deltoid.
Radial nerve – supplies extensor compartment of the
upper limb
Ulnar nerve – supplies medial side of the upper limb
Median nerve – runs in the midline of the limb and
has contributions from the medial and lateral cords.
Clinical Aspect
• Erb - Duchene paralysis:-
It is the injury to upper trunk of brachial plexus caused by the undue separation of head and neck as
may happen during vaginal delivery or a violent displacement of head from shoulder (eg, a fall from
motorcycle).
Adduction and medial
rotation at shoulder
joint

Extension at the
elbow joint

Pronation at the
radio ulnar joint

Policeman/waiter’s tip
hand deformity
Lumbar Plexus
• It is formed within the substance of
the psoas major muscle by the
union of ventral rami of L1-L3
lumbar nerves and a larger upper
part of the ventral ramus of L4
nerve.

• It mainly supplies

Inferior anterior abdominal wall

Thigh and leg.
Sacral plexus
• The sacral plexus is formed by
the ventral primary rami of
L4,L5,S1,S2,S3
• Sacral plexus predominantly
supplies the pelvis
• It gives two terminal nerves :
Sciatic nerve (L4,L5,S1,S2,S3)
Pudendal nerve (S2,S3,S4)
Clinical Aspect
Pudendal Anesthesia
• It is a form of local anesthesia commonly
used in obstetrics to relieve the pain in
forceps delivery
• The anesthesia is produced by blocking
the pudendal nerves near the ischial
spine of the pelvis.
Coccygeal plexus
• It is the small nerve plexus formed
by the ventral rami of S4, S5 and
coccygeal nerve.
• It lies on the pelvic surface of the
coccygeus.
• It supplies coccygeus and part of
the levator ani.
• It pierces the coccygeus and
supplies the skin from the coccyx to
anus.