The Spinal Cord (Gross Anatomy)

1. Extent Begins: Below foramen magnum in the skull; upper border of 1st cervical vertebra,
atlas.
Ends: at intervertebral disc btwn L1 and L2
;at birth = (L2-L3)
;3rd month IUL (intrauterine life – in the worm), level of spinal cord = level of
vertebrae
2. Enlargement 2 enlargements:
1) Cervical => brachial plexus
2) Lumbo-Sacral => lumbar & sacral plexus
3. Ending -tapers = to form Conus Medullaris
-continues d/w = as a fibrous thread called filum terminalis (=pia) which ends at the
coccyx
4. Length 45 cm
5. Protection i. Bony protection = Vertebral canal, formed by the bony vertebral column

i.Bony ii.Membranous Protection = Meninges:

ii.Membranous a. Dura mater: (Latin: dura hard)
iii.Fluid Suspension b. Arachnoid mater: (Greek: arakness = spider)
iv. Denticulate c. Pia mater: (Greek: pia = tender)
ligaments # Arachnoid & dura mater normally occupy the vertebral canal well in the sacrum,
down to about vertebral level S2.

iii.Fluid Suspension = Cerebro-spinal Fluid = CSF

# CSF is contained in the subarachnoid space, btwn the pia & arachnoid

Epidural space or extradural space;

Site: outside the dura mater, btwn dura mater & walls of the vertebral canal
Contains connective tissue, fat & internal vertebral plexus

Surface Anatomy;
Vertebral lvl T11 – L1/2 : sacral region of spinal cord
Vertebral lvl L1/2 : end of spinal cord (in adult)
Vertebral lvl S2 : end of dura sac & subarachnoid space

iv. Denticulate ligament

- Lateral extension of the pia mater
- extending from the cord in a coronal plane
- about midway btwn the dorsal & ventral nerve roots
- To meet the internal aspect of the arachnoid in a series of sawtooth-like
projections
- Which helps to tether the spinal cord within the subarachnoid space.
6. Features External features
Anterior aspect: Anterior median fissure (1) & anterior nerve root of spinal nerve.
-external Posterior aspect: Posterior median sulcus (2), postero-lateral sulcus (3)(posterior
-internal root of spinal nerve)& postero-intermediate sulcus (4)(only on cervical and upper
thoracic segments).
 *Spinal segments: = part of spinal cord to which a pair of posterior and anterior
spinal roots are attached. 31 spinal segments.

*Dermatomes = area of skin supplied by the somatosensory fibers from a single

spinal nerve

Internal features
=central canal, central gray matter, peripheral white matter, RF

Central Gray Matter;

*H-shape with central canal
*Anterior horn (Motor)
*Posterior horn (Sensory)
*Lateral horn (Autonomic)
-T1 to L2 or L3
*Gray commissure

Peripheral White Matter (P, L, A)

*Myelinated nerve fibers
*Anterior white column
*Lateral white column
*Posterior white column (C&G)
*Anterior white commissure

7. Blood supply 1.Spinal artery (2 ant 1 ant & 2 post)

Ant & post spinal arteries are not of
2.Radicular arteries (ant & post) sufficient calibre to maintain throughout
the entire spinal cord. Hencem they rely to
a great extent on the radicular component

Vertebral art  ant spinal art (2 spinal artery join)  single anterior spinal artery.
This courses along the anterior median fissure of the spinal cord.
Supplies anterior 2/3 of the cord.

Posterior inferior cerebellar artery (PICA) or vertebral art  post spinal art (2 in no)
– supply the posterior 1/3 of the cord

Cervical region – radicular artery from deep and ascending branches of cervical art
Thoracic region - radicular artery from posterior intercostals artery
Lumbar region – radicular artery from lumbar artery
Sacral region – radicular artery from lateral sacral artery

Radicular arteries are segmentally represented.

Branches are mainly given to anterior and lateral horns of the cord and tracts of the
anterior and lateral white matters of the cord.

The largest radicular art  artery of ADAMKIEMICZ (radicularis magna) - present at

the spinal cord level T12-L2 may provide the entire arterial supply for the caudal
2/3 of the spinal cord. – enters the spinal cord in the lower thoracic or upper lumbar
area.
Clinically, this area of the spinal cord is susceptible to vascular insult should this
radicular art be compromised.
8. Venous drainage  This is by 6 irregular, plexiform channels.

 There is one along:

1. The anterior and posterior midlines;

2. Along the line of attachment of the dorsal roots of each side;

3. Along the line of attachment of the ventral roots of each side.

 These are drained by the radicular veins.

 Each, in turn empty into a dense plexus of veins located in the epidural
space epidural venous plexus/ Batson internal vertebral venous plexus.
9. Clinical importance 1.Lumbar puncture (LP);
-Lumbar cistern; subarachnoid space below vertebral level L1/2 occupied with
CSF & cauda equina not by spinal cord.
-Inserting needle into it to get a sample of CSF w/out damaging spinal cord = LP
Adult; best done at vertebral level L3/4
[Highest point of iliac crest = over L4 spine]
Child; LP perform one or two intervertebral spaces lower.

Subarachnoid space; LP, for diagnostis purpose or myelography (X-ray)

Epidural space; epidural anaesthesia

1.will anaesthetize the spinal nerve roots
2.useful for the procedures in the pelvis & perineum (supplied by lumbar &
sacral nerves) where the patient is unfit for general anaesthesia

Subarachnoid spaces; spinal anaesthesia;

(a) Anaesthetics injected into the subarachnoid spaces. The specific gravity
of the agent is greater than the CSF & so by altering the position of the
patient the anaesthetic can be restricted to the lower region of the
subarachnoid space.
(b) It produces more profound anaesthesia & lasts longer than an epidural
anaesthesia.

Spinal cord injury

Cx = fracture or dislocation; Vertebral canal size larger. Spinal cord escape from
injury.
-but if there is displacement of the spinal cord section  immediate death
-respiration stop if lesion above origin of phrenic nerve
Th = Vertebral canal size smaller; spinal cord displacement
L= anatomy help the patient  spinal cord ends at lower border of L1
↘V foramina enlarged – spinal roots ample, minimal injury
Injury = functional disturbance at or below the lesion level.