SPINAL CORD

INTRODUCTION
The spinal cord or the spinal medulla is the most important content of the vertebral canal and in adults; it
occupies only the upper two-thirds of the vertebral canal. It begins as a downward extension of medulla
oblongata at the level of the upper border of the first cervical vertebra (C1) and extends down to the level of the
lower border of the first lumbar vertebra (L1). Thus, it occupies the upper two-thirds of the vertebral column.
The level is, however, variable and the cord may terminate one vertebra higher or lower than this level. The
level also varies with flexion or extension of the spine.
The lowest part of the spinal cord is conical and is called the conus medullaris. The conus is continuous, below,
with a fibrous cord called the filum terminale which is a prolongation of pia mater and is attached to the
posterior surface of the coccyx.
Dimensions of the Cord
The length of the cord varies from 42 to 45 cm. The spinal cord is not of uniform thickness. It resembles a
flattened cylinder with variable transverse width i.e. about 38 mms at the cervical enlargement and about 35
mms at the lumbar enlargement. The spinal segments that contribute to the nerves of the upper limbs [from 3rd
cervical to 2nd thoracic segments] are enlarged to form the cervical enlargement of the cord. Similarly, the
segments innervating the lower limbs (1st lumbar to 3rd sacral segments) form the lumbar enlargement.
Age-wise Changes in the Cord
In early fetal life (third 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, therefore, 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 roots of 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.
Functions of Spinal Cord
The spinal cord has three major functions:

 It acts as a pathway for motor information, which travels down the spinal cord.
 It serves as a conduit for sensory information in the reverse direction.
 It is a centre for coordinating simple reflexes.

SURFACE FEATURES OF SPINAL CORD

The anterior surface of the spinal cord is marked by a deep anterior median fissure, which contains anterior
spinal artery. The posterior surface is marked by a shallow posterior median sulcus.
The anterior median fissure and posterior median sulcus divide the surface of the cord into two symmetrical
halves. Each half of the cord is further subdivided into posterior, lateral, and anterior regions by anterolateral
and posterolateral sulci.
The rootlets of the dorsal or sensory roots of spinal nerves enter the cord at the posterolateral sulcus on either
side. The rootlets of the ventral or motor roots of spinal nerves emerge through the anterolateral sulcus on
either side.

SPINAL NERVES
The spinal cord gives attachment on either side to 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal. Each spinal nerve arises by two roots, anterior motor root and posterior sensory root.
Each root is formed by aggregation of a number of rootlets that arise from the cord over a certain length.
The rootlets that make up the dorsal nerve roots are attached to the surface of the spinal cord along a vertical
groove (called the posterolateral sulcus) opposite the tip of the posterior grey column. The rootlets of the
ventral nerve roots are attached to the anterolateral sulcus of the cord opposite the anterior grey column.
Both the roots of spinal nerve receive a tubular prolongation from the spinal meninges and enter the
corresponding intervertebral foramen. In the intervertebral foramen, anterior and posterior spinal nerve roots
unite to form the mixed spinal nerve trunk. Thus, a spinal nerve is made up of a mixture of motor and sensory
fibres.
Just proximal to the junction of the two roots, the dorsal root is marked by a swelling called the dorsal nerve
root ganglion or spinal ganglion.

The rootlets of dorsal root are made up of the central processes of neurons of the dorsal root ganglion. The
dorsal root itself contains peripheral processes of neurons of the dorsal root ganglion.
After emerging from the intervertebral foramen, each spinal nerve is divided into a dorsal and a ventral rami.
The dorsal ramus passes posteriorly around the vertebral column to supply the muscles and skin of the back.
The ventral ramus continues anteriorly to supply the muscles and skin over the anterolateral body wall and all
the muscles and skin of the limbs.

Clinical Correlation
The dorsal nerve root ganglia (and the sensory ganglia of cranial nerves) can be infected with a virus. This leads
to the condition called herpes zoster. Vesicles appear on theskin over the area of distribution of the nerve. The
condition is highly painful.

Exit of Spinal Nerves

Each spinal nerve emerges through the intervertebral foramen. The cervical nerves leave the vertebral canal
above the corresponding vertebrae with the exception of eighth, which emerges between seventh cervical and
first thoracic vertebrae. Rest of the spinal nerves emerge below the corresponding vertebrae.

SPINAL SEGMENTS
As mentioned earlier, each spinal nerve arises from the spinal cord by two roots—anterior (or ventral) and
posterior (or dorsal). Each nerve root is formed by an aggregation of a number of rootlets that arise from the
cord over a certain length. The length of the spinal cord giving origin to the rootlets for one spinal nerve
constitutes one spinal segment. However, this definition applies only to the superficial attachment of nerve
roots. The neurons associated with one spinal nerve extend well beyond the confinement of a spinal segment.
So, the spinal cord is made up of 31 such segments – 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal.
Note: In the cervical and coccygeal regions, the number of spinal segments and spinal nerves, does not
correspond to the number of vertebrae.

Vertebral levels of Spinal Segments

Since the length of spinal cord (45 cm) is smaller than that of vertebral column (65 cm), the spinal segments are
short and crowded, more so in the lower part of the cord. Thus, the spinal and vertebral segments (spines) do
not lie at the same level. The spinal segments as a rule always lie above their numerically corresponding
vertebral spines. As a rough guide, it may be stated that in the cervical region, there is a difference of one
segment (for example, the fifth cervical spine overlies the sixth cervical segment); in the upper thoracic region,
there is a difference of two segments (for example, the fourth thoracic spine overlies the sixth thoracic
segment); and in the lower thoracic region, there is a difference of three segments (for example, the ninth
thoracic spine lies opposite the twelfth thoracic segment).This is clinically important for assessing the level of
cord compression following an injury or disease of the surrounding vertebrae.
SPINAL MENINGES
DURA MATER
The spinal dura mater forms a loose tubular covering for the spinal cord. The spinal dura mater does not fuse
with the endosteum of the vertebral canal. Hence there is a well-developed epidural space surrounding the
spinal cord. The spinal epidural space is filled with the internal vertebral venous plexus (Batson’s plexus) and fat.
The dorsal and ventral roots of spinal nerves pass through the spinal dura mater separately. Sheaths derived
from dura extend over the nerve roots. These dural sheaths reach up to the intervertebral foramina and are
attached to the margins of these foramina. The dorsal and ventral nerve roots unite in the intervertebral
foramina to form the trunks of spinal nerves. The pia mater and arachnoid mater also extend on to the roots of
spinal nerves as sheaths. These sheaths reach up to the site where the nerve roots pass through dura mater.
The dura and arachnoid [along with the subarachnoid space containing cerebrospinal fluid (CSF)] extend up to
the level of second sacral vertebra. Beyond that level, the dura covers the filum terminale and distally gets
attached to the dorsal surface of the first coccyx vertebra. At the upper end of the vertebral canal, the dura
fuses with the endosteum at foramen magnum. So the epidural space ends at that level and does not continue
into the cranium even as the dura is continuous.
Arachnoid Mater
The spinal arachnoid mater is present deep to the dura and extends upto the level of second sacral vertebra.
Above it is continuous with the cranial arachnoid mater and so also the subarachnoid space.
Pia Mater
The spinal pia mater is a thin vascular membrane closely applied to the spinal cord and specialized in some areas
and continues above with the cranial pia mater.
Linea splendens: Along the anteromedian fissure, the pia mater is thickened to form a glistening band called as
linea splendens. The branches from the anterior spinal artery pierce this to enter the spinal cord.
Ligamenta denticulata: Along the lateral aspect of spinal cord, between the dorsal and the ventral roots, the pia
forms triangular thickenings which pierce the arachnoid and are attached to the dura. These tooth- like
thickenings are called as ligamenta denticulata. There are 21/22 pairs of ligamenta denticulata.
Filum terminale: At the lower end of the spinal cord, the pia mater extends as a thin filament surrounded by
the leash of nerves. This is the filum terminale and it passes through the sacral hiatus and gets attached to the
dorsal surface of the first coccygeal vertebra.
Clinical Correlation
Epidural anesthesia
As the spinal nerves pass through the spinal epidural space, they may be anesthetized by injecting a local
anaesthetic drug into the spinal epidural space. This type of epidural anesthesia is used in obstetric procedures
during childbirth. One has to be careful about the venous plexus while introducing the needle for anesthesia as
it may injure the veins and cause an epidural hematoma.
Caudal epidural anesthesia
For this procedure, the needle is introduced through the sacral hiatus and the anesthetic drug is injected. This
will anesthetize perineal area supplied by S4, S5 nerves and may be useful in perineal surgeries.
BLOOD SUPPLY OF SPINAL CORD
Arterial Supply
The arterial supply of the cord is derived from following arteries

 Anterior spinal artery

 Two posterior spinal arteries
 The radicular arteries.
Venous Drainage
The veins draining the spinal cord are arranged in the form of six longitudinal channels. These are:

 Two median longitudinal channels, one in the anterior median fissure called the anteromedian channel,
and the other in the posteromedian sulcus called the posteromedian channel.
 The paired anterolateral channels, one on either side, posterior to the anterior nerve roots
 The paired posterolateral channels, one on either side posterior to the posterior nerve roots.