SCHOOL OF MEDICINE

NEUROANATOMY
CHAPTER 5

SPINAL CORD

Dr.Mohamed Boqore
1
MBBS, FAM.MED
 OVERVIEW
• The spinal cord is the lower elongated part of the
central nervous system (CNS).

• It is cylindrical in shape, slightly flattened

anteroposteriorly and occupies the upper two-third of
the vertebral canal.

• Spinal cord measures about 45 cm (18”) in adult male

and 42 cm in adult female, and weighs about 30 g.
• It extends as a downward continuation of
medulla oblongata from the upper border of the
posterior arch of first cervical vertebra (C1) to the
lower border of the first lumbar vertebra (LI).

• Its lower tapering extremity is called conus

medullaris. The apex of conus medullaris
continues downwards as a thin, thread-like
filament called filum terminale.
• Spinal cord provides attachment to 31 pairs of
spinal nerves which connect it to the tissues of the
trunk, girdles, limbs, and the viscera.

• The spinal cord contains large number of ascending

and descending pathways, which serve as conduits
for nervous information, passing to and fro
between different parts of the body and the brain.
FUNCTIONS OF THE SPINAL CORD
• The execution of simple reflexes.

• The transmission of impulses to and from the

brain
 POSITIONAL CHANGES OF THE CORD

• Up to the 3rd month of intrauterine

development, the spinal cord extends
throughout the entire length of the vertebral
canal and the spinal nerves pass through the
intervertebral foramina at their level of origin.
• Thereafter, the vertebral column grows faster
than the spinal cord and the terminal end of the
spinal cord gradually shifts to a higher level.
• Consequently at birth spinal cord ends at the
level of third lumbar vertebra while in adult, it
terminates at the level of lower border of L1 (or
the intervertebral disc between the LI and L2).

• The knowledge of these variations in the vertebral

level of the lower end of the cord is important to
avoid injury to the cord while performing lumbar
puncture, especially in children.
 SPINAL MENINGES
• The spinal cord is surrounded by three
protective membranes called spinal meninges.

• From outside inwards these are: dura mater,

arachnoid mater, and pia mater
Schematic transection of vertebral canal showing
spinal cord and its surrounding meninges
 Schematic transverse section of spinal cord showing meninges
and formation of meningeal sheaths onto the spinal nerve roots.
 DURA MATER
• The spinal dura extends from foramen magnum
to the lower border of second sacral vertebra
(S2).

• The space between spinal dura and vertebral

canal is termed epidural space.
• This space contains loose areolar tissue,
semiliquid fat and internal vertebral venous
plexus.

• The space between dura and arachnoid mater

termed subdural space. It contains capillary
layer of fluid.
DIFFERENCES BETWEEN SPINAL & CRANIAL
DURA
 ARACHNOID MATER
• Arachnoid mater is a thin delicate transparent
avascular membrane which invests the spinal
cord loosely.

• Above it is continuous with the arachnoid

mater of the brain and below it extends up to
the lower border of the second sacral vertebra
(S2).
 PIA MATER
• Pia mater is a thin highly vascular membrane
that closely invests the spinal cord and
continues below the spinal cord as a thin
thread-like prolongation, the filum terminale.

• The subarachnoid space between the pia mater

and the arachnoid mater is filled with
cerebrospinal fluid (CSF).
• Above it is continuous with subarachnoid space
around the brain.

• Distal to the termination of spinal cord, the sub-

arachnoid space around the filum terminale,
becomes roomy, forming a pool of CSF called
lumbar cistern. The lumbar puncture is done at
this site to take out the CSF.
 Sagittal section through lumbosacral region showing conus
medullaris, filum terminale (internum and externum), lower end
of subarachnoid space and site of lumbar puncture
EXTERNAL FEATURES OF THE SPINAL CORD

1. Fissures and sulci.

2. Attachment of spinal nerves.
3. Enlargements.
4. Cauda equina.
 1. FISSURES AND SULCI
• The anterior aspect of the spinal cord presents
anterior median fissure, and two anterolateral
sulci while the posterior aspect presents:
posteromedian sulcus, two posterolateral and
two posterointermediate sulci
 2. ATTACHMENTS OF SPINAL NERVES

• Thirty-one pairs of spinal nerves emerge from

the sides of the cord.

• Of these, 8 are cervical, 12 are thoracic, 5 are

lumbar, 5 are sacral, and 1 is coccygeal.
• 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.
• The remainder spinal nerves emerge below the
corresponding vertebrae.

• Each spinal nerve is attached to the cord by two

roots, anterior motor root and posterior
sensory root.
• The posterior root has a ganglion, the posterior
root ganglion consisting of pseudounipolar
cells.

• Each of the two roots is made up of number of

rootlets that arise from the spinal cord over a
certain length.
• The rootlets of posterior root enter the
dorsolateral aspect of the cord along the
posterolateral sulcus whereas the rootlets of
anterior root emerge from the anterolateral
sulcus/anterolateral aspect of cord opposite to
the anterior grey column.
A section of spinal cord showing attachment
of nerve roots on one side.
 SPINAL SEGMENTS
• Like the vertebral column, the spinal cord is also
segmented though the segments are not visible
externally.

• The part of spinal cord to which a pair of spinal

nerves (right and left) is attached is known as
spinal segment.
Schematic diagram to represent the spinal
segments.
• The number of spinal segments corresponds to
the number of vertebrae in thoracic, lumbar
and sacral regions, but in cervical region, one
segment is more than the number of
vertebrae, whereas in coccygeal region there is
only one segment for four coccygeal vertebrae.
• Thus, the spinal cord is made up of 31 spinal
segments: 8 cervical, 12 thoracic, 5 lumbar, 5
sacral, and 1 coccygeal.

• Since, the length of spinal cord (45 cm) is smaller

than the length of vertebral column (65 cm), the
spinal segments are, short and crowded,
especially 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.

• In the lower part of the spinal cord, they lie well above
their corresponding vertebrae . For example, the
lumbar segments are related to the thoracic vertebrae
The spinal segments
and their
corresponding
vertebrae levels.
 Approximate vertebral levels of the spinal
cord segments

• These levels, although not strictly accurate, give a

reliable assessment of the level of cord compression
following an injury or disease of the surrounding
vertebrae.
• The approximate relationship helps in
understanding the consequences of spinal
injuries and clinical findings of motor and
sensory levels.

• They also help in planning for surgical approach

for diagnostic and therapeutic purposes.
 3. ENLARGEMENTS
• The spinal cord is roughly cylindrical in shape
with an average diameter of about 1.25 cm.

• However, opposite to the attachments of the

nerve roots contributing to the formation of
brachial and lumbosacral plexuses, the spinal
cord presents definite fusiform swellings called
cervical and lumbar enlargements respectively.
• These enlargements are produced due to the
presence of large number of large motor neurons
in these regions to supply the musculature of the
upper and lower limbs and associated girdles.

• The cervical enlargement extends from C5 to T1

spinal segments whereas lumbar enlargement
extends from L2 to S3 spinal segments.
Comparison between cervical and lumbar
spinal enlargements
 4. CAUDA EQUINA
• Since 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 intervertebral
foramina.
• 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.
INTERNAL STRUCTURE OF THE SPINAL CORD

• It consists of an inner core of grey matter, and

a peripheral zone of white matter.
 GREY MATTER
• In cross-section of cord the grey matter is seen as
H-shaped (or butterfly-shaped) fluted column,
extending throughout the length of the spinal
cord.

• It is divided into symmetrical right and left

comma-shaped masses which are connected
across the midline by a transverse grey
commissure.
• The central canal of the cord passes through
the centre of grey commissure.

• The lateral comma-shaped mass of grey matter

is further divided by a transverse grey
commissure into a narrow elongated posterior
horn, and a broad anterior horn.
• In the thoracic region and upper two lumbar
segments (T1 to L2), a triangular projection juts
out from the side of lateral grey mass between
the anterior and posterior horns, nearly
opposite to the grey commissure. It is called
lateral horn.
 NERVE CELL GROUPS IN THE GREY
COLUMNS OF THE SPINAL CORD

1) Cell groups in the anterior grey column

2) Cell groups in the posterior grey column
3) Cell groups in the intermediate (lateral) grey
column
1) Cell groups in the anterior grey column
2) Cell groups in the posterior grey column
3) Cell groups in the intermediate (lateral)
grey column
 WHITE MATTER
• In each half of the spinal cord, the white matter is
divided into three parts called white columns or
funiculi:
• Posterior white column, between the posterior
median septum, and the posterior horn.
• Lateral white column, between the anterior and
posterior horns.
• Anterior white column, between the anterior
median fissure and the anterior horn.
• The anterior white columns are joined together
by the white commissure.

• Each white column is made up of tracts which

are either ascending (sensory), descending
(motor) or intersegmental (association).
• N.B. In general, the posterior white column is
sensory, the anterior column is motor and
lateral column is mixed (i.e. motor as well as
sensory).

• Further, the ascending tracts are located at the

periphery and the descending tracts in the
centre.
TRACTS OF
THE SPINAL
CORD
• The tracts are defined as collections of nerve
fibres within the central nervous system, which
have same origin, course and termination.

• They are sometimes referred to as fasciculi (=

bundles) or lemnisci
• The tracts are named after the names of masses
of grey matter connected by them.

• The name usually consists of two components

(or terms), the first term denotes the origin and
second the termination of the tract.
• For example, a tract arising in cerebral cortex
and terminating in the spinal cord is called
corticospinal tract, similarly a tract arising in
the spinal cord and terminating in the thal-
amus is called spinothalamic tract.
 CLASSIFICATION OF THE TRACTS
• The tracts are classified into three types:

(a) descending,
(b) ascending, and
(c) intersegmental.
The presence of different tracts in anterior, lateral
and posterior white columns of the spinal cord
 MAJOR
DESCENDING
TRACTS IN THE
SPINAL CORD
LATERAL CORTICOSPINAL TRACT
ANTERIOR CORTICOSPINAL TRACT
RUBROSPINAL TRACT
VESTIBULOSPINAL TRACT
TECTOSPINAL TRACT
LATERAL RETICULOSPINAL TRACT
MEDIAL RETICULOSPINAL TRACT
 MAJOR
ASCENDING
TRACTS IN THE
SPINAL CORD
LATERAL SPINOTHALAMIC TRACT
ANTERIOR SPINOTHALAMIC TRACT
SPINOTECTAL TRACT
SPINOCEREBELLAR TRACT
GRACILIS & CUNEATUS TRACTS
 INTERSEGMENTAL TRACTS
• The short ascending and descending tracts, which
originate and end within the spinal cord, exist in the
anterior, lateral and posterior white columns.

• The function of these tracts is to interconnect the

neurons of different segmental levels.

• These tracts are particularly important in

intersegmental spinal reflexes.
Blood Supply of
The Spinal Cord
Arterial Supply
1. Anterior spinal artery.
2. Two posterior spinal arteries.
3. Segmental arteries.
 1. ANTERIOR SPINAL ARTERY
• The anterior spinal artery is formed by the
union of two small spinal branches of the 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.
 2. POSTERIOR SPINAL ARTERIES
• There are two posterior spinal arteries each
arising as a small branch from either the
vertebral or posterior inferior cerebellar
artery.
 3. SEGMENTAL ARTERIES
• The segmental arteries are 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.
 VENOUS DRAINAGE
• Two median longitudinal, one in the anterior
median fissure and the other in the posteromedian
sulcus.

• Two anterolateral, one on either side, posterior to

the anterior nerve roots.

• Two posterolateral, one on either side posterior to

the posterior nerve roots