INTRODUCTION

•Synonym: Spinal medulla (medulla spinalis L.)

•Lower elongated part of CNS.

•Most important content of Vertebral Column.

•Extent and Location:

•Begins as downward extension of medulla oblongata at the upper border

of Cervical vertebra(C1).

• Extends Down to the lower border of First Lumbar Vertebra(L1).

•Occupies the upper 2/3rd of vertebral column.

• Level of Termination is variable

• 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.

• filum terminale: It is a prolongation of pia mater and is attached to the

posterior surface of the соссух.

DIMENSIONS

•Length of the cord varies from 42cm to 45cm.

•Enlargements: cord doesn't have uniform thickness.

-The spinal segments that contribute to the nerves of the upper limbs
(C3-T2) are enlarged to form the cervical enlargement of the cord.

-The segments innervating the lower limbs (L1-S3) form the lumbar
enlargement.

FUNCTIONS

• The spinal cord has three major functions:

1. It acts as a pathway for motor information, which travels down the spinal
cord.

2. It serves as a passage for sensory information in the reverse direction.

3. It is a centre for coordinating simple reflexes.

AGE-WISE CHANGES

•Early fetal life (3rd month):

-The spinal cord is as long as the vertebral canal

-Each spinal nerve arises from the cord at the level of the corresponding
intervertebral foramen.

•At the time of birth:

-Gradually ascends to reach the level L3.

•In Adult:
-lower border of the L1.

•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 spinal nerve roots longer.

•The obliquity and length of the roots are 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.

SPINAL MENINGES

•Cord is surrounded by the Meninges.

•From Outside to inside:

-Dura Mater (Durus - Hard, Mater -Mother L.)

-Arachnoid Mater (Arachne -cobweb or spider, eidos resembling G.) -

-Pia Mater (Pia - Tender L.)

•Name of Spaces:

-DuraMater & Vertebra: Extradural/ Epidural

-DuraMater & Arachnoid: Subdural

-Arachnoid & PiaMater: Subarachnoid.

 DURA MATER

-Forms a loose tubular covering for the spinal cord.

-Does not fuse with the endosteum of the vertebral canal.

-There is a well-developed epidural space surrounding the spinal cord.

-The spinal epidural space is filled with loose areolar tissue, fat and the
internal vertebral venous plexus (Batson's plexus).

-The dorsal and ventral roots of spinal nerves pass through the spinal dura
mater separately.

-The dura-arachnoid partially enclose the dorsal nerve root ganglion as a

Sheath.

-The dura and arachnoid (along with the subarachnoid space containing
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 coccygeal vertebra.

ARACHNOID MATER

-Transparent and Avascular Membrane.

-Extends up to the level of second sacral vertebrae(S2).

-The Dura & Arachnoid extends up to S2.

-Between L1 & S2 Subarachnoid space around filum terminale becomes

roomy and contains cauda equine in pool of CSF called lumbar cistern.
-The lumbar cistern is broadest between L2 and L4 level.

-Lumbar puncture is therefore done at L3-L4 space or L2-L3 space.

PIA MATER

-The spinal pia mater is a thin membrane closely applied to the spinal cord

-The modifications of pia mater are as follows:

• Ligamenta denticulate

• Linea splendens

• Filum terminale

• Spinal Subarachnoid Septum

EXTERNAL FEATURES

•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

-Posterior sensory root.

•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.

•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.

•A spinal nerve is made-up of a mixture of motor and sensory fibres.

•After emerging from the intervertebral foramen, each spinal nerve divides
into dorsal and ventral rami

•The dorsal ramus passes posteriorly around the vertebral column to

supply the deep muscles of the back 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.
•Each root is formed by aggregation of a number of rootlets that arise from
the cord over a certain length.

•The last rootlet of hypoglossal nerves arises in line with the first ventral
rootlet of C1 spinal nerve.

•The junction between these two rootlets marks the junction of medulla
oblongata and the spinal cord.

SPINAL SEGMENTS

-The part of the spinal cord giving origin to the rootlets for one pair of spinal
nerves constitutes one spinal segment.

-The spinal cord is made-up of 31 such segments-

• 8 cervical

• 12 thoracic

• 5 lumbar

• 5 sacral

• 1 coccygeal

VERTEBRAL LEVEL OF SPINAL SEGMENTS:

•The length of spinal cord (45 cm) is smaller than that of vertebral column
(65 cm), the spinal segments are thinner and crowded, more so in the
lower part of the cord.

•Thus, the spinal and vertebral segments (vertebral bodies) do not lie at the
same level.
•The spinal segments as a rule always lie above their numerically
corresponding vertebral bodies.

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.

•The remaining spinal nerves emerge below the pedicles of the

corresponding vertebrae.

•As the spinal cord ends at the level of L1 vertebra, the lower spinal nerves
below L1 level descend down with the filum terminale as a leash, which
resembles a horse's tail and hence called as cauda equina.

INTERNAL STRUCTURE

The cross-section of the spinal cord shows that it consists of an innercore

of grey matter and a peripheral zone of white matter.

-Grey Matter: Forms an H-shaped structure in a transverse section. It

includes:

•Anterior (ventral) grey column (larger)

•Posterior (dorsal) grey column (narrow)

•Lateral grey column (present in some regions)

•Grey commissure connects both halves and contains the central canal
with cerebrospinal fluid.

-White Matter: Divided into right and left halves by:

•Anterior median fissure (front)

•Posterior median septum (back)

•Each half contains:

° Posterior funiculus (white column) (medial to the dorsal grey column)

° Anterior funiculus (white column) (medial and ventral to the anterior grey
column)

° Lateral funiculus (between anterior and posterior grey columns)

° The anterior and lateral funiculi together form the anterolateral funiculus.

The ventral white commissure connects the white matter across the
midline. There is no distinct dorsal white commissure, though some
transverse myelinated fibers are referred to as such.

KEY VARIATIONS

•White Matter: Increases progressively from the lower to the upper spinal
cord as more ascending fibers are added, and descending fibers decrease
as they terminate segmentally.

•Grey Matter: The amount correlates with the tissue it supplies, being
largest in the cervical and lumbar enlargements that control limb
movements.
Grey Matter Subdivisions:

•Traditional Subdivisions:

-Ventral grey column → Divided into a head (ventral part) and base
(dorsal part).

-Dorsal grey column → Divided into a base, neck, and head (anterior to
posterior).

•Nuclei Collections: Neuron clusters exist within the grey matter, varying
at different spinal levels but are not described in detail.

-The spinal cord grey matter is organized into distinct regions, each with
specific functions:

•Dorsal Horn: Contains the substantia gelatinosa at its apex, which

processes pain and temperature sensations.

•Intermediate Zone: Located between the dorsal and ventral grey

columns, it includes the intermediolateral and intermediomedial nuclei,
involved in autonomic functions.

•Ventral Horn: Contains motor neurons that innervate skeletal muscles.

DIVISION OF SPINAL GREY MATTER INTO LAMINAE

1. Lamina I: Posteromarginal nucleus; processes pain and temperature

sensations.
2. Lamina II: Substantia gelatinosa; involved in pain and temperature
processing.

3. Laminae III and IV: Nucleus proprius; processes mechanical and

temperature sensations.

4. Lamina V: Neck of the dorsal horn; involved in processing sensory

afferent stimuli from cutaneous, muscle, and joint mechanical nociceptors,
as well as visceral nociceptors.

5. Lamina VI: Base of the dorsal horn; receives input from large-diameter
fibers innervating muscles and joints, and from muscle spindles sensitive to
joint movement and muscle stretch.

6. Lamina VII: Intermediate grey matter; includes the intermediomedial,

intermediolateral, and dorsal nuclei. It gives off fibers that reach the
midbrain and cerebellum and receives fibers from these regions.

7. Lamina VIII: Motor interneurons; involved in motor control.

8. Lamina IX: Contains motor neurons that innervate skeletal muscles.

9. Lamina X: Surrounds the central canal; connects the anterior and

posterior grey columns.

TYPES OF NEURONS IN SPINAL GREY COLUMN

•Ventral Grey Column (Anterior Horn) Neurons:

1. Alpha (α) Motor Neurons: Located in lamina IX.

Innervate skeletal muscles, causing contraction.
2. Gamma (γ) Motor Neurons:Also in lamina IX. Innervate intrafusal
fibers of muscle spindles, influencing α-neurons indirectly.

3. Interneurons (Internuncial Neurons):

Most abundant in lamina VIII.
Relay sensory and motor signals between neurons.

4. Renshaw Cells:
Regulate α-neurons through feedback inhibition.

Dorsal Grey Column (Posterior Horn) Neurons:

1. Internuncial Neurons: Similar to those in the ventral grey column.

2. Dorsal Column Neurons:

Receive sensory inputs from dorsal root ganglia.
Their axons either:
Form intersegmental tracts (ascending/descending within the spinal cord).
Join ascending tracts to carry sensory signals to the brain.

Lateral Grey Column Neurons:

1. Intermediolateral Neurons:

Found in thoracic and upper lumbar segments.

Act as preganglionic visceral efferent neurons for the autonomic nervous
system.

2. The second group of visceral efferent neurons is located in the second to

fourth sacral segments of the spinal cord. These preganglionic
parasympathetic neurons send axons through the ventral nerve roots,
joining spinal nerves before forming the pelvic splanchnic nerves. These
nerves innervate pelvic and abdominal viscera, synapsing with ganglion
cells in organ walls. The short postganglionic fibers then supply smooth
muscles and glands within these organs.

WHITE MATTER OF SPINAL CORD

The anterior, lateral and posterior funiculi of the spinal cord are made up of
nerve fibres running up or down the cord. These constitute the ascending
and descending tracts.

TRACTS OF SPINAL CORD

A collection of nerve fibres that connect two masses of grey matter whithin
the central nervous system is called tract. There are two types of tract
1. Ascending
2. Descending - (a) pyramidal
(b) extrapyramidal

•Name & Function :-

Pyramidal tracts

1. Lateral corticospinal - Main motor tract for skillful voluntary movements

2. Anterior corticospinal - Facilitates flexors

Extrapyramidal tracts

1. Rubrospinal - Efferent pathway for cere-bellum and corpus striatum

2. Medial reticulospinal - Extrapyramidal tract Facilitates extensors

3. Lateral reticulospinal - Extrapyramidal tract Facilitates flexors

4. Olivospinal - Extrapyramidal tract

5. Lateral vestibulospinal - Efferent pathway for equilibratory control

6. Tectospinal - Efferent pathway for visual reflexes

7. Descending auto-nomic fibres - Control parasympathetic and

sympathetic systems
Ascending:-

Name & Function

1. Lateral spinothalamic - Pain and temperature from opposite half of body

2. Anterior spinothalamic - Touch (crude) and pressure from opposite half

of body

3. Fasciculus gracilis - Conscious proprioception Discriminatory touch

Vibratory sense Stereognosis

4. Fasciculus cuneatus - Conscious proprioception Discriminatory touch

Vibratory sense Stereognosis

5. Posterior spino-cerebellar - Unconscious proprio-ception from individual

muscles of lower limb

6. Anterior spinocere-bellar - Unconscious proprio-ception from lower limb

as a whole

7. Spino-olivary - Proprioceptive sense

8. Spinotectal - Afferent limb of reflex movements of eyes and head

[2
BLOOD SUPPLY OF SPINAL CORD

1. Arterial Supply:

•Anterior Spinal Artery: Formed by branches of the vertebral arteries, runs

in the anterior median fissure.

•Posterior Spinal Arteries: Paired arteries from the vertebral arteries,

running along the dorsal roots.

•Radicular Arteries: Supplement blood supply, originating from vertebral,

intercostal, lumbar, and sacral arteries.

•Arteria Radicularis Magna: A large radicular artery, crucial for supplying

the lower two-thirds of the spinal cord.

2. Intrinsic Blood Supply:

•Anterior Spinal Artery: Supplies the anterior two-thirds of the spinal cord,
including anterior and lateral grey columns and funiculi.

•Posterior Spinal Arteries: Supply the posterior one-third of the spinal cord.

•Arterial Vasocorona: A plexus in the pia mater, contributing to spinal cord

perfusion.

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

CLINICAL ANATOMY

•Spondylolisthesis: Slipping of one vertebra over another, commonly at

L4-L5, potentially compressing the cauda equina.

•Cervical Spondylosis: Osteophytes at C4-C5 may compress the C5

spinal nerve, causing deltoid muscle paralysis.

•Lumbar Spondylosis: Degenerative changes in the lumbar spine, often

linked to chronic back pain.

•Epidural Anaesthesia: Injected into the epidural space for pain relief
during childbirth; care needed to avoid venous plexus injury and epidural
haematoma.

•Herpes Zoster: Viral infection of dorsal nerve root ganglia, leading to

painful skin eruptions along affected nerves.

•Brown-Séquard syndrome: This is caused due to hemisection of the

spinal cord. Figure shows various features of hemisection on the left side.

•Below the level of lesion:

a. Ipsilateral upper motor neuron paralysis caused by pyramidal tract

damage.
b. Ipsilateral loss of conscious proprioceptive sensations caused due to
damage to posterior white column in the figure.

c. Contralateral loss of pain and temperature and touch caused due to

damage to lateral spino-thalamic and anterior spinothalamic tracts.

•At the level of lesion:

a. Ipsilateral lower motor neuron paralysis caused due to damage to ventral

nerve roots.

b. Ipsilateral anaesthesia over the skin of the segment due to injury to the
ventral nerve roots.

•Above the level: Ipsilateral hyperaesthesia above the level of lesion due to
irritation of dorsal nerve roots.

•Syringomyelia (central spinal cord syndrome): There is formation of

cavities around the central canal usually in the lower cervical region. Its
features are:

a. Bilateral loss of pain and temperature occurs due to injury to the

decussating fibres of lateral spinothalamic fibres (Figure)

b. Bilateral loss of touch occurs due to injury to anterior spinothalamic

tract.

-As the decussation of lateral and anterior spino-thalamic tracts occurs at

different levels, there is dissociated sensory loss.

-As this disease occurs in lower cervical and upper thoracic regions, there
is problem in both the upper limbs and front of chest.
-Syringomyelia disrupts the crossing fibres of anterolateral system. The
medial lemniscal system is spared.

•Partial cord lesion (unilateral): In high cervical lesions, there is

weakness of finger movements accompanied by dragging of the leg.

a. Upper motor neuron paralysis on the side of lesion.

b. Sensory loss: Numbness on the side of lesion. Joint position sense and
two-point discrimination impaired on the side of lesion.