Anatomy of the spinal cord

Endre Dob

Spinal cord
elongated cylindrical portion of the cerebrospinal axis, or central nervous
system, which is contained in the vertebral canal
boundary of the spinal cord with reference to the axial skeleton in adults:
> foramen magnum
> upper level of the 2nd lumbar vertebra (LII)
boundary of the spinal cord with the brain stem:
> rostral to the origin of the first cervical nerve
> caudal to the level of the pyramidal decussation

External features of the spinal cord

> cervical enlargement
> extremity-related spinal cord enlargement at the C4-T1 segments
> lumbosacral enlargement [TA] / lumbar enlargement
> L2-S2 segments, due to the lumbar and sacral plexuses
> L4-5 segments are the thickest
> medullary cone / conus medullaris
> spinal cord ends at the upper level of LII vertebra in the adult
> spinal cord ends at the level of LIII in the newborn
> exits of the 4th, 5th sacral and the coccygeal nerves
> terminal filum / filum terminale
> the vertebral column grows longer than the spinal cord
> long tissue strand, by which the conus medullaris remains anchored to the coccyx
> at the level of the middle of the sacrum (SII), the subarachnoid and subdural spaces close
> pial part / filum terminale internum
> extends from the extremity of the medullary cone to the inner aspect of the spinal dural sac
> dural part / filum terminale externum / coccygeal ligament
> stout strands of connective tissue attaching the spinal dural sac to the coccyx
> cauda equina
> collection of all spinal nerve roots from L1-2 caudally

Spinal cord segments

parts of the spinal cord,

spinal cord segments
> cervical part
> 8 cervical segments
> thoracic part
> 12 thoracic segments
> lumbar part
> 5 lumbar segments
> sacral part
> 5 sacral segments
> coccygeal part
> 1 coccygeal segment

Extent of the gray and white

matters, and their ratio vary
at the spinal cord segments
cervical part
thoracic part
lumbar part
sacral part

spinal cord is divided into two major

distinct parts from anatomical and
histological points of view:
> gray matter (substantia grisea)
> white matter substantia alba)
myelin sheath staining

Comparison of the parts

of the spinal cord

cat spinal cord;

Weigert-Pal staining

External features of the spinal cord

> anterior median fissure
> deep groove; anterior spinal a. runs along it
> anterolateral sulcus / ventrolateral sulcus
> indistinct furrow on the ventral surface
> on either side, there is a line of exit of the rootlets of anterior spinal nerve
> posterolateral sulcus / dorsolateral sulcus
> longitudinal furrow on either side of the posterior median sulcus
> marks the line of entrance of the posterior nerve rootlets
> dorsolateral tract of Lissauer is located between this and the tip of the posterior horn
> posterior intermediate sulcus / dorsal intermediate sulcus
> marks the gracile fasciculus from the cuneate fasciculus in the cervical part
> intermediate cervical septum / posterior intermediate septum
> extends from the pia mater into the depths of the posterior funiculus between
the gracile and cuneate fasciculi
> posterior median sulcus / dorsal median sulcus
> longitudinal furrow dividing the spinal cord into two symmetrical halves
> posterior median septum / dorsal median septum
> pial tissue extending from the central canal dorsally to the sulcus

Internal features of the spinal cord

and organization of the spinal nerve
gray matter:
1: anterior horn
lateral horn
(T1-L2 segments)

2: posterior horn
3: intermediate zone/region

white matter:
4: anterior funiculus
5: lateral funiculus
6: posterior funiculus
7: anterior white commissure
8: posterior white commissure
9: posterior median septum

10: central canal

11: anterior root / motor root
12: posterior root / sensory root
13: dorsal root ganglion

Cervical enlargement
(photomontage)

Nissl staining

myelin sheet staining

Gray columns
> three somewhat ridge-shaped cellular masses of the gray matter
> in transverse sections these columns appear as gray horns
> anterior column / ventral column (A)
> major cell type
> somatomotor neurons
> intermediate column (B)
> especially marked in the T1-L2 segments
> lateral column
> slight protrusion into the lateral funiculus
> cell column that forms the lateral horn in the
> major cell type
> visceromotor neurons
> posterior column / dorsal column (C)
> major cell types
> sensory-related neurons

Laminar organization of gray matter

(spinal laminae of Rexed)

Spinal laminae, based on cytoarchitectonic studies of Rexed.

Rexeds lamination serves a descriptive rather than a functional purpose.
Laminae are numbered consecutively by Roman numerals.

General patterns of gray matter and

white matter of spinal cord
> white matter increases in a caudal-to-rostral direction
> cervical and lumbosacral enlargements for innervation of the upper
and lower limbs
> brachial plexus and lumbosacral plexus
> lateral horn is characteristic of the thoracic and upper lumbar
segments:
> intermediolateral nucleus, contains the autonomic motor
neurons that give rise to the preganglionic fibers of the
sympathetic system
> proceeding rostrally, fibers are continually added to the internal
aspect of the tract:
> Kahler-Pick law

Major pathways of the spinal cord

Motor and descending pathways (left, red):
1 Pyramidal tract
1a Lateral corticospinal tract
1b Anterior corticospinal tract
2 Extrapyramidal tracts
2a Rubrospinal tract
2b Reticulospinal tract
2c Vestibulospinal tract
2d Olivospinal tract

Sensory and ascending pathways (right,

blue)
3 Dorsal column system
3a Gracile fasciculus
3b Cuneate fasciculus
4. Spinocerebellar tracts
4a Posterior spinocerebellar tract
4b Anterior spinocerebellar tract
5. Anterolateral system
5a Lateral spinothalamic tract
5b Anterior spinothalamic tract
----6 Spino-olivary fibers

Somatotopy abbreviations:
C cervical, Th thoracic, L lumbar, S sacral

Spinal meninges
> endorachis
> periosteum and outermost layer of the spinal dura mater (periosteal layer), together
> formation
> cranial dura mater divides into two layers at the foramen magnum
> periosteal layer
> meningeal layer of the spinal dura mater
> epidural space / extradural space
> true space containing the internal vertebral venous plexus embedded in a matrix of epidural fat
> spinal dura mater (meningeal layer)
> extends to the SII vertebra (dural sac is longer than the spinal cord)
> lower part of the dural sac contains the cauda equina
> dural part of filum terminale
> ensheathes the spinal ganglia
> spinal arachnoid mater
> forms the perineurium of the spinal nerves
> subarachnoid space
> contains cerebrospinal fluid
> lumbar cistern
> enlargement of the subarachnoid space below the medullary cone
> spinal pia mater
> attached to the outermost surface of the parenchyma of the spinal cord
> denticulate ligament
> serrated, shelflike extension of the spinal pia mater projecting in a frontal plane from either side
of spinal cord, and fuses laterally with the arachnoid

Liquor spaces of the spinal cord

> internal liquor space
> central canalis
> begins as calamus scriptorius of the rhomboid fossa, continuous
with the 4th ventricle
> ends with a dilation, referred to as terminal ventricle
> terminating within the filum terminale in the young adult and just
rostral to the conus medullaris by the fourth decade of life
> lined by ependymal cells

> external liquor space

> subarachnoid space
> CSF flows caudally behind the spinal cord,
whereas cranially in front of the spinal cord
> drainage of CSF occurs locally, as well
> via the internal vertebral venous plexus
> at the spinal ganglia, lymph is formed from CSF

Lumbar puncture

> puncture into the subarachnoid space of the lumbar region to obtain spinal fluid for diagnostic
or therapeutic purposes
> between the arches of vertebrae LIII and LIV or vertebrae LIV and LV

> the layers that are pierced through:

> skin
> superficial fascia
> supraspinal lig.
> interspinal lig.
> lig. flavum
> endorachis
> spinal dura mater

Arterial supply to the spinal cord

Branches from the anterior and posterior spinal arteries form coronal vessels,
termed arterial vasocorona (vasa coronaria).

Arterial branches from the posterior

intercostal arteries enter the vertebral
canal, and contribute to the blood
supply of the spinal cord.

The radicular and medullary arteries passing

through the intervertebral foramen supply to
the vasocorona segmentally

Adamkiewicz artery

> largest anterior medullary feeder artery

> most often arises on the left side
> from a spinal branch of either one of the lower posterior
intercostal arteries [T9-11]

Blood supply to the spinal cord (summary)

vertebral a.
posterior spinal a.
deep cervical a.

posterior segmental medullary a.

posterior radicular a.

dorsal branches,
posterior intercostal aa.

"vasocoronaria"

spinal bb.

vertebral a.

anterior radicular a.
subcostal a.

anterior segmental medullary a.

anterior spinal a.

lumbar aa.

iliolumbar aa.

lateral sacral aa.

major anterior
segmental medullary a.
(Adamkiewicz a.

sulcal branches

Vertebral venous plexuses

Venous drainage of the spinal cord

Venous drainage of the spinal cord (summary)

post. ext. vertebral venous plexus
vertebral v.

post. int. vertebral venous plexus

post. spinal v.

SVC

postt. intercostal vv.

post. segmental medullary v.
subcostal v.

post. radicular v.

intervertebral vv.

vertebral foramen

ant. radicular v.

lumbar vv.

ant. segmental medullary v.

IVC

intervertebral
foramen

iliolumbar v.
ant. spinal v.
latt. sacral vv.

ant. int. vertebral venous plexus

ant. ext. vertebral venous plexus