Spinal cord

• The second organ of the CNS is spinal cord which serve as communication link
between the brain and the PNS

• In adult spinal cord ranges between 42 and 45 cm in length and extends inferiorly
from the brain through the foramen magnum and then through the vertebral canal
and ends at the level of the L1 vertebra.

• It is considerably shorter than the vertebral column because it does not grow as
rapidly as the vertebral column during development.

• The spinal cord gives rise to 31 pairs of spinal nerves, which exit the vertebral
column through intervertebral and sacral foramina

• The spinal cord is divided into four regions

❑ The cervical part- superiormost region of the spinal cord, continuous with the medulla
oblongata
❑ The thoracic part lies inferior to the cervical part
❑ The lumbar part is a shorter segment of the spinal cord
❑ The sacral part
❑ The coccygeal part is the most inferior “tip” of the spinal cord
• Two prominent enlargements can be seen in a external view. The cervical
enlargement is located between the third cervical and the second thoracic
vertebrae. Nerves emerging from this region serve the upper extremities.

• The lumbar enlargement lies between the ninth and twelfth thoracic vertebrae.
Nerves from the lumbar enlargement supply the lower extremities.

• Immediately inferior to the lumbosacral enlargement, the spinal cord tapers to

form a conelike region called the conus medullaris which makes the inferior end of
spinal cord.

• Inferior to conus medullaris there is groups of axons collectively called the cauda
equina

• Arising from the conus medullaris is the filum terminale which is an extension of
the pia mater that extends inferiorly and fuses with the arachnoid mater and dura
mater and anchors the spinal cord to the coccyx

• Two grooves, an anterior median fissure and a posterior median sulcus, extend
the length of the spinal cord and partially divide it into right and left portions.

• Like the brain, the spinal cord is protected by three distinct meninges and is
cushioned by cerebrospinal fluid.
• A transverse section of the spinal cord reveals regions of white matter that
surround an inner core of gray matter.

• The gray matter of the spinal cord is shaped like the letter H or a butterfly; it
consists of dendrites and cell bodies of neurons, unmyelinated axons, and
neuroglia.

• Projections of the gray matter within the spinal cord are called horns, and are
named according to the direction in which they project.

❑ The paired posterior horns extend posteriorly. Contain cell bodies and axons of
interneurons as well as axons of incoming sensory neurons
❑ The paired anterior horns project anteriorly. Contain somatic motor nuclei,
which are clusters of cell bodies of somatic motor neurons that provide nerve
impulses for contraction of skeletal muscles
❑ Paired Lateral horns extend to the sides between the posterior and anterior
horns. Contain autonomic motor nuclei, which are clusters of cell bodies of
autonomic motor neurons that regulate the activity of cardiac muscle, smooth
muscle, and glands.

• The gray commissure forms the crossbar of the H. In the center of the gray
commissure is a small space called the central canal; it extends the entire length of
the spinal cord and is filled with cerebrospinal fluid. At its superior end, the central
canal is continuous with the fourth ventricle
• The spinal cord has six columns of white matter
called funiculi which are named according to their
relative position within the spinal cord.

❑ The two anterior funiculi are located between the two

anterior horns of gray matter, to either side of the anterior
median fissure.

❑ The two posterior funiculi are located between the two

posterior horns of gray matter, to either side of the
posterior median sulcus.

❑ Two lateral funiculi are located between the anterior and

posterior horns of gray matter.
 Spinal nerves
• Spinal nerves are the paths of communication between the spinal cord and specific
regions of the body.
• There are 31 pair of spinal nerves.
❑ 8 pairs of cervical nerves (C1–C8),
❑ 12 pairs of thoracic nerves (T1–T12),
❑ 5 pairs of lumbar nerves (L1–L5),
❑ 5 pairs of sacral nerves (S1–S5),
❑ 1 pair of coccygeal nerves (Co1).

• A spinal nerve is a mixed nerve attached to the spinal cord by a posterior (dorsal)
root, composed of sensory fibers, and an anterior (ventral) root, composed of
motor fibers

• The posterior root is formed from merger of posterior rootlets which arise from
posterior root ganglion which itself is attached to spinal cord. Posterior root axons
bring sensory information. The posterior root ganglion is made up of cell bodies of
sensory neurons.

• The anterior root is formed from merger of multiple anterior rootlets which arise
from spinal cord. The anterior root consists of axons of motor neurons, which
convey motor impulses away from the CNS.
• A spinal nerve is formed as the fibers from the posterior and anterior roots
converge and emerge through an intervertebral foramen

• After leaving the intervertebral foramen spinal nerve splits into branches,
termed rami.

• There are three types of rami:

❑ Anterior ramus: splits into multiple other branches, which innervate the
anterior and lateral portions of the trunk, the upper limbs, and the lower
limbs.
The anterior/ventral rami are distributed in two ways. In the thoracic
region, the ventral rami form intercostal (between ribs) nerves which
extend along the inferior margin of each rib and innervate the
intercostal muscles and the skin over the thorax.
The ventral rami of the cervical, lumbar, sacral, and coccygeal spinal
nerves form plexuses
❑ Posterior ramus: innervates the deep muscles and the skin of the back
❑ Rami communicantes: These rami contain axons associated with the
autonomic nervous system. Each set of rami communicantes extends
between the spinal nerve and the sympathetic trunk ganglion
 Spinal Plexus
• Except in thoracic nerves, T2 through T12, the anterior rami
of the spinal nerves combine and then split again as networks
of nerve fibers referred to as nerve plexuses

• The principal plexuses are the cervical plexus, brachial plexus,

lumbar plexus, and sacral plexus

• Nerves emerging from the plexuses are named according to

the structures they innervate

• The anterior rami of spinal nerves T2–T12 do not enter into

the formation of plexuses and are known as intercostal or
thoracic nerves. These nerves directly connect to the
structures they supply in the intercostal spaces. They supply
the intercostal muscles, rib cage, abdominal muscles and skin
of these areas
• The cervical plexus is positioned deep on the side of the neck,
lateral to the first four cervical vertebrae.

• It is formed by the anterior rami of the first four cervical

nerves (C1–C4) and a portion of C5.

• Branches of the cervical plexus innervate the skin and

muscles of the neck and portions of the head and shoulders.

• Some fibers of the cervical plexus also combine with the

accessory and hypoglossal cranial nerves to supply dual
innervation to some specific neck and pharyngeal muscles.

• An important nerve that originate from cervical plexus with

contribution from brachial plexus is phrenic nerve. It descend
along each side of the neck to enter the thorax, after passing
through mediastinum reaches the diaphragm
 Brachial plexus
• The brachial plexus is positioned to the side of the last four
cervical vertebrae and the first thoracic vertebra.

• It is formed by the anterior rami of C5 through T1, with

occasional contributions from C4 and T2.

• From its emergence, the brachial plexus extends downward

and laterally, passes over the first rib behind the clavicle, and
enters the axilla.

• Each brachial plexus innervates the entire upper extremity of

one side, as well as a number of shoulder and neck muscles.

• Structurally, the brachial plexus is divided into roots, trunks,

divisions, and cords.
• The roots of several spinal nerves unite to form trunks
in the inferior part of the neck. These are the superior,
middle, and inferior trunks. Posterior to the clavicles,
the trunks divide into divisions, called the anterior and
posterior divisions. In the axillae, the divisions unite to
form cords called the lateral, medial, and posterior
cords. The cords are named for their relationship to the
axillary artery, a large artery that supplies blood to the
upper limb. The principal nerves of the brachial plexus
branch from the cords.

• The important nerves that arise from the brachial

plexus are axillary nerve, musculocutaneous nerve,
radial nerve, ulnar and medial nerve
 Lumbar plexus

• The lumbar plexus is positioned to the side of the

first four lumbar vertebrae.

• It is formed by the anterior rami of spinal nerves L1

through L4 and some fibers from T12.

• The nerves that arise from the lumbar plexus

innervate structures of the lower abdomen and
anterior and medial portions of the lower extremity.
 Sacral Plexus
• The sacral plexus lies immediately inferior to the lumbar
plexus.

• It is formed by the anterior rami of spinal nerves L4, L5,and

S1 through S4.

• The nerves arising from the sacral plexus innervate the

lower back, pelvis, perineum, posterior surface of the thigh
and leg, and dorsal and plantar surfaces of the foot.

• Because some of the nerves of the sacral plexus also

contain fibers from the nerves of the lumbar plexus through
the lumbosacral trunk, these two plexuses are frequently
described collectively as the lumbosacral plexus.
The sciatic nerve is the largest nerve arising from the sacral plexus
and is the largest nerve in the body.

The sciatic nerve passes from the pelvis through the greater sciatic
notch of the os coxae and extends down the posterior aspect of the
thigh.

It is actually composed of two nerves—the tibial and common

fibular nerves—wrapped in a connective tissue sheath.

The tibial nerve arises from the anterior division of the sacral
plexus, extends through the posterior regions of the thigh and leg,
and branches in the foot to form the medial and lateral plantar
nerves.

The common fibular nerve (peroneal nerve) arises from the

posterior division of the sacral plexus, extends through the posterior
region of the thigh, and branches in the upper portion of the leg into
the deep and superficial fibular nerves