Spinal Nerves

Chapter 13
The Spinal
Cord and
Spinal Nerves
Lecture slides prepared by Curtis DeFriez, Weber State University

Copyright © John Wiley & Sons, Inc. All rights reserved.
Introduction to the Spinal Cord
❖ About 100 million neurons and even more neuroglia
comprise the spinal cord, the part of the central nervous
system that extends from the brain
▪ The spinal cord and its associated spinal nerves contain reflex circuits that
control some of your most rapid reactions to environmental changes
▪ The gray matter of the cord is a site for integration of postsynaptic potentials
(IPSPs and EPSPs)
▪ The white matter of the cord contains major sensory and motor tracts to and
from the brain.

.
External Cord Anatomy

❖ The spinal cord begins as a continuation of the medulla
oblongata (the most inferior portion of the
brain stem) extending
from the foramen
magnum of the
occipital bone to its
termination as the
conus medullaris
between L1 - L2.


❖ The spinal cord is oval in shape and slightly flattened
anteriorly and posteriorly
❖ Two types of connective tissue
coverings protect the cord
and provide physical stability
▪The bony vertebral column
provides the backbone.
▪The spinal meninges surround
the cord as a continuation of
the cranial meninges that encircle the brain.


❖ These three membranes (each called a meninx) are
labeled from superficial to deep as follows:
▪The outermost dura mater (tough mother) forms a sac that encloses the entire cord
▪The middle meninx is a delicate avascular covering
called the arachnoid mater. It is attached to the inside
of the dura and forms the roof of the subarachnoid space (SAS) in which
cerebral spinal fluid (CSF) circulates.
▪The transparent pia mater is pressed-up against the cord and is filled with blood
vessels that supply nutrients to it.


❖ The epidural space runs between the dura mater and the more superficial
ligamentum flavum (which lines the underside of the bony vertebral lamina)
❖ The subdural space lies between the dura and the
arachnoid. In the spinal column, the dura and arachnoid
membranes
are held firmly togethe
so that the subdural
space is often no more
than a potential space.


❖ The pia mater has 21 pairs of denticulate ligaments which attach it to the
arachnoid and dura maters. Named for their tooth-like appearance, the denticulate
ligaments are traditionally believed to provide stability for the spinal cord against
sudden
shock and
displacement within
the vertebral column.


❖ Arising from the conus medullaris is the filum
terminale, an extension of the pia mater that extends
inferiorly and
blends with the
arachnoid and dura to
anchor the spinal cord to
the coccyx
❖ The cauda equina or “horses
tail” are the roots of the
lower spinal nerves that angle
down alongside the filum terminale.

.

❖ The spinal cord has two enlargements, one in the cervical
area from C4–T1, and another in the lumbar area between
T9–T12.
▪ The cervical enlargement
correlates with the sensory
input and motor output to the
upper extremities
▪ The lumbar enlargement handles
motor output and sensory input
to and from the legs.

.

❖ From superior to inferior, the
spinal cord becomes progressively
smaller
▪ There is less and less white matter as we
descend because there are fewer sensory tracts
going up (they haven’t “jumped on” yet), and
there are fewer motor tracts going down
(they’ve “jumped off ” already.)

.

❖ Two bundles of axons, called roots, connect each spinal
nerve to a segment of the cord by even smaller bundles of
axons called rootlets.
▪ The posterior (dorsal) root and rootlets contain only sensory axons, which
conduct
nerve impulses from sensory
receptors in the skin, muscles,
and internal organs into the
central nervous system.


❖ Each posterior root has a swelling, the posterior (dorsal)
root ganglion, which contains the cell bodies of sensory
neurons. The anterior (ventral) root and rootlets
contain axons of motor neurons, which conduct nerve
impulses from the CNS to
effectors (muscles
and glands).

Epidural Anesthesia
❖ Epidural anesthesia is commonly administered to women
about to go into labor. In this procedure, a needle is
placed between the bones of the posterior spine until it
just penetrates the ligamentum flavum yet remains
superficial to the dura mater.
❖ Local anesthetic is used to provide pain relief –

even complete anesthesia if a cesarean section is required.

Lumbar Puncture
❖ A needle inserted into the subarachnoid space for the
purpose of withdrawing CSF (for diagnosis or to reduce
pressure) or to introduce a drug or contrast agent is called
a lumbar puncture
▪ CSF is often collected to diagnose meningitis or some other disease of the CNS
▪ Agents injected into the SAS include drugs such as antibiotics, chemotherapeutic
agents, or analgesics, or contrast media for radiographic procedures
• The pressure of CSF in the SAS can also be measured during a lumbar
puncture.

.
Lumbar Puncture
❖ The site used for most lumbar punctures is between the 3rd
and 4th (or 4th and 5th) lumbar vertebrae - below the
termination of the actual cord in the region of the cauda
equina. With the needle in the SAS, CSF can be sampled
▪ Anesthetics can also
be given in this way,
but using 1/10 the
dose required for

epidural anesthesia.

Internal Cord Anatomy

❖ In the spinal cord, the white matter is on the outside, and
the gray matter is on the inside. In the brain the white
matter is on the inside, and the gray matter is on the
outside.

❖ The white matter of the cord consists of millions of
nerve fibers which transmit electrical information
between the limbs, trunk and organs of the body, and the
brain
❖ Internal to this peripheral region, and surrounding the
central canal, is the
butterfly-shape
central region made
up of nerve cell
bodies (gray matter –
here stained brown).

.

❖ Anterior (ventral) gray horns consist of somatic
motor neurons
❖ Posterior (dorsal) gray horns consist of somatic and
autonomic sensory nuclei
▪ The posterior gray horn is the site of synapse between first-order sensory
neurons coming in from the periphery, and second-order neurons which either
ascend in the cord or exit back out as parts of reflex arcs.

.

❖ The lateral gray horns are found only in the thoracic,
upper lumbar, and sacral segments of the cord
▪ They contain cell bodies of autonomic motor neuron
• Some of these fibers ascend outside the dura but close to the cord to supply
sympathetic
innervation to the head
• Others travel in sympathetic
trunks to the organs and
glands of the thorax, abdomen,
and pelvis.


❖ Other notable features visualized on a transected cord are
the anterior median fissure, the posterior median sulcus,
the gray and white commissures, and the central canal
▪ The central canal extends the entire length of the spinal cord and
is filled
with CSF.


❖ A tract is a bundle of
neuronal axons that are all
located in a specific area of
the cord and all traveling
to the same place (higher
or lower in the brain or
cord).

❖ The white matter of the cord is divided into anterior,
posterior, and lateral columns in which ascending sensory
tracts are traveling to someplace in the brain and
descending motor tracts (red) are traveling to a location in
the cord.
The afferent tracts are noted here in blue, while the efferent tracts are shown in red.
❖ Names of tracts are formed by using compound words
that denote the origin of the tract, and the place where it
ends.
▪ The spinothalamic tract goes from the spinal cord to the brain – it is an afferent
tract
▪ The corticospinal tract goes from the cortex of the brain to the spinal cord – it is
an efferent tract
▪ The vestibulospinal tract originates from an area in the brain which you probably
don’t recognize; however, you can recognize the destination in the spine, and
therefore deduce that it is a motor tract.

.

❖ The posterior columns are afferent tracts that
convey nerve impulses for discriminative touch, light
pressure, vibration, and conscious proprioception
(awareness of tendon and joint position in space and
their
relative movements).
❖ The spinothalamic tract is an
afferent tract that transmits sensation
of pain, warmth, coolness, itching,
tickling, deep pressure, and
crude touch.


❖ The lateral and anterior corticospinal tracts are
major pathways for carrying signals from the cerebral
cortex that result in voluntary movement of skeletal
muscles
❖ Other motor tracts convey nerve impulses from the
brain stem that coordinate
visual stimuli with body
movements, maintain
posture and regulate
skeletal muscle tone.

.
Dermatomes
❖ A dermatome is an area of skin that is
innervated by a single spinal nerve,
indicated by the letters and number of a
particular segmental nerve.
❖ Important dermatomes include
▪ C6/C7 - thumb and index
finger (“six-shooter”
▪ T4 - nipple lin
▪ T10 - umbilicu
▪ L1-L5 - lower extremities
“L for legs”)
e
Damage to the Cord

❖ “Transection” of the spinal cord means that ascending
and descending tracts are partially or completely severed
❖ If transection occurs, say in a motor vehicle or diving
accident, paralysis will occur depending on the level of the
injury. Transection
▪ at the base of skull results in death by asphyxiatio
▪ in the upper cervical area results in quadriplegi
▪ between the cord enlargements results in some form of paraplegia

:
Peripheral Nerves

Peripheral Nerves
❖ Spinal nerves are the paths of communication between
the spinal cord and specific regions of the body
▪ Nerves are arranged in fascicles surrounded by a perineurium, with the entire
nerve sheathed by a CT epineurium.

.
Peripheral Nerves
❖ 31 left-right pairs of spinal nerves emerge from the
cord at regular intervals (called segments). Except for
the first cervical pair the spinal nerves leave the vertebral
column from the intervertebral foramen between
adjoining vertebrae – the first pair leaves between the
skull and the first cervical vertebrae
▪Cervical – 8 pairs, C1-C
▪Thoracic – 12 pairs, T1-T1
▪Lumbar – 5 pairs, L1-L
▪Sacral - 5 pairs, S1-S5
▪Coccygeal – 1 nerve pair

.
Peripheral Nerves
❖ Piercing the dura, the segmental (spinal) nerves exit the
central nervous system into the peripheral nervous system
and almost immediately split into 3 major branches: An
anterior ramus, posterior ramus, and rami communicante
(connections to
sympathetic
ganglia).

Peripheral Nerves
❖ The anterior rami of the segmental nerves may travel alone
(such as the intercostal nerves which run underneath each
of the 12 ribs), or they can join together to form large
“braided ropes” – a plexus of nerves.
▪ There are a number of major nerve plexuses, all formed from anterior rami of
spinal nerves, and all located anterior to the spine: The cervical plexus,
brachial plexus, celiac (solar) plexus, lumbar plexus, sacral plexus, and
coccygeal plexus

Nerve Plexuses
❖ The cervical plexus, formed by the anterior rami of C1-
C5, serves the head, neck, and diaphragm

▪ The phrenic nerves arise from the cervical plexus to supply the major muscle of
respiration (“C3,4,5 keep
the diaphragm alive”).

Nerve Plexuses
❖ The brachial plexus is
formed by the anterior rami of
C5-C8 and T1. It is divided
into roots → trunks →

divisions → cords → nerves.
▪ The nerves from the brachial
plexus supply the shoulders
and upper limbs.

Nerve Plexuses
❖ Some of the major nerves that arise from the brachial
plexuses are the
▪ musculocutaneous
nerve
▪ axillary nerve
▪ radial nerve
▪ median nerve
▪ ulnar nerve
▪ long thoracic nerve

Nerve Plexuses
❖ Injuries to the brachial plexus are not uncommon
▪ Erb’s palsy is a paralysis of the arm that most often
occurs as an infant's head and neck are pulled toward
the side at the same time as the shoulders pas
through the birth canal.
• A similar injury may be observed at any age,
including adults, following a traumatic fall

or other trauma whereby
the nerves of the plexus are
violently stretched.

s

Nerve Plexuses
❖ Injuries to the brachial plexus or peripheral nerves
▪ Median nerve injury, either at the plexus or occurring more distally, results in
numbness, tingling and pain in the palm and fingers.
• Carpal tunnel syndrome is a common type of median nerve injury that is seen
in people who perform repetitive motions of the hand and
wrist like typing on a computer
keyboard.

Nerve Plexuses
❖ The ulnar nerve is the largest unprotected (by muscle or
bone) nerve in the human body. It emerges from the
medial and lateral cords of the brachial plexus to supply
the medial half of the hand. Striking the medial
epicondyle of the humerus where the nerve is exposed
is referred to as bumping one’s “funny bone”
▪ Damage to the nerve leads to
abnormal sensations in the 4–5th
fingers and an inability to abduct
or adduct the little and ring fingers.

Nerve Plexuses
❖ The long thoracic nerve emerges from the cords of the
brachial plexus to supply the serratus anterior muscle
▪ Because of its long, relatively superficial course, it is susceptible to injury either
through direct trauma or stretch of the plexus. Injury (resulting in
a “winged scapula” in which th
arm cannot be abducted beyond th
horizontal position) has been reported
in almost all sports.

e
Nerve Plexuses
❖ The lumbar plexus is formed by the anterior rami of L1-
L4 to supply the anterolateral abdominal wall, external
genitalia, and part of the lower limbs

▪ The femoral and obturator
nerves come from the

lumbar plexus.

Nerve Plexuses
❖ The sacral plexus is formed by the anterior rami of L4-L5
and S1-S4. It supplies the buttocks, perineum, and part of

the lower limbs
▪ It gives rise to the largest
nerve in the body, the
sciatic nerve.

.
Nerve Plexuses
❖ The coccygeal plexus is formed by the anterior rami of
S4-S5 and the coccygeal nerves. It is a small plexus from
which the anococcygeal nerve exits to supply a small area

of skin in the
coccygeal region.

Nerve Terminology Summary

❖ Rootlets ! roots (ant. and post.) ! segmental nerves !
• anterior ramus ! form large nerve plexuse
• posterior ramu
• rami communicantes

s
Reflexes
❖ A reflex is a fast, involuntary response to a stimulus. In a
spinal reflex the integration takes place in the spinal
cord, not the brain
▪ Spinal reflexes can be monosynaptic (sensory neuron with motor neuron) or
polysynaptic (involving interneurons), and they can go in and out on the same,
or on the opposite
side of th
cord.

e
Reflexes
❖ A reflex arc is a pathway that a nerve impulse follows to
produce a reflex. Components of a reflex arc include a
sensory receptor and a sensory neuron, an
integrating center inside the cord, an exiting motor
neuron, and an effector (which is usually some
sort of muscle or a gland
which makes some
thing move or secrete
“involuntarily”).

-
Reflexes
❖ Sensory receptors involved in reflex arcs are
specifically adapted to perceive the stimulus and initiate
an impulse
❖ The motor neuron
becomes stimulated
without any processing
in the brain (that comes
later)… first you kick the
person examining you
(patellar reflex), then you feel
the tap of the hammer!

.
Reflexes
Interactions Animation
❖ Components of a Reflex Arc Animations
You must be connected to the internet to run this animation

 
Reflexes
❖ Reflex arcs can be ipsilateral (all neurons and effectors
on the same side of the body) or contralateral (the
receptors and afferent neurons are on the opposite
side of the body as the efferent
neurons and effectors.
▪The flexor (withdrawal)
reflex is a good example

of a contralateral refle
(stepping on a tack).

x
Reflexes
❖ In addition to initiating the flexor
reflex that causes you to
withdraw the limb, the pain impulses from
stepping
on the tack also
initiate a crossed-
extensor reflex to
help you maintain
your balance.

Reflexes
❖ Some important spinal reflexes include
▪ The patellar reflex in which the leg extends in response to stretch of the
patellar tendon. This reflex can be blocked by damage in the corticospinal tracts
from diabetes, neurosyphilis, or damage to the lumbar region of the spinal cord
▪ The Achilles reflex causes contraction of the calf when a force is applied to the
Achilles tendon. It is absent after damage to the lower cord or lumbosacral
plexus.

:
Reflexes
❖ Some important spinal reflexes include
▪ The Babinski, or plantar flexion reflex is considered normal in adults if they
flex (curl) the big toe when the sole of the foot is stimulated. If the sole of the
foot is stimulated and the patient extends the big toe, it would indicate damage in
the corticospinal tract
▪ Infants normally extend their toes when stimulated in this way; so an “abnormal
Babinski” does not indicate any disease or damage in this age group.

.
Reflexes
Interactions Animation
❖ Summary of Reflexes Animation
You must be connected to the internet to run this animation

 
End of Chapter 13
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Chapter 13

Lecture slides prepared by Curtis DeFriez, Weber State University

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

External Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

❖ Local anesthetic is used to provide pain relief –

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

but using 1/10 the

dose required for

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Internal Cord Anatomy

Copyright © John Wiley & Sons, Inc. All rights reserved.

Damage to the Cord

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

▪Cervical – 8 pairs, C1-C

▪Thoracic – 12 pairs, T1-T1

▪Lumbar – 5 pairs, L1-L

▪Sacral - 5 pairs, S1-S5

▪Coccygeal – 1 nerve pair

Copyright © John Wiley & Sons, Inc. All rights reserved.

Copyright © John Wiley & Sons, Inc. All rights reserved.

C5, serves the head, neck, and diaphragm

Copyright © John Wiley & Sons, Inc. All rights reserved.

into roots → trunks →