Spinal Cord and Nerve Plexii

By

DR. T
 Part I: Spinal cord
1. Organization
- General
- Cauda equina
- Meninges
2. Structure
• Grey matter
• White matter
3. Blood supply
4. Spinal nerves
- Typical n.
- Components
 1. Organization
• Cauda equina
• Meninges
 2. Structure: Grey matter
• Components: Nerve cells, Processes, Neuroglia, Blood
vessels
• Grey columns: Anterior, Posterior, Transverse, Lateral
 Grey columns:
• Anterior:
– Medial group: skeletal
muscles of the neck and
trunk
– Central group: cervical and
lumbosacral segments &
contains the phrenic,
asccessory and lumbosacral
nuclei
– Lateral group: cervical and
lumbosacral areas
innervating skeletal muscles
of the limbs
• Posterior:
– Substantia gelatinosa: concerned
with pain, temperature and touch
– Nucleus proprius: fibers from
white posterior column
associated with proprioception,
2-piont discrimination and
vibration
– Nucleus dorsalis (Clark’s
column) from C8 – L3/4
proprioceptive endings in
spindles
– Visceral afferent nucleus from
T1– L3 receives visceral afferent
information
 Grey columns (cont.)
Transverse: Lateral:
– Contains central canal – From T1–L2/3
that starts in the MO,
– Give rise to preganglionic
– Inferiorly expands in the sympathetic fibers
conus medullaris as the
– Similar group in S2-4 give
terminal ventricle: CSF &
rise to preganglionic
ependyma parasympathtic fibres
 2. Structure: White matter
• Mixture of myelinated nerve fibers, neuroglia and
blood vessels
• Ascending tracts
• Descending tracts
• Ascending and descending tracts with the same origin,
course and termination: Fasciculus
• Intersegmental tracts
 Ascending tracts:
• Sensory, contain 1st, 2nd and 3rd order neurons
• Pathways for temperature, pain, proprioception
• Examples: Spinothalamic tract (lateral & anterior, fasciculus
gracilis and cuneatus); Spinocerebellar tract (anterior &
posterior); Cuneocerebellat tract.
• Other: Spinotectal, spinoreticular, spino-olivary, visceral sensory
 Descending tracts:
• White matter from the supraspinal centers with 1st, 2nd and 3rd
order motor neurons
• Examples: Corticospinal, reticularspinal, tectospinal, rubrospinal,
vestibulospinal, olivospinal, descending autonomic
 3. Blood supply: Spinal arteries
• From vertebral, posterior intercostal, lumbar, lateral sacral, ascending cervical,
deep cervical, iliolumbar aa.
• Posterior spinal a. in close association to posterior spinal roots, but is insufficient to
supply the spinal cord alone
• Anterior spinal a. unite to for a single artery on the median fissure of the spinal
cord.
 Spinal arteries (cont.)
• Radicular a. reinforce the spinal arteries by entering through the
intervertebral foramina
• Larger anterior radicular arteries: A. radicularis magna (artery
of Adamkiewicz) from the left an intersegmental branch of the
descending aorta, that supplies 2/3rds of the spinal cord
 3. Blood supply: Venous drainage
• Internal (anterior & posterior) venous plexus
• External venous plexus (anterior & posterior)
• Basivertebral and intervertebral veins.
 4. Typical spinal nerve
• Posterior (dorsal) root: Supplies synovial joints of the vertebral
column, deep muscles of the back & overlying skin. Posterior root
ganglia: Sensory, unipolar with satellite cells.
• Anterior (ventral) root: Supplies the remaining areas: anterior &
lateral regions of the trunk and limbs
 Part II: Nerve plexii

1. Cervical plexus
2. Brachial plexus
3. Lumbar plexus
4. Sacral plexus
 Concepts of nerve plexii
• Peripheral nerve that divide and join other peripheral
nerves to form a network
• Plexus permits individual nerve fibers to pass from one
peripheral nerve to another allowing redistribution of
nerves
• Peripheral nerve: Bundle of nerve fibers in a sheath,
can be cranial or spinal
• Ganglion: Collection of nerve bodies outside the CNS
• T2 – L1 segmental innervation of skin and muscles
• Other areas: nerve plexii
 1. Cervical plexus (C1 – C4)
• Ansa cervicalis: superior
(C1) & inferior (C2,3)
radix
• Minor occipital n. (C2)
• Greater auricular n.
(C2,3)
• Transverse cervical n.
(C2,3)
• Supraclavicular n. (C3,4)
• Deep branches
• Phrenic n. (C3,4,5)
1. Cervical plexus in situ
 2. Brachial plexus (C5 – T1)
• Roots (C5-T1)
• Trunks: Upper (C5,6),
middle (C7), lower (C8,T1)
• Divisions: anterior &
posterior
• Cords:
– Lateral cords formed by the
anterior divisions of the upper end
middle trunks
– Medial cord formed by the
anterior division of the lower
trunk
– Posterior cord formed by the
posterior division of the middle,
lower & upper trunks
 3. Lumbar plexus (L1 – L4)
• Iliohypogastric n. (L1)
• Ilioinguinal n. (L1)
• Genitofemoral n. (L1,2)
• Lateral cutaneous n. of
thigh (L2,3)
• Femoral n. (L2-L4)
• Obturator n. (L2-L4)
 4. Sacral plexus (L4 – S4)
To LL and gluteal regions:
• Sciatic n.
• Superior gluteal n. (L4-S1)
• Inferior gluteal n. (L5-S1)
• Posterior cutaneous nerve of the
thigh (S1-3)
• To quadriceps femoris (L4 – S1)
• To obturator internus (L5,S1)
To Pelvis:
• Pudendal nerve (S2-4)
• Nn. Splanchini pelvini (S2-4)
• To levator ani & coccygeus
(S3-4)
• Perineal branch (S4)