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Spinal Cord and Spinal Nerves 487 NERVOUS SYSTEM OUTLINE 16.1 Gross Anatomy of the Spinal Cord 487 16.2 Spinal Cord Meninges 489 16 16.3 Sectional Anatomy of the Spinal Cord 491 16.3a Location and Distribution of Gray Matter 491 16.3b Location and Distribution of White Matter 493 16.4 Spinal Nerves 493 Spinal Cord 16.4a Spinal Nerve Distribution 493 16.4b Nerve Plexuses 495 16.4c Intercostal Nerves 496 16.4d Cervical Plexuses 496 and Spinal 16.4e Brachial Plexuses 499 16.4f Lumbar Plexuses 503 16.4g Sacral Plexuses 506 16.5 Reflexes 510 Nerves 16.5a Components of a Reflex Arc 510 16.5b Examples of Spinal Reflexes 512 16.5c Reflex Testing in a Clinical Setting 512 16.6 Development of the Spinal Cord 513 MODULE 7: NERVOUS SYSTEM mck78097_ch16_486-517.indd 486 2/14/11 3:35 PM Chapter Sixteen Spinal Cord and Spinal Nerves 487 he spinal cord provides a vital link between the brain and filum terminale is a thin strand of pia mater that helps anchor T the rest of the body, and yet it exhibits some functional inde- the conus medullaris to the coccyx. Figure 16.1c shows the conus pendence from the brain. The spinal cord and its attached spinal medullaris and the cauda equina. nerves serve two important functions. First, they are a pathway for Viewed in cross section, the spinal cord is roughly cylin- sensory and motor impulses. Second, the spinal cord and spinal drical, but slightly flattened both posteriorly and anteriorly. Its nerves are responsible for reflexes, which are our quickest reactions external surface has two longitudinal depressions: A narrow to a stimulus. In this chapter, we describe the anatomy of the spinal groove, the posterior (or dorsal) median sulcus, dips internally cord and the integrative activities that occur there. on the posterior surface, and a slightly wider groove, the anterior (or ventral) median fissure, is observed on its anterior surface. Cross-sectional views of the spinal cord vary, depending upon the part from which the section was taken (table 16.1). 16.1 Gross Anatomy These subtle differences make identifying specific spinal cross of the Spinal Cord sections a bit easier. For example, the diameter of the spinal cord changes along its length because the amount of gray Learning Objectives: matter and white matter and the function of the cord vary in 1. Describe the structure of the spinal cord. different parts. Therefore, the spinal cord parts that control 2. Explain the basic functions of the spinal cord. the upper and lower limbs are larger because more neuron cell bodies are located there, and more space is occupied by A typical adult spinal cord ranges between 42 and 45 centi- axons and dendrites. The cervical enlargement, located in the meters (cm) (16 to 18 inches) in length. It extends inferiorly from the inferior cervical part of the spinal cord, contains the neurons brain through the foramen magnum and then through the vertebral that innervate the upper limbs. The lumbosacral enlargement canal and ends at the level of the L vertebra. The spinal cord may be 1 extends through the lumbar and sacral parts of the spinal cord subdivided into the following parts (figure 16.1a): and innervates the lower limbs. ■ The cervical part is the superiormost region of the The spinal cord is associated with 31 pairs of spinal nerves spinal cord. It is continuous with the medulla oblongata. that connect the CNS to muscles, receptors, and glands. Spinal The cervical part contains motor neurons whose axons nerves are considered mixed nerves because they contain both contribute to the cervical spinal nerves and receives motor and sensory axons. Spinal nerves are identified by the first input from sensory neurons through these spinal nerves letter of the spinal cord part to which they attach combined with (figure 16.1b). a number. Thus, each side of the spinal cord contains 8 cervi- ■ The thoracic part lies inferior to the cervical part. It cal nerves (called C1–C8), 12 thoracic nerves (T1–T12), 5 lumbar contains the neurons for the thoracic spinal nerves. nerves (L1–L5), 5 sacral nerves (S1–S5), and 1 coccygeal nerve ■ The lumbar part is a shorter segment of the spinal cord (Co1). Spinal nerve names can be distinguished from cranial nerve that contains the neurons for the lumbar spinal nerves. names (discussed in chapter 15) because cranial nerves are desig- ■ The sacral part lies inferior to the lumbar part and contains nated by CN followed by a Roman numeral. the neurons for the sacral spinal nerves. ■ The coccygeal (kok-sij ē ́ -ăl) part (not shown in figure 16.1) is the most inferior “tip” of the spinal cord. (Some texts consider this part a portion of the sacral part of the spinal cord.) One pair of coccygeal spinal nerves arises Study Tip! from this region. With one exception, the number of spinal nerves matches the num- Note that the different parts of the spinal cord do not match ber of vertebrae in that region. For example, there are 12 pairs of thoracic up exactly with the vertebrae of the same name. For example, the spinal nerves and 12 thoracic vertebrae. The sacrum is formed from lumbar part of the spinal cord is actually closer to the inferior 5 fused sacral vertebrae, and there are 5 pairs of sacral spinal nerves. thoracic vertebrae than to the lumbar vertebrae. This discrepancy The coccygeal vertebrae tend to fuse into one structure, and there is is due to the fact that the growth of the vertebrae continued longer 1 pair of coccygeal nerves. The only exception to this rule is that there than the growth of the spinal cord itself. Thus, the spinal cord in are 8 pairs of cervical spinal nerves, but only 7 cervical vertebrae, an adult is shorter than the vertebral canal that houses it. because the first cervical pair emerges between the atlas (the first The tapering inferior end of the spinal cord is called the cervical vertebra) and the occipital bone. conus medullaris (kō n ́ŭs med-oo-lăr ́is; ko¯nos = cone, medulla = middle). The conus medullaris marks the official “end” of the spinal cord proper (usually at the level of the first lumbar ver- tebra). Inferior to this point, groups of axons collectively called WHATW DID YOU LEARN? the cauda equina (kaw ́dă ē -kwı̄ n ́ ă) project inferiorly from the spinal cord. These nerve roots are so named because they resemble ●1 Identify the spinal cord enlargements. What is their function? a horse’s tail (cauda = tail, equus = horse). Within the cauda equina ●2 List the specific names of spinal nerves according to their region is the filum terminale (f ı̄ ́lŭm ter mi-n ́ ăl; terminus = end). The and the total number of pairs of spinal nerves. mck78097_ch16_486-517.indd 487 2/14/11 3:35 PM 488 Chapter Sixteen Spinal Cord and Spinal Nerves Atlas C1 Cerebellum Cervical plexus C2 C3 Cervical part C4 C5 Cervical enlargement C6 Spinal cord C7 C8 Posterior T vertebra Brachial plexus T1 1 rootlets T2 T3 T4 Posterior T5 median Thoracic part Denticulate sulcus ligaments T6 T7 (b) Cervical part T8 T9 Spinal cord T10 T11 Lumbosacral enlargement T12 Lumbar part L1 vertebra Conus medullaris Sacral part Posterior rootlets L1 Conus medullaris L2 Lumbar plexus L3 Cauda equina L4 L5 Posterior Posterior Sacral plexus root S1 root ganglion Cauda S2 equina S3 S4 Filum terminale S5 Co1 Filum terminale (a) Posterior view (c) Conus medullaris and cauda equina Figure 16.1 Gross Anatomy of the Spinal Cord. The spinal cord extends inferiorly from the medulla oblongata through the vertebral canal. (a) The vertebral arches have been removed to reveal the anatomy of the adult spinal cord and its spinal nerves. (b) Cadaver photo of the cervical part of the spinal cord. (c) Cadaver photo of the conus medullaris and the cauda equina. mck78097_ch16_486-517.indd 488 2/14/11 3:35 PM Chapter Sixteen Spinal Cord and Spinal Nerves 489 Table 16.1 Cross Sections of Representative Parts of the Spinal Cord Spinal Cord Part General Size General Shape White Matter/Gray Other (Diameter) Matter Ratio Characteristics Cervical Largest of all spinal cord Oval; slightly fl attened Large proportion of In superior segments parts (13–14 mm in on both anterior and white matter compared (C1–C5), anterior horns Posterior transverse diameter) posterior surfaces to gray matter are relatively small, and posterior horns are relatively large Posterior In inferior segments median (C6–C8), anterior horns sulcus are larger and posterior horns are even more Anterior enlarged median fissure Anterior Thoracic Smaller than the Oval; still slightly Larger proportion of Anterior and posterior cervical part (9–11 mm fl attened anteriorly and white matter than gray horns are enlarged Posterior in transverse diameter) posteriorly matter only in fi rst thoracic segment; small lateral horns are visible Anterior Lumbar Slightly larger than the Less oval, almost Relative amount of Anterior and posterior thoracic part (11–13 mm circular white matter is reduced horns are very large; Posterior in transverse diameter) both in proportion to small lateral horns gray matter and in present in fi rst two comparison to cervical sections of lumbar part part only Anterior Sacral Very small Almost circular Proportion of gray Anterior and posterior matter to white matter horns relatively large Posterior is largest in this spinal compared to the size of cord part the cross section Anterior tebra, and houses areolar connective tissue, blood vessels, and 16.2 Spinal Cord Meninges adipose connective tissue. It is in this space that an epidural Learning Objective: anesthetic is given.
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