1. Structure of the spinal cord

2. - Comparable to Input-Output (IO) System of the Computer Input-Output (IO) System of the Computer - Spinal Nerve (C8, T12, L5, S5, Cx1) - Segmental Structure of Neural Tube Origin - Comparable to Input-Output (IO) System of the Computer Input-Output (IO) System of the Computer - Spinal Nerve (C8, T12, L5, S5, Cx1) - Segmental Structure of Neural Tube Origin Spinal Cord

3. Spinal segment C8, T12, L5, S5, Cx1 C8, T12, L5, S5, Cx1 Anterior (Ventral) Root Posterior (Dorsal) Root Dorsal Root (Spinal) Ganglion Dorsal Root (Spinal) Ganglion Root - Rootlets

4. Conus Medullaris (L1-2) Spinomedullary Junction Spinomedullary Junction - Foramen Magnum, Pyramidal decussation, C1 ventral root Enlargements - cervical (C5-T1) & lumbosacral (L1-L4) Longitudinal Fissures - anterior median fissure - anterolateral fissure - posterior median sulcus - posterolateral sulcus Conus Medullaris (L1-2) Spinomedullary Junction Spinomedullary Junction - Foramen Magnum, Pyramidal decussation, C1 ventral root Enlargements - cervical (C5-T1) & lumbosacral (L1-L4) Longitudinal Fissures - anterior median fissure - anterolateral fissure - posterior median sulcus - posterolateral sulcus Spinal Cord Spinal Cord

5. Conus Medullaris (L1-2) Cauda Equina Anterior median fissure Anterolateral fissure

6. Posterior median sulcus median sulcusPosterolateral sulcus sulcusPosterior intermediate intermediate sulcus sulcus Fasciculus Fasciculus cuneatus cuneatus Fasciculus Fasciculus gracilis gracilis Posterior surface of the spinal cord

7. Periosteum of Vertebra Periosteum of Vertebra - Epidural Space ----------------- epidural anesthesia Dura Mater Spinalis Dura Mater Spinalis Arachnoid Membrane Arachnoid Membrane - Subarachnoid Space -------- Lumbar Puncture Spinal Anesthesia Spinal Anesthesia Pia Mater Spinalis - Denticulate Ligament --------- Cordotomy - Filum Terminale - Filum Terminale Periosteum of Vertebra Periosteum of Vertebra - Epidural Space ----------------- epidural anesthesia Dura Mater Spinalis Dura Mater Spinalis Arachnoid Membrane Arachnoid Membrane - Subarachnoid Space -------- Lumbar Puncture Spinal Anesthesia Spinal Anesthesia Pia Mater Spinalis - Denticulate Ligament --------- Cordotomy - Filum Terminale - Filum Terminale Spinal Cord Spinal Cord

8. Meninges of Meninges of the spinal cord the spinal cord Dura mater Dura mater Arachnoid membrane Arachnoid membrane Pia mater Pia mater Denticulate ligament - specilization of the pia mater - specilization of the pia mater - landmark for cordotomy - landmark for cordotomy

9. Meninges of the spinal cord Meninges of the spinal cord

11. Lumbar Puncture – lumbar (terminal) cistern

12. Arterial Supply - Spinal Arteries - Spinal Arteries Anterior (1) & Posterior (2) Spinal Artery Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery from Vertebral artery - Radicular Arteries ----- Segmental arteries - Radicular Arteries ----- Segmental arteries from Vertebral, Ascending Cervical, from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery Intercostal and Lumbar Artery Venous Drainage Venous Drainage - Longitudinal & Radicular Veins to Intervertebral veins ---- to Internal Vertebral Venous Plexus to Intervertebral veins ---- to Internal Vertebral Venous Plexus to external vertebral venous plexus ---- to segmental veins to external vertebral venous plexus ---- to segmental veins Arterial Supply - Spinal Arteries - Spinal Arteries Anterior (1) & Posterior (2) Spinal Artery Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery from Vertebral artery - Radicular Arteries ----- Segmental arteries - Radicular Arteries ----- Segmental arteries from Vertebral, Ascending Cervical, from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery Intercostal and Lumbar Artery Venous Drainage Venous Drainage - Longitudinal & Radicular Veins to Intervertebral veins ---- to Internal Vertebral Venous Plexus to Intervertebral veins ---- to Internal Vertebral Venous Plexus to external vertebral venous plexus ---- to segmental veins to external vertebral venous plexus ---- to segmental veins Spinal Cord Blood Supply Spinal Cord Blood Supply

13. anterior spinal artery segmental arteries 5. Adamkiwicz artery 5. Adamkiwicz artery

14. White Matter White Matter Anterior Funiculus (Anterior White Column) Anterior Funiculus (Anterior White Column) Posterior Funiculus (Posterior White Column) Posterior Funiculus (Posterior White Column) Fasciculus Gracilis & Fasciculus Cuneatus Fasciculus Gracilis & Fasciculus Cuneatus Lateral Funiculus (Lateral White Column) Lateral Funiculus (Lateral White Column) Gray Matter Gray Matter Anterior Horn ---------------motor Anterior Horn ---------------motor Posterior Horn --------------sensory Posterior Horn --------------sensory Lateral Horn -----------------autonomic (sympathetic) Lateral Horn -----------------autonomic (sympathetic) Gray Commissure -------- anterior and posterior Gray Commissure -------- anterior and posterior White Matter White Matter Anterior Funiculus (Anterior White Column) Anterior Funiculus (Anterior White Column) Posterior Funiculus (Posterior White Column) Posterior Funiculus (Posterior White Column) Fasciculus Gracilis & Fasciculus Cuneatus Fasciculus Gracilis & Fasciculus Cuneatus Lateral Funiculus (Lateral White Column) Lateral Funiculus (Lateral White Column) Gray Matter Gray Matter Anterior Horn ---------------motor Anterior Horn ---------------motor Posterior Horn --------------sensory Posterior Horn --------------sensory Lateral Horn -----------------autonomic (sympathetic) Lateral Horn -----------------autonomic (sympathetic) Gray Commissure -------- anterior and posterior Gray Commissure -------- anterior and posterior Spinal Cord Internal Structure Spinal Cord Internal Structure

15. 1. posterior horn 2. anterior horn 3. intermediate zone (intermediate gray) (intermediate gray) 4. lateral horn 5. posterior funiculus 6. anterior funiculus 7. lateral funiculus 8. Lissauer's tract 9. anterior median 9. anterior median fissure fissure 10. posterior median sulcus sulcus 11. anterolateral sulcus sulcus 12. posterolateral sulcus sulcus 13. Posterior intermediate intermediate sulcus sulcus

16. cervical enlargement (C8) thoracic cord (T8) cervical enlargement (C8) thoracic cord (T8) lumbal enlargement (L3) sacral cord (S1) lumbal enlargement (L3) sacral cord (S1)

17. Principles of Cord Organization 1) Longitudinal Arrangement 1) Longitudinal Arrangement Fibers (White Matter) ------------- White Column Fibers (White Matter) ------------- White Column Cell Groups (Gray Matter) ------- Gray Column Cell Groups (Gray Matter) ------- Gray Column 2) Transverse Arrangement Afferent & Efferent Fibers Afferent & Efferent Fibers Crossing (Commissural and Decussating) Fibers Crossing (Commissural and Decussating) Fibers 3) Somatotopical Arrangement Principles of Cord Organization 1) Longitudinal Arrangement 1) Longitudinal Arrangement Fibers (White Matter) ------------- White Column Fibers (White Matter) ------------- White Column Cell Groups (Gray Matter) ------- Gray Column Cell Groups (Gray Matter) ------- Gray Column 2) Transverse Arrangement Afferent & Efferent Fibers Afferent & Efferent Fibers Crossing (Commissural and Decussating) Fibers Crossing (Commissural and Decussating) Fibers 3) Somatotopical Arrangement Spinal Cord Internal Structure Spinal Cord Internal Structure

18. Columnnar arrangement somatotopical arrangement

19. Lamina of Rexed Lamina of Rexed Lamina I ---------- posteromarginal nucleus Lamina I ---------- posteromarginal nucleus Lamina II ---------- substantia gelatinosa of Rolando Lamina II ---------- substantia gelatinosa of Rolando Lamina III, IV ----- nucleus proprius Lamina III, IV ----- nucleus proprius Lamina V, VI Lamina V, VI Lamina VII --------- intermediate gray Lamina VII --------- intermediate gray intermediolateral cell column (ILM) intermediolateral cell column (ILM) Clarke’s column (Nucleus dorsalis) Clarke’s column (Nucleus dorsalis) intermediomedial cell column (IMM) intermediomedial cell column (IMM) Lamina VIII Lamina VIII Lamina IX ---------- anterior horn (motor) cell Lamina IX ---------- anterior horn (motor) cell Lamina X ----------- gray commissure Lamina X ----------- gray commissure Lamina of Rexed Lamina of Rexed Lamina I ---------- posteromarginal nucleus Lamina I ---------- posteromarginal nucleus Lamina II ---------- substantia gelatinosa of Rolando Lamina II ---------- substantia gelatinosa of Rolando Lamina III, IV ----- nucleus proprius Lamina III, IV ----- nucleus proprius Lamina V, VI Lamina V, VI Lamina VII --------- intermediate gray Lamina VII --------- intermediate gray intermediolateral cell column (ILM) intermediolateral cell column (ILM) Clarke’s column (Nucleus dorsalis) Clarke’s column (Nucleus dorsalis) intermediomedial cell column (IMM) intermediomedial cell column (IMM) Lamina VIII Lamina VIII Lamina IX ---------- anterior horn (motor) cell Lamina IX ---------- anterior horn (motor) cell Lamina X ----------- gray commissure Lamina X ----------- gray commissure Spinal Cord Internal Structure Spinal Cord Internal Structure

20. Lamina of Rexed