Spinal Cord

Jerry D. King
 Lecture Outline
• Introduction
• Protection
• Structure
• Spinal Nerves
• Spinal Reflexes

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 Introduction

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Nervous System Outline
Spinal Cord
• C1 – L1
• Spinal Nerves
• Cauda Equina
 Protection

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Vertebral Column
 Meninges
• Pia mater
– Filum terminale
• Arachnoid
– Subarachnoid space
– Cerebrospinal fluid
• Dura mater
– Epidural
– Subdural
Anatomy Coloring Book
Wynn Kapit, Lawrence M. Elson
– LP
Lumbar Puncture
 Technique
Author: Carlos Eduardo Reis, MD
1. Place the patient in the lateral decubitus position lying on the edge of the bed and facing away from operator. Place the patient in a
knee-chest position with the neck flexed. The patient's head should rest on a pillow, so that the entire cranio-spinal axis is parallel to the
bed. Sitting position is the second choice because there may be a greater risk of herniation and CSF pressure cannot be measured

2. Find the posterior iliac crest and palpate the L4 spinous process, and mark the spot with a fingernail. Prepare the skin by starting at the
puncture site and working outward in concentric circles. Put on sterile gloves. Drape the patient

3. Anesthetize the skin using the 1% lidocaine in the 5 mL syringe with the 25-gauge needle. Change to 22-gauge needle before
anesthetizing between the spinous process. Insert in the midline with the needle parallel to the floor and the point directed toward the
patient's umbilicus

4. Advance slowly about 2 cm or until a "pop'' (piercing a membrane of the dura) is heard. Then withdraw the stylet in every 2- to 3-mm
advance of the needle to check for CSF return. If the needle meets the bone or if blood returns (hitting the venous plexus anterior to the
spinal canal), withdraw to the skin and redirect the needle. If CSF return cannot be obtained, try one disk space down

5. When cerebrospinal fluid begins to flow from the needle, discard the first few drops. Do not aspirated cerebrospinal fluid, because a
nerve root may be trapped against the needle and injuried

6. Measure the opening pressure with a manometer; allow the patient to relax, and check for good respiratory variation of the fluid level in
the manometer to ensure that the needle is properly positioned.

7. Remove the manometer and allow 1 to 2 cc of CSF to flow into each of the three sterile tubes. Send the first for glucose and protein, the
second for Gram stain and culture and sensitivity (C&S), and the third for cell count and differential. A fourth tube, when indicated, is
collected for viral titer or cultures, India ink preparation, Cryptococcus antigen, VDRL, or cytology

8. Withdraw the needle without replacing the stylet

9. Dress the puncture site with a bandage. Have the patient lie in bed for a few hours

http://www.medstudents.com.br/proced/lumbpunc.htm
Review Bones, Meninges
 Structure

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 Cross Section
• Ventral median
fissure
• Dorsal median sulcus
• Gray matter
• White matter
• Central canal

biology.clc.uc.edu/.../ Spinal_Cord_Histology.htm
 White vs. Gray Matter

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 More views

biology.clc.uc.edu/.../ Spinal_Cord_Histology.htm

Spinal cord
sections from
cervical to sacral.
www.gpc.edu/~jaliff/ hunerv17.gif
Sensory and Motor Paths
 Spinal Nerves

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31 Pairs
• 8 Cervical
• 12 Thoracic
• 5 Lumbar
• 5 Sacral
• 1 Coccyxgeal

• Note perpendicular to
oblique pattern
VERTEBRAE NERVES

• 1st 7 exit above the bone

C1
C1
C2 • The rest below
C2
C3
C3
C4
C4
C5
C5
C6
C6
C7
C7
C8
T1
T1
T2
T2
T3
T3
Nerve Structure
Dermatomes
 Roots
Sensory vs. Motor
 Dorsal root ganglion

biology.clc.uc.edu/.../ Spinal_Cord_Histology.htm
Rami (branches)
From Above
Ventral & Dorsal Rami
Cervical Plexus (C1-C4)
• To skin over neck &
clavicle
• Diaphragm (phrenic)
Brachial Plexus (C5-T1)

To upper limb
No Thoracic Plexus
 Lumbar Plexus (L1-L4)

To anterior lower limb

 Sacral Plexus (L4-S4)

To posterior lower limb

 Spinal Reflexes

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Stretch Reflex
• Muscle spindle
• Response to
stretch
• Adjustable
Reflex Circuit
Golgi Tendon Reflex
Pain Reflex
 The End

• Quiz Preview

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 The End

• Bonus

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 The End

• Other than
that, there’s
nothing on
the quiz.

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Spinal Cord
Jerry D. King