Key

List
Important

Pelvis and Perineum

 Pelvis
 Bony aspect is known as the pelvic girdle
 Os coxae: term for the fusion of these three bones in the pelvis
 ischium and pubis form the obturator foramen which is a The Pelvis
hole for passage of VAN
 pubic symphysis adjoins both sides of the pelvic• girdle
Comprised of three fused bones: The ilium
 Ilium ischium, and pubis
 Found in the superior region of the pelvic girdle
 Landmarks and important structures include: • Ilium: Superior region;important structur
iliac crest, anterior/posterior superior ilia
 Iliac crest: placement of hands on hips=iliac crest
 Auricular surface: articulates with the sacrumanterior/posterior inferior iliac spines.
 anterior superior iliac spine
 inguinal ligament
• Ischium:Posteroinferior region;ischial spin
 tensor fasciae latae ischial tuberosity;lesser sciatic notch.
 Sartorius • Pubis:Superior/inferior rami, pubic symph
 posterior superior iliac spine
pubic arch;forms obturator foramen(isch.
 anterior inferior iliac spine
 rectus femoris attachment site
 iliofemoral ligament attachment site
 posterior inferior iliac spine
 Ischium
 Most posterior-inferior aspect of pelvis
 Landmarks and important structures include
 Ischial spines:
 Symmetric ischial spines with the pubic symphysis forms the Urogenital
Triangle or UG triangle
 Symmetrical ischial spines with the coccyx forms the Anal Triangle
 Ischial tuberosity: portion of the pelvis which bears the weight of your body when
in the seated position
 Lesser sciatic notch
 Ischium and pubis form the obturator foramen
 Pubis
 Superior/inferior rami: superior rami contributes to
a part of the area adjoining at pubic symphysis
 Rami means branch
 Pubic symphysis
 Fibrocartilage adjoins both halves of the pelvic girdle
  usually rigid unless during parturition when it becomes more
pliable
 “a great point of reference”
 Pubic arch/subpubic angle
 Differs in gender
 Male subpubic angle=90’
 Female subpubic angle >90’
 Reason for this is parturition requires more room to pass
fetus
 Ischium and pubis form the obturator foramen

 True Pelvis
 Portion of the pelvis inferior to the pelvic brim or inferior
to the vicinity of pubic tubercle
 Forms deep bowl containing the bladder, reproductive organs
and rectum
 False Pelvis
 Portion of the pelvis superior to the pelvic brim or superior to vicinity of
pubic tubercle
 Hands on hips is false pelvic placement
 Muscles of pelvic floor
 Levator ani group
 Pubococcygeus:
origin at pubic and insertion in coccyx
 Iliococcygeus:
origin in ilium and insertion in coccyx
 Sphincter urethrae/Urogenital diaphragm
 Skeletal muscle which allows for voiding of urinary bladder; voluntarily after training
the muscle during younger years
 Ischiocavernosus
 Bulbospongiosus
 Pelvic inlet
 Superior portion and entrance into pelvis
 Pelvic outlet
 Inferior portion and exit of pelvis
 Occluded by muscles that form the pelvic floor
 Levator ani group, sphincter urethrae, bulbus spongiosus,
and ischiocavernosus
 SURGICAL CORRELATE: Episiotomy/perineotomy
 During parturition, a tear can occur in the vagina due to the of muscles of vaginal
wall not being pliable; this correlates with the shape of the newborn’s head
 The pubococcygeus muscle surrounding the vagina and rectum can be incised in
order to allow for more room during parturition
 Arteries of the pelvis
 Bifurcates of the abdominal aorta
 RT/LT common iliac
 Found in vicinity of abdominopelvic cavity
 Common iliacs bifurcate into internal
and external iliac arteries
 Internal iliac
 Bifurcate of the common iliac
 Supplies blood to the urinary bladder,
int/ext walls of the pelvis, and genitalia
 External iliac
 Continues inferiorly giving rise to the femoral artery
 Provides blood to the pelvic limbs

 Nerves of the pelvis

 Sacral plexus
 Spinal nerves between L4-S4
 Pudenal
 Levator ani/coccygeus
 Pelvic splanchnic

 Urinary system
 Urinary bladder
 Urachus
 fibrous remnant of fetal shunt located at the apex of the bladder which allowed
fetus to empty bladder through the umbilical cord
 obliterated after birth
 MEDIAN umbilical ligament/Xander’s ligament in adults: extends from apex of
bladder to naval; anchors the urinary bladder to the anterior abdominal wall
 Medial umbilical ligaments
 Remnants of umbilical arteries in fetus
 Cut when the umbilical cord is cut after
  Results in vestiges of these arteries which become the medial umbilical
ligaments
 Rugae
 Folds found in the stomach and urinary bladder
 Rugae are present and superficial layer of urothelium is dome shaped when UB is
empty
 Rugae are absent and superficial urothelium is flattened when bladder is
distended
 Ureteric openings and Internal urethra opening (trigone)
 Two ureteral openings where ureters empty kidney contents
 One internal urethra opening which allows for emptying of bladder outside of
body
 CLINICALLY SIGNIFICANT: Trigone formed by these three openings is the target
site for clinicians to obtain culture samples to test for UTI

 Histology
 Deep to superficial
 Lumen  mucosasubmucosa  inner longitudinal muscularis  middle
circular muscularis  outer longitudinal muscularis  adventitia
 Musculature cohesively known as the Detrusor muscle
 Urethra
 Thin walled muscular tube
 Mostly stratified columnar epithelium
 Male urethra
 18-20 cm long
 3x longer than female urethra
 Three divisions
 Prostatic
 Membranous
 Shortest section of urethra surrounded by the UG diaphragm/sphincter
urethrae
 Penile/Spongy

 Male Reproductive system

 Scrotum/Scrotal sac
 Composed of skin and connective tissue protecting and surrounding the testes
 Testes
 Tunica albuginea: white tissue covering the testicle
 Tunica vaginalis: visceral and parietal layers
 CLINICAL
 hydrocoele: buildup of fluid (most commonly in newborns) in between the
parietal and visceral layers of tunica vaginalis
 Varicocele: abnormal enlargement of the pampiniform plexus
 Seminiferous tubules
 Convoluted tubules inside the lobules of the testicles
 Transport sperm to the epididymis
 Epididymis
 Tube that connects the testicles to the vas deferens
 Ductus/vas deferens
 Duct that transports sperm from the epididymis to the urethra through the
ejaculatory ducts
 Leydig/Interstitial cells
 Responsible for producing androgens in the testicles
 Angiology
 Paired gonadal arteries of the abdominal aorta in males is known as the testicular
arteries
 Drainage of blood through the pampiniform plexus
 CLINCIAL
 Injury to scrotal sac can result in testicular torsion which is a result of the scrotal sac
twisting along with the blood vessels which can lead to ischemia
 Glans
 Head/Anterior most aspect of the penis
 Anterior most aspect of the corpus spongiosum
 Composed of corpus spongiosum
 Prepuce
 Known as foreskin
 Circumcision removes this skin
 Corpus spongiosum and cavernosum
 Erectile component of the penis
 Humans do not have osseous tissue in penis unlike other
animals (dogs, horses, ox) known as the os penis
 Erectile dysfunction: condition where vascular issues lead to
inability to acquire or maintain an erection
 Corpus spongiosum: penile urethra found in center of this erectile tissue
 glans of penis composed of spongiosum
 Corpus cavernosum: erectile tissue surrounding a central artery
 Seminal vesicles
 Produce 60% of the semen volume
 Fluid contains fructose and is alkaline in pH
 Alkalinity in pH serves to buffer the urethra since
the penis is a dual function organ reproductive/urinary
 Fructose serves as source of fuel for spermatozoa
 Prostate
 produce 1/3 of semen volume
 produces large amounts of citrate during secretion
 fluid contains citrate, acid phosphatase, and hyaluronidase
 epididymis
 functions in gauging composition of tubular fluid, recycling and functional
maturation of spermatozoa occurs in this tube
 urethra
 dual purpose organ
 Cremaster muscle
 Skeletal muscle which allows for elevation of a testicle
 Extension of the internal oblique muscle which occurred during male development
 Testes began to descend pushing through the inguinal ligament wall and retaining a
sliver of the internal oblique muscle
 Elevates and depresses the testicles away from abdominal wall to avoid the heat
killing the spermatozoa
 Yoyo effect
 Dortus muscle/tunic
 Smooth muscle layer surrounding the testicles
 Responsible for wrinkling of testicle
 Spermatic cord
 Cord like structure formed by the vas deferens which contains the P(lexus) VAN and
the vas deferens itself
 Spermatogenesis
 Cohesively defines the process of producing sperm from spermatogonia to spermatozoa
 Spermatogonia (stem cell undergoes MITOSIS)  primary spermatocytes
(undergoes MEIOSIS) secondary spermatocytes (23 chromosomes present and 2nd
MEIOSIS)  spermatids (spermiogenesis)  spermatozoa
 spermatozoa
 head or acrosome which contains enzymes
 middle piece containing a large amount of mitochondria in order to provide fuel
 flagellum provides motility
 Sertoli/Sustentacular cells
 Provides sustenance or scaffolding to the spermatocytes

 Female reproductive system

 Ovaries
 Ovarian arteries: paired arteries supplying blood to the ovaries
 Ovarian veins: return blood
 Ovarian follicles
 Primary
  Secondary
 Graafian
 Ruptures during ovulation and becomes corpus luteum
for several days
 Ovarian cysts: buildup of fluid in the corpus luteum
 If no implantation, luteum degenerates and becomes corpus albicans
(contributes to scar tissue)
 If implantation occurs, luteum continues for 16-20 weeks
 Oogenesis
 Oogonium (assymetrically divide/mitosis)  primary oocyte (meiosis)
secondary oocyte  ovum released from Graafian follicle

 Uterine/fallopian tubes/uterine horn/oviducts

 Composed of 4 parts
 Infundibulum: fimbriae or fingerlike projections guide the ovum from the ovary
into the uterine tube
 Ampulla: site of fertilization
 Isthmus: elongated portion of uterine tube
 Interstitial/uterotubal: transition from uterine tube into uterine cavity/uterus
 Transport ova from ovary into uterus
 Ovulation alternates between ovaries every month

 Uterus
 Fundus
 Expansive portion of uterus responsible for implantation of zygote
 Ectopic pregnancy if implantation occurs elsewhere
 Uterine wall composed of
 Myometrium (90%)
 Smooth muscle contractile layer which contracts and elicits the cramping
effect during menses
 Contracts and expels fetus during parturition
 Endometrium (10%)
 Inner lining of the uterus
 Two layers
 Stratum functionalis: proliferates, thickens, and sloughs off during
menses
 Stratum basale: responsible regeneration of the endometrium
 CLINICAL
 Anterograde flow: Ovary  uterine tube  uterine cavity  vagina
 Retrograde flow: uterine cavity  uterine tube  ovary
 Endometrial cells can leak out of the uterine cavity through the uterine
tube fimbriae which can lead to a condition known as endometriosis
  Suspensory ligament of the ovary
 Homologue of the male spermatic cord due to the contents of VAN
 External Genitalia
 Labia majora and minora
 Homologues of the scrotal sac
 Clitoris
 Homologue of the penis
 More specifically, homologue of the corpus cavernosum since can become erect and
does not surround a urethra
 Additionally, the suspensory ligament connects to from the pubic symphysis to the
clitoris in females as it does in the males with the corpus cavernosum
 Female androgen injections can lead to an enlarged clitoris
 Bartholin’s/Vestibular glands
 Serve mainly for lubrication of the vagina during coitus/intercourse
 Skene’s/periurethral glands
 Involved in female’s capacity to ejaculate
 Homologue of male prostate

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Lower limb
 Femur
 Largest, longest, and strongest bone of the body
 Articulates with the acetabulum
 Acetabulum formed by the fusion of the 3 pelvic bones
 Length is .25xPerson’s height
 Fovea capitis
 Site of attachment of ligamentum teres femoris
 Depression in the head of the femur that
reinforces it into the acetabulum
 Head
 Portion of femur that articulates with the acetabulum
 Iliofemoral ligament/ Y-Ligament of Bigelow: surrounds
and anchors the head of the femur into the acetabulum
 Neck
 Weakest portion
 CLINICAL
 Broken hip is a misnomer since most often
a fracture in the neck of the femur occurs
 Most likely to break if affected by osteoporosis
  Greater and lesser trochanters
 Psoas and iliacus insertion at lesser trochanter
(EXTRA)
 Linea aspera
 Ridge or elevation in the shaft of the femur
which is the site of attachment for some adductor
muscles
 Lateral and medial condyles
 Projections from the distal end of the femur
which form the upper half of the knee joint
 Also found in tibia
 Epicondyles
 Superior to the LM condyles
 Lateral epicondyle origin for Lateral Collateral Ligament
 Medial epicondyle origin for Medial Collateral Ligament
 Patellar surface
 Portion of the femur that articulates with the patella
 Patella
 Articulates with the patellar surface of the femur
 Patellar tendon/quadriceps tendon attach at the base of the patella
 Patellar ligament attaches to the base of the patella
 Articular surface on the posterior aspect of the patella is made of hyaline cartilage
 Anterior cruciates and medial cruciates cross over in between the space of the
bones

 Tibia
 2nd largest, longest, and strongest bone in the body
 medial and lateral condyles
 make up lower half of the knee joint
 medial condyle is insertion for medial
collateral ligament
 medial and lateral menisci are sandwiched in between
lateral and medial condyles of tibia
 menisci made of fibrocartilage and acts as shock
absorbers
 intercondylar eminence
 located in between the condyles
 eminence with tubercles are the attachment site
for the cruciates ligament
 Tibial tuberosity
 Anterior crest
 Medial malleolus
 Distal aspect of the tibia
 Fibula
 Stick like bone with slightly expanded ends
 Head
 Insertion for the Lateral collateral ligament
 lateral malleolus
 Lower end/distal aspect of fibula
 Crural interosseous membrane
 Membrane found in between the tibia and fibula
 Knee injury
 Ligaments
 Lateral collateral ligament
 Origin at lateral epicondyle of the femur and insertion at head of fibula
 Medial collateral ligament
 Origin at medial epicondyle of femur and insertion at medial condyle of tibia
 Injury to lateral aspect of knee will result in tears of the
 1. Medial collateral ligament
 2. Meniscus
 3. Cruciates

 Foot
 Tarsal bones
 Talus
 transmits weight of body from tibia towards toes
 2nd largest foot bone
 calcaneus
 largest of tarsal bones
 cuboid bones and the posterior surface of calcaneus
attaches calcaneal/Achilles tendon
 heel bone
 Cuboid bone
 Navicular
 Cuneiforms
 Medial
 Intermediate
 Lateral
 Metatarsals
 5 mini long bones
 1st metatarsal supports weight of body
 phalanges
 14 long bones organized anatomically
 Distal, middle, and proximal phalanges
 hallux/big toe
 hallux only digit without middle phalanx
  demipointe: “tippy toes” not really because foot
is actually being placed entirely on distal phalanx
of the hallux and spread to the other toes
 en pointe: weight is placed entirely on the distal
phalanx of the hallux as seen in ballerinas

 Pelvic girdle muscles and lower limbs

 Larger and stronger than pectoral limb muscles
 3 groups
 thigh movement
 at the hip joint
 leg movement
 at the knee joint
 foot and toe movement
 at the ankle joint where tallus meets with tibia
 toe movement between your metatarsals and phalanges
 Thigh movement
 Anterior compartment
 Iliopsoas
 Above the inguinal ligament, it is the iliac and psoas muscles
 Below is the iliopsoas
 Filet mignon from this muscle
 Sartorius
 Origin at anterior superior iliac spine
 Medial compartment
 Adductors medial to lateral
 Magnus
 Longus
 Brevis
 Pectineus
 Gracilis
 Performing a split with legs at 180’ apart can result in
a groin pull injury of the gracilis and the adductor longus
 Posterior compartment
 Glutei
 maximus
 biggest and most superficial muscle in this compartment
 medius
 CLINICAL: preferred site of IM injections since
it is furthest from sciatic nerve
  minimus
 deepest muscle in this compartment
 piriformis
 sciatic nerve exits distally
 inflammation results in SCIATICA
 obturator internus
 Superior and Inferior gemellus
 quadratus femoris
 tensor fasciae latae: small muscle continuous with iliotibial band of thigh; origin at
anterior superior iliac spine

 Leg movement
 Anterior thigh compartment - Extensors of the leg
 Rectus femoris
 Origin at anterior inferior iliac spine
 Vastus
 Lateralis
 Medialis
 Intermedius
 Visualization possible through
removal of rectus femoris muscles
 Posterior thigh compartment – flexors of the leg/hamstrings
 Biceps femoris
 Short head
 Long head
 Semitendinosus
 Semimembranosus
 Lateral to medial
 1. Short head biceps femoris
 2. Longhead biceps femoris
 3. Semitendinosus
 4. Semimembranosus
 Foot and Toe Movement
 Anterior compartment
 Tibialis anterior
 Extensor digitorum longus
 Extensor hallucis
 Lateral compartment
 Peroneus/Fibularis longus
 Peroneus/Fibularis brevis
  Posterior compartment
 Gastrocnemius
 Soleus
 Gastrocnemius and soleus form the calcaneal/Achilles tendon
 When removed, deeper muscle visualized
 1. Flexor hallucis longus
 2. Tibialis posterior Medial to Lateral – Posterior view
 3. Flexor digitorum longus
 Arteries of the leg and thigh
 Femoral
 Deep femoral
 Femoral artery branch
 Popliteal
 Continuous with femoral artery
 Posterior tibial
 Gives rise to the peroneal/fibular, medial, and lateral plantar arteries
 Anterior tibial
 Gives rise to dorsalis pedis
 Peroneal
 Supplies medial
 Arteries of the foot
 Dorsalis pedis
 Medial plantar
 Lateral plantar
 Forms the plantar arch
 Systemic veins – Pelvic limb venous drainage
 Plantar & dorsal venous arch
 Anterior & posterior tibial
 Peroneal
 Popliteal
 Femoral
 Great & small saphenous
 Great saphenous is the largest vein in the body
 External iliac
 Great saphenous  External iliac common iliac IVC
 Nerves
 Lumbar plexus T12- L4 with most contributions from L1-L4
 Arises from 1st four lumbar spinal nerves and lies within the psoas major muscle
 L1-L4 comprise the main part of plexus by divisions of the 1st four lumbar spinal
nerves
 L1: iliohypogastric and ilioinguinal nerves
 These two contribute to formation of genitofemoral nerve
 L2: contributes to formation of genitofemoral nerve
 Iliohypogastric
  Ilioinguinal
 Genitofemoral
 Lateral femoral cutaneous
 Femoral
 Obturator
 Sacral Plexus L4-S4
 Larger branches
 Sciatic
 Largest nerve in the body
 Common fibular and tibial divisions
 Tibialis
 Common peroneal
 Deep peroneal
 Superficial peroneal
 Smaller branches
 Superior gluteal
 Inferior gluteal
 Posterior femoral cutaneous
 CLINICAL
 Borders of femoral triangle: inguinal ligament, adductor longus, and Sartorius
 Femoral Vein, Femoral Artery, and Femoral nerve found in this triangle
 Injury to this area likely to be fatal
 Also known as triangle of death
-------------------------------------------------------------------------------------------------------------------------------

Back

 Vertebral column
 Comprised of 26 irregular bones
 Axial support of the trunk
 VC protects the Spinal cord found in vertebral foramen
 Point of attachment for the ribs and back muscles
 Divisions
 Cervical
 7 Cervical Vertebrae
 Thoracic
 12 Thoracic Vertebrae
 Lumbar
 5 Lumbar Vertebrae
 Sacrococcygeal
 1 sacrum
 1 coccyx
 Primary curvature
  Thoracic and Sacral
 Pertains to fetal development
 C-Shaped VC in womb
 Out of the womb, baby on bed begins
to prop head and raise the neck forming
the primary curvature
 Secondary curvature
 Cervical and Lumbar
 once bipedal, lumbar and cervical curvature develop

 Irregular curvatures
 Kyphosis “Hunchback”
 Exaggerated thoracic curvature
 Lordosis “Swayback”
 Exaggerated lumbar curvature
 Develops in third trimester pregnancies
 Scoliosis
 Lateral curvature of the VC
 Lateral deviation results in angled shoulders and pelvis
 Vertebrae Structure
 Body
 Vertebral arch
 Lamina and pedicles
 Vertebral foramen
 Body + Vertebral arch(Lamina + Pedicles) = Vertebral foramen
 Spinous process
 Transverse process
 Superior articular process/facets
 Inferior articular process/facets
 Superior and Inferior articular facets face each other
forming a joint
 Intervertebral foramina
 Exit for the spinal nerves
 CLINICAL
 Laminectomy: To expose the spinal cord, a surgeon
will cut through the lamina and remove it to create space
in the case of a herniated disc
 Cervical Vertebrae
 C1: Atlas
 No body
 No spinous process
 Articular facets facing the skull allow for articulation in the vertical
plane; i.e. neck flexion and extension; nod yes
 Openings in the transverse process= transverse foramina
housing the cerebral artery

 C2: Axis
 Body
 Spinous process
 Dens/odontoid process
 Articulates with the atlas and forms a pivot which allows for lateral
rotation of the head i.e. nods no
 CLINICAL: Hangman’s fracture occurs by fractures in the pedicles of C-2
forcing the odontoid process into the spinal cord
 Reinforced by the transverse ligament

 C3-C7: Typical vertebrae

 Oval body
 Short bifid spinous process
 Transverse foramina
 Houses vertebral blood vessels
 Vein plexus and arteries forms part of the Circle of Willis
 Vertebra prominens: spinous process of C7

 Thoracic Vertebrae
 Increase in size from T1 T12
 Heart shaped body
 Circular vertebral foramen
 Costal facets on the transverse processes
 T-Vertebrae are the only vertebrae with costal facets
articulating with the ribs; exclusions to the rule are cervical ribs
  Direct of articular facets in the T-Vertebrae
 Superior articular process faces posterior
 Inferior articular process faces anterior
 This combination allows for twisting movement in the area of the thoracic
vertebrae

 Lumbar vertebrae
 Large bodies
 Short lamina and pedicles
 Short and flat spinous process
 Superior/inferior articular processes
 modified to lock to prevent rotation of the lumbar spine
 In the lumbar vertebrae, the superior facets face medial and inferior facets face
laterally as opposed to the thoracic facets; by doing this, it prevents over-
rotation in the lumbar region

 Sacrum
 Formed by 5 fused vertebrae in adults
 Sacroiliac joint/Auricular surface
 Auricular surface articulates with the ilium of the pelvis forming the sacro-iliac
joint
 Shapes the posterior wall of the pelvis
 Two wing like alae
 Sacral promontory
 Transverse lines/ridges
 Fusion points of sacral vertebrae
 Sacral foramina
 Cauda equina nerves exit through sacral foramina
 Median and lateral sacral crests
 Median sacral crest equivalent to the lumbar spinous process
 Lateral sacral crest equivalent to lumbar transverse process
 Sacral canal and hiatus
 Parts of the sacrum
 Canal is point of entry for the cauda equina (horse tail)
 Cauda equina: mesh of nerves that come off the end of the spinal cord
 Hiatus
 Extensions of the dura matter, coccygeal ligament, and the filum terminale
(extension of the innermost layer of spinal cord) exit through the hiatus and
attach to the last coccygeal vertebrae=coccyx
 CLINICAL: interest for caudal epidural, palpate the sacral cornu to pinpoint
hiatus for the epidural
  Coccyx
 Vestigial tail bone
 Attachment site for ligaments and sphincter muscles
 Four or five fused vertebrae (completed in late adulthood)
 Gender different
 Male curves more
 Female is more vertical due to need for space during parturition

 Ligaments and discs

 Supporting ligaments are anterior and posterior longitudinal ligaments
 Runs the length of the vertebral column
 Intervertebral discs
 Cushion like paddings can withstand trauma with inner
semifluid nucleus pulposus and strong outer ring
of fibrocartilage called the annulus fibrosus
 Nucleus pulposus
 Remnant of the embryonic notochord
 Annulus fibrosus
 Fibrocartilage ring to protect vertebral foramina

 Discs account for 25% of height

 As you age, disc degeneration will lead to smaller overall height
 Herniated disc is rupturing of the annulus fibrosus
 Nucleus pulposus will protrude through the outer ring and pinch against the
root of the spinal cord resulting in a pinched nerve/slipped disc/herniated
disc

 Muscles of the back

 Extrinsics
 Reinforce the vertebral column
 Origin outside VC and attachment at VC
 Intrinsics
 Located within vertebral column
 Superficial/splenius
 Intermediate medial to lateral
 Erector spinae group
 spinalis
 Longissimus
 Iliocostalis
  Deep
 Semispinalis
 Multifidus
 Rotatores
 Interspinales
 In between the spinous processes
 Intertransversarii
 In between the transverse processes
 Muscles elevate the ribs

 Spinal cord and spinal nerves

 Spinal cord extends from foramen magnum to L1/L2 (42 cm long and 1.8cm thick)
 CNS
 Spinal nerves=PNS
 Vertebrae outgrow the spinal cord
 Major reflex center
 CNS: nerve cell bodies =nuclei
axons=tracts
 PNS: nerve cell bodies=ganglia
axons=nerves
 Ascending tracts
 Sensory
 Going to the brain
 Descending tracts
 Going away from brain
 Motor function

 Gross anatomy of spinal cord

 Posterior and Anterior median sulci
 Grooves
 Cervical and Lumbar enlargements
 Conus medullaris
 Marks the terminus of spinal cord (forms little cone) at L1
 Filum terminale
 Caudal extension of the pia matter (innermost layer of the meninges)
 Dorsal and Ventral root ganglia
 Aggregates of nerve cell bodies in the PNS
 Cauda equina
 Horse tail
 Mesh of nerves (L2-L5, S1-S5, and coccygeal nerves)
 Arise from the conus medullaris and enters the sacral canal
 Clinical significance
  Lumbar puncture/spinal tap at L3-L4 after the conus medullaris
into subarachnoid space
 Paraplegia can result if Lumbar puncture above L2
 Cross-sectional anatomy of spinal cord
 Gray matter and spinal roots
 Posterior (dorsal) gray horn
 Somatic and visceral sensory neurons (interneurons)
 Afferent information
 Dorsa(fferent)l gray horn
 Anterior (ventral) gray horn
 Somatic neurons: Efferent/motor control
 Ve(fferent)ntral gray horn

 Lateral gray horn

 Limited to the thoracic/superior lumbar segments of spinal cord containing
mostly visceral motor nuclei
 Ventral root
 Dorsal root
 Gray commissures
 Extension of gray matter mostly composed of cell bodies and dendrites
 White matter
 Anterior and posterior white columns (funiculi) Anter(i)or poster(i)or – both have
I so funiculi
 Anterior white commissure
 Lateral white columns
 these columns, ascending and descending with sensory and motor nuclei lay
the reason for lesion causing paraplegia
 Spinal nerves
 Arrangement of spinal nerves similar to muscle
 Endoneurium
 Surrounds individual axons
 Perineurium
 Surround fascicles
 Epineurium
 Collagen fibrous sheath continuous with dura at
intervertebral foramina
 31 pairs (cervicals precede adjacent vertebrae)
 1st cervical spinal nerve
 between the skull and atlas
 C1-C8
 Lesion above C-7 causes quadriplegia
 Lesion below c-7 causes paraplegia
  Thoracic spinal nerves proceed adjacent vertebrae

 Spinal Meninges
 Three layers from superficial to deep
 All three layers are continuous with cranial meninges
 Dura matter (superficial)
 Fibrous CT
 Outermost covering of the spinal cord and brain
 Fuses at margins of the foramen magnum
 Merges with components of filum terminale
 This merger along with the coccygeal ligaments insert at caudal most aspect
of the coccyx
 Arachnoid
 Middle meningeal layer
 Simple squamous epithelium
 Subarachnoid space composed of arachnoid trabeculae which are made of
collagen and elastin fibers
 Pia matter (deep)
 Innermost layer
 Close proximity to anterior and posterior spinal arteries
 Astrocytes: glia or neuroglia are the supportive component of pia matter which
function to reinforce
 Lateral extensions of pia matter= denticulate ligament
 Caudal extension of pia matter=filum terminale
 Cerebrospinal fluid
 Circulates in subarachnoid space which is target region for LP
 Epidural space
 In the vertebral foramen of this space, adipose tissue can be found outside of the
dura matter