contents of vertebral canal and its applied aspects mbbs
TRANSCRIPT
Vertebral Column
� Central bony pillar of the body.
� Supports the skull, pectoral girdle, upper
limbs and the thoracic cage.
� Within its cavity lie the spinal cord, the roots
of the spinal nerves, the covering-meninges.
� Composed of 33 vertebrae: 7 cervical, 12
thoracic, 5 lumbar, 5 sacral, 4 coccygeal.
� It is a flexible structure made up of
fibrocartilage called intervertebral discs.
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VERTEBRAL CANAL
� The vertebral canal is formed by placing the vertebra in a sequence, that their vertebral foraminae are lie one below the other forming continuous canal
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The vertebral canal
� The vertebral canal is bounded
anteriorly by the vertebral bodies and
the intervertebral discs, each
covered by the posterior longitudinal
ligament, which is continuous from
the back of the body of the axis to
the sacrum.
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The vertebral canal
� Posteriorly it is bounded
by the laminae,
ligamenta flava and the
arch of the vertebra.
� The vertebral canal is
usually larger in the
cervical and lumbar
regions.
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CONTENTS OF VERTEBRAL CANAL
� The contents –from outwards;
� 1.epidural or extra dural space
� 2.thick dura mater or pachymenix
� 3.subdural capillary space
� 4.delicate arachnoid mater
� 5.wide subarachnoid space containing CSF
� 6.firm pia mater .The Arachnoid and Piamater together-leptomeninges
� 7.spinal cord and the cauda equina
� 8.Blood supply [arteries and lodges, valveless, dangerous venous plexus [Batsons].. 12
CONTENTS OF THE VERTEBRAL CANAL
� Spinal cord
� is a cylindrical, grayish-white structure, 42-45 cm in length that begins above the foramen magnum, where it is continuous with the medulla oblongata of the brain.
� It terminates below in the adult at the level of the lower border of the first lumbar vertebra.
� In the young child it is relatively longer and ends at the upper border of the third lumbar vertebra.
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BLOOD SUPPLY OF THE SPINAL CORD
� The spinal cord receives its
arterial supply from three
small, longitudinally running
arteries-the two posterior
spinal arteries branches of
posterior inferior cerebellar
arteries and the one anterior
spinal artery branch of
Vertebral artery,15
Meninges of the spinal cord1. Dura mater
� the most external membrane and is a dense, strong, fibrous sheet that encloses the spinal cord and cauda equina.
� Continuous above through the foramen magnum with the meningeal layer of duracovering the brain.
� Inferiorly, it ends on the filumterminale at the level of the lower border of the second sacral vertebra.
� Epidural space- contains loose areolar tissue and the internal vertebral venous plexus.
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2. Arachnoid mater
� a delicate impermeable membrane covering the spinal cord and lying between the pia mater internally and the dura mater externally.
� Separated from the dura by the subdural space that contains a thin film of tissue fluid.
� Separated from the pia mater by a wide space, the subarachnoid space, which is filled with cerebrospinal fluid.
� Inferiorly , it ends on the filum terminale.
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3. Pia mater
� A vascular membrane
that closely covers the
spinal cord.
� Below it fuses with the
filum terminale
� The pia mater is
thickened on either side
between the nerve roots
to form the ligamentum
denticulum, which
passes laterally to be
attached to the dura.
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LIGAMENTUM DENTICULATUM
� These are the ribbon like
thickened bands of pia
mater,extending
laterally,piercing the arachnoid
and attached to the inner
surface of the duramater
� The first teeth of denticulatum
lies at the level of foramen
magnum
� The last between T12andL1
� The lowest tooth is forked and
the posterior root of the L1 lie
at the outer prong of the fork
� Serve as a guide in cardotomy
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CONUS MEDULLARIS and CAUDA
EQUINA
� The roots of the nerves lumbar, sacral and coccygeal leave through appropriate numbered intervertebral foramen
� They together look like a horse tail-cauda equina
� The terminal end of the spinal cord-conus medullaris.
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EPIDURAL SPACE
� Lies between the spinal duramater and the periosteum and ligaments lining the vertebral canal
� 1.loose areolar connective tissue
� 2.semiliquid fat
� 3.spinal arteries
� 4.the internal vertebral venous plexus.
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Applied anatomy
� Lumbar epidural anaesthesia
� Between L3 and L4 spine n eedle course through, skin, fat, supraspinous and interspinous ligaments, ligamentum flava, epidural space.
� This space is confirmed by the fact that it is a space with negative pressure
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CAUDAL EPIDURAL ANAESTHESIA
� The needle is passed
through sacral hiatus
which lies equidistant
from the right and left
posterior superior iliac
spines and enters the
sacral canal
� This space lies below
S2
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SUBDURAL SPACE
� Is a potential space between the duramaterand the arachnoid, containing thin film of serous fluid.
� Permits movements of dura over the arachnoid
� Continued for a short distance on to the spinal nerve
� Free comunication with the lymph spaces around the nerves
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Figure 12.29a
Cervical
enlargement
Dura and
arachnoid
mater
Lumbar
enlargementConus
medullarisCauda
equina
Filum
terminale
Cervical
spinal nerves
Lumbar
spinal nerves
Sacral
spinal nerves
Thoracic
spinal nerves
FILUM TERMINALE
� he filum terminale("terminal thread"), is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris. It is one of the modifications of piamater.
SUB ARACHNOID SPACE
� IS a wide space
between the pia and
the arachnoid filled
with CSF
� Spinal sub arachnoid
space is wider then the
space around the brain
� Widest below where it
encloses the caudae
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Applied aspects
� LUMBAR PUNCTURE:
� Done through the
Intervertabral disc
between L3 and L4 for
threuptic and diagnostic
purpose.
� In children-vertabrel
level-L1.
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VERTESBRAL SYSTEM OF VEINS
� The vertebral venous
system –
valveless,complicated
network ,with
longitudinal pattren
� Runs parallel to SVC
andIVC and
anastomoses with
them
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� This network has three intercommunicatiingsub divisions
� 1,the epiduralplexus lies in the vertebral canal outside the durameter
� Consists of 1. postcentral2.pre laminar portion
� This plexus drains the structures in the vertebral canal
� Itself drained at regular intervals by
� Segmental veins-vertebral,posteriorintercostal,lumbar and lateral sacral .
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� Plexus within the
veretebral bodies-
drains backwards into
the epidural plexus
� Anterolaterally-into
the external vertebral
plexus
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3. External vertebral venous plexus-
� It consists of anterior vessels lying in front of the vertebral bodies
� Posterior vessels on the back of the vertebral arches and on adjacent muscles- drained by segmental veins
� The sub occipital plexus of veins lying in the sub occipital triangle is a part of external venous plexus
� It receives the occipital veins of the scalp – connected with the transverse sinus by emissary veins and drains into the subclavian veins
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BATSON’S PLEXUS
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The azygos system also
communicates with a valveless
venous network known as
BATSON’S PLEXUS. When the
vena cava is partially or totally
occluded, Batson’s plexus
provides an alternate route for
blood return to the heart.
The vessels of Batson’s
plexus may be referred to as
epidural veins
Batson’s plexus
� Communications- valveless vertebral system of veins communicates
1. Above with intracranial venous sinuses
2. Below with the pelvic veins, portal vein and cavalsystem of veins
� The veins are valveless and so the blood can flow in either direction
� An increase in intra thoracic or intra abdominal pressure due to coughing and straining may cause blood to flow either upwards or downwards away from heart
� Such periodic changes in venous pressure are clinically important
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� There may possible spread of tumours or
infection-eg: cells from pelvic, abdominal
thoracic and breast tumours-venous system-
lodge in the vertebra, spinal cord, skull or the
brain
� Primary sites of tumours causing secondaries in
vertebra are breast, prostate and kidney
� Vertebral caries – tuberculous infection with in
the veretebrae
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