2. Case study
17 years old boy presented to the casualty after
attach of fits and he had headache for 3 days. The
patient was stuperosed ,acute meningitis is
suspected and lumber puncher was performed.
1. List the covering of the spinal cord (in order) are
penetrated by the needle
2. What are the structures that support the spinal
cord
3. How the lumber puncher is performed
4. What is the external feature of the spinal cord
5. At which level the spinal cord end
3. • Its cylindrical in shape .
• Cervical and lumber
enlargements .
• 45 cm length .
• Start just below the
foramen magnum ,
continuous above with
medulla oblongata.
• Ends at L1 or L2
conus medullaries ( in
adults ).
• Occupies the upper
2/3rds of the vertebral
canal .
4. • The vertebral column grows faster than
the spinal cord before and after birth that’s
why :
• At 3rd month of intrauterine life
occupies the whole canal .
• At birth it ends at the level of 3rd lumber
vertebra .
• Adult hood L1 or L2.
6. • In adults :
• Cervical lordosis, which is
convex anteriorly.
• The thoracic kyphosis,
which is concave anteriorly,
• The lumbar lordosis, convex
anteriorly.
• the sacral kyphosis,
concave anteriorly .
7. Fetus:
• C-shaped curvature,
which is concave
anteriorly over its
entire length .
• After birth 2
curvatures develop :
• Cervical one .
• Lumber one .
8. Gross appearance of the spinal
cord
• Has 31 segments and 5 regional segments:
• 8 cervical
• 12 thoracic
• 5 lumber
• 5 sacral
• 1 coccygeal
• Each spinal segment gives rise to a pair of
spinal nerves
10. • Anterior and
posterior rootlets
anterior (motor) and
posterior (sensory)
roots spinal nerve .
• Spinal nerves leaves
the vertebral canal
through the
intervertebral
foramen.
11.
12. • As the spinal cord
ends at L1 or L2 ,
the lumber , sacral
and coccygeal
nerves travels along
distance to leave the
canal through their
corresponding
foramina
• As they do so , their
shape resembles
the horse tail
(Cauda equina) .
13. Meninges
• Collectively, the
dura mater,
arachnoid mater,
and pia mater
surrounding the
spinal cord
constitute the
spinal meninges .
17. Dura Mater
• Is a dense, strong, fibrous
membrane that encloses
the spinal cord and the
cauda equina.
• It is continuous above
through the foramen
magnum with the dura
covering the brain.
• Inferiorly, it ends on the
filum terminale at the level
of the lower border of the
second sacral vertebra .
18.
19.
20.
21.
22. Arachnoid Mater
• The arachnoid mater is
a delicate impermeable
membrane that covers
the spinal cord and lies
between the pia mater
internally and dura
mater externally .
• It is separated from the
pia mater by a wide
space, the
subarachnoid space,
which is filled with
cerebrospinal fluid.
23. • above through the
foramen magnum with
the arachnoid
covering the brain.
• ends on the filum
terminale at the level
of the lower border of
the second sacral
vertebra.
24.
25.
26. Pia Mater
• The pia mater, a vascular
membrane that closely
covers the spinal cord .
• thickened on either side
between the nerve roots to
form the ligamentum
denticulatum, which passes
laterally to adhere to the
arachnoid and dura.
• by this means that the
spinal cord is suspended in
the middle of the dural
sheath.
27. • Inferior to the
medullary cone,
the pia mater
continues as the
terminal filum .
34. Case study
17 years old boy presented to the casualty after
attach of fits and he had headache for 3 days. The
patient was stuperosed ,acute meningitis is
suspected and lumber puncher was performed.
1. List the covering of the spinal cord (in order) are
penetrated by the needle
2. What are the structures that support the spinal
cord
3. How the lumber puncher is performed
4. What is the external feature of the spinal cord
5. At which level the spinal cord end
