1. „SelectedChaptersfromtheCross-SectionalAnatomyof the Human Body”SpineanatomyAndrás Jakab MD, Levente István Lánczi MD

3. The SpinalCord Cervical (7) C1-C7 C1: atlas C2: axis Thoracic (12) T1-T12 Lumbar (5) L1-L5 Sacral(5) S1-S5, synosthosis Coccyx Coc3-5

4. Spinalcord – macroscopicanatomy =medullaspinalis conusmedullaris (termianlis) cervical and lumbarenlargement filumterminale anteriormedianfissura posteriormediansulcus dorsalroot(sensory) et ventralroot(motor) spinalnerves

5. Spinalcord – structure Segments – functions 8 cervical Segment+nerve: level of intervertebralforamen C1 nerve: exitsbetweenoccipitalbone and atlas Remember!C8exitsonintervertebralforamenbetween C7-Th1! Spinalcordsegmentsareshorterthanvertebraeheight!Nerveexitsspinalcordupperthanintervertebralforamen. 12 thoracic 5 lumbal (nervesdescend almost vertical!) 5 sacral 1 coccyx Altogether: 31 pairs of spinalnerves

8. Spinalcord vs. spinalcolumn (C7) Spinousprocess Vertebralarch arachnoidea mater Periosteum Epiduralspace Spinaldura mater Subarachnoidspace Pia mater Posteriorroot Anteriorroot Spinalganglion n. spinalis; r. posterior Transverseprocess n. spinalis; r. anterior

12. Thoracicvertebrae

13. Lumbalvertebrae

14. Sacrum

17. Crosssectionalstructureof thespinalcord

18. Crosssectionalstructureof thespinalcord Centralcanal White matter commisura alba funiculi Posteriorfuniculus Lateralisfuniculus Anteriorfuniculus Grey matter PEG (periaqueductalgreymatter) Anteriorroot Posteriorroot …Rexed laminae…

24. Spinalcord – tracts Ascendingtracts Fasciculus gracilis, Goll(skin) Fasciculuscuneatus, Burdach Spinothalamictract (pain) Ant. & post. spinocerebellartract Descendingtracts Corticospinaltract Rubrospinaltract Reticulo-vestibulo-tectospinaltract Fasciculuslongitudinalismedialis Descendingvegetativetracts

28. Epiduralfat T11 Intervertebralface lumbarenlargement T12 Intervertebraldisc Anulusfibrosus Nucleuspulposus L1 conusterminalis L2 filum terminale (cauda equina) L3 Spinalcanal Spinousprocess L4 Interspinal ligament L5 promontory Sacralcanal S1 S2

29. Intervertebralforamen Vertebralarch, pediculus Articularprocess Spinousprocess

30. Vertebral body Level: lowerthoracic,T2 weighted MRI Ant. & post. longitudinalligament Transverseprocess Ventralroot Dorsalroot Spinalmedulla Ligamenta flava Spinousprocess

31. Vertebral body Level: Lumbar,T2 weighted MRI Ant. longitudinal ligament Transverseprocess Spinalganglion caudaequina ligamenta flava Spinousprocess

34. Spinalnerves

35. Rootsymptoms C- headache, dizziness T- upperlimbweakness, no skinsensationorpain L- lowerlimbweakness, no skinsensationorpain S- buttocks, toes; incontinence, erectiledysfunction

36. Neck – C2, C3 Upperlimb: C6, C8, T1 Hand: C6-C8 Level of nipples: Th4 Level of umbilice: Th10 Genitalorgans: S2-S3 Gluteus: S1-S4 Smalltoe: S1 Big toe: L4-5

38. Spinal reflex – an example (patella-reflex) Receptor -> afferent-> center -> efferent -> effector

39. Cranialnerves 12 pairs Motory, sensory and parasymphateticnerves Eyemovements Specialsensorynerves – sensoryorgans N. vagus (X)

40. Vegetativenervoussystem Center inbrain: hypothalamus Parasympathetic („rest&digest”) Heartrate, bloodpressuredecreases, pupilnarrows N. Sympathetic(„fightorflight”) Stress: respiration+, heartrate+, bloodpressure+, pupilbroadens, hair Truncussympaticus

41. Parasymphateticnerves

42. Symphateticnerves

43. Symphateticnerves

44. Sensoryorgansdemonstratedon IMAIOS

45. Clinicalcase 68 year old female 4-hour history of pain in the back and epigastrium with paraesthesia and weakness of the lower limbs. Warfarintherapy (earlier: PE) Sensoryloss below the umbilicus http://www.eurorad.org/case.php?id=2954

46. Clinicalcase 56 year old female 3 yearshistory of dizzinessand heaviness of the neck, withoutneurologicsigns Plain radiographsof the cervical spine in the lateral view, in an erect position; CT scan http://www.eurorad.org/case.php?id=978

47. Othercases Cervicalspineepiduralmass http://www.eurorad.org/case.php?id=4361 Spinalarachniodcysthttp://www.eurorad.org/case.php?id=2550 Traumaticmeningocelehttp://www.eurorad.org/case.php?id=2403