Intervertebral disc - norm and pathology. How does lumbar spinal stenosis manifest itself? What is spinal stenosis

Based on the book:
Degenerative-dystrophic lesions of the spine (radiological diagnosis, complications after discectomy)

Rameshvili T.E. , Trufanov G.E., Gaidar B.V., Parfenov V.E.

vertebral column

The normal spinal column is a flexible formation, consisting of an average of 33-34 vertebrae connected in a single chain by intervertebral discs, facet joints and a powerful ligamentous apparatus.

The number of vertebrae in adults is not always the same: there are anomalies in the development of the spine, associated with both an increase and a decrease in the number of vertebrae. So the 25th vertebra of the embryo in an adult is assimilated by the sacrum, however, in some cases it does not fuse with the sacrum, forming the 6th lumbar vertebra and 4 sacral vertebrae (lumbarization - likening the sacral vertebra to the lumbar).

There are also opposite relationships: the sacrum assimilates not only the 25th vertebra but also the 24th, forming 4 lumbar and 6 sacral vertebrae (sacralization). Assimilation can be complete, bone, incomplete, bilateral and unilateral.

The following vertebrae are distinguished in the spinal column: cervical - 7, thoracic - 12, lumbar - 5, sacral - 5 and coccygeal - 4-5. At the same time, 9-10 of them (sacral - 5, coccygeal 4-5) are connected motionlessly.

Normal curvature of the spinal column in the frontal plane is absent. In the sagittal plane, the spinal column has 4 alternating smooth physiological bends in the form of arcs facing anteriorly with a bulge (cervical and lumbar lordosis) and arcs directed posteriorly with a bulge (thoracic and sacrococcygeal kyphosis).

The severity of physiological curves testifies to the normal anatomical relationships in the spinal column. The physiological curves of the spine are always smooth and normally not angular, and the spinous processes are at the same distance from each other.

It should be emphasized that the degree of curvature of the spinal column in different departments is not the same and depends on age. So, by the time of birth, the bends of the spinal column exist, but their degree of severity increases as the child grows.

Vertebra

A vertebra (except for the two upper cervical vertebrae) consists of a body, an arch, and processes extending from it. The vertebral bodies are connected by intervertebral discs, and the arches are connected by intervertebral joints. The arcs of adjacent vertebrae, joints, transverse and spinous processes are connected by a powerful ligamentous apparatus.

The anatomical complex, consisting of the intervertebral disc, two corresponding intervertebral joints and ligaments located at this level, represents a kind of segment of spinal movements - the so-called. vertebral segment. The mobility of the spine in a separate segment is small, but the movements of many segments provide the possibility of significant mobility of the spine as a whole.

The dimensions of the vertebral bodies increase in the caudal direction (from top to bottom), reaching a maximum in the lumbar region.

Normally, the vertebral bodies have the same height in the anterior and posterior sections.

An exception is the fifth lumbar vertebra, whose body has a wedge-shaped shape: in the ventral region it is higher than in the dorsal (higher in front than behind). In adults, the body is rectangular with rounded corners. In the transitional thoracolumbar spine, a trapezoid shape of the body of one or two vertebrae with a uniform beveling of the upper and lower surfaces anteriorly can be detected. The trapezoid shape can be at the lumbar vertebra with a bevel of the upper and lower surfaces posteriorly. A similar shape of the fifth vertebra is sometimes mistaken for a compression fracture.

The vertebral body consists of a spongy substance, the bone beams of which form a complex interlacing, the vast majority of them have a vertical direction and correspond to the main load lines. The anterior, posterior and lateral surfaces of the body are covered with a thin layer of dense substance perforated by vascular channels.

An arc departs from the upper lateral sections of the vertebral body, in which two sections are distinguished: the anterior, paired - leg and posterior - plate ( Iamina), located between the articular and spinous processes. From the arch of the vertebrae, processes depart: paired - upper and lower articular (facet), transverse and single - spinous.

The described structure of the vertebra is schematic, since individual vertebrae, not only in different sections, but also within the same section of the spinal column, may have distinctive anatomical features.

A feature of the structure of the cervical spine is the presence of holes in the transverse processes of the C II -C VII vertebrae. These holes form a canal in which the vertebral artery passes with the sympathetic plexus of the same name. The medial wall of the canal is the middle part of the semilunar processes. This should be taken into account with an increase in the deformation of the semilunar processes and the occurrence of arthrosis of the uncovertebral joints, which can lead to compression of the vertebral artery and irritation of the sympathetic plexuses.

Intervertebral joints

The intervertebral joints are formed by the lower articular processes of the overlying vertebra and the superior articular processes of the underlying one.

Facet joints in all parts of the spinal column have a similar structure. However, the shape and location of their articular surfaces is not the same. So, in the cervical and thoracic vertebrae, they are located in an oblique projection, close to the frontal, and in the lumbar - to the sagittal. Moreover, if in the cervical and thoracic vertebrae the articular surfaces are flat, then in the lumbar vertebrae they are curved and look like segments of a cylinder.

Despite the fact that the articular processes and their articular surfaces in different parts of the spinal column have peculiar features, however, at all levels, the articular articular surfaces are equal to one another, lined with hyaline cartilage and reinforced with a tightly stretched capsule attached directly to the edge of the articular surfaces. Functionally, all facet joints are inactive.

In addition to the facet joints, the true joints of the spine include:

paired atlanto-occipital joint, connecting the occipital bone with the first cervical vertebra;
unpaired median atlanto-axial joint, connecting the vertebrae C I and C II;
a paired sacroiliac joint that connects the sacrum to the ilium.

intervertebral disc

The bodies of adjacent vertebrae from II cervical to I sacral are connected by intervertebral discs. The intervertebral disc is a cartilaginous tissue and consists of a gelatinous (pulpous) nucleus ( nucleus pulposus), fibrous ring ( Annulus fibrosis) and from two hyaline plates.

nucleus pulposus- a spherical formation with an uneven surface, consists of a gelatinous mass with a high water content - up to 85-90% in the core, its diameter varies between 1-2.5 cm.

In the intervertebral disc in the cervical region, the nucleus pulposus is displaced somewhat anteriorly from the center, and in the thoracic and lumbar it is located on the border of the middle and posterior thirds of the intervertebral disc.

Characteristic of the nucleus pulposus are great elasticity, high turgor, which determines the height of the disk. The nucleus is compressed in a disk under a pressure of several atmospheres. The main function of the nucleus pulposus is spring: acting like a buffer, it weakens and evenly distributes the influence of various shocks and tremors over the surfaces of the vertebral bodies.

The nucleus pulposus, due to turgor, exerts constant pressure on the hyaline plates, pushing the vertebral bodies apart. The ligamentous apparatus of the spine and the fibrous ring of the discs counteract the nucleus pulposus, bringing adjacent vertebrae together. The height of each disc and the entire spinal column as a whole is not a constant value. It is associated with the dynamic balance of the oppositely directed influences of the nucleus pulposus and the ligamentous apparatus and depends on the level of this equilibrium, which mainly corresponds to the state of the nucleus pulposus.

The nucleus pulposus tissue is able to release and bind water depending on the load, and therefore, at different times of the day, the height of a normal intervertebral disc is different.

So, in the morning, the height of the disk increases with the restoration of the maximum turgor of the gelatinous nucleus and, to a certain extent, overcomes the elasticity of the traction of the ligamentous apparatus after a night's rest. In the evening, especially after physical exertion, the turgor of the nucleus pulposus decreases and adjacent vertebrae approach each other. Thus, human growth during the day varies depending on the height of the intervertebral disc.

In an adult, the intervertebral discs make up about a quarter or even a third of the height of the spinal column. The noted physiological fluctuations in growth during the day can be from 2 to 4 cm. Due to the gradual decrease in the turgor of the gelatinous nucleus in old age, growth decreases.

A kind of dynamic counteraction to the effects of the nucleus pulposus and ligamentous apparatus on the spinal column is the key to understanding a number of degenerative-dystrophic lesions that develop in the spine.

The nucleus pulposus is the center around which the mutual movement of adjacent vertebrae occurs. When the spine is flexed, the nucleus moves posteriorly. When unbending anteriorly and with lateral inclinations - towards the convexity.

annulus fibrosus, consisting of connective tissue fibers located around the nucleus pulposus, forms the anterior, posterior and lateral edges of the intervertebral disc. It is attached to the bone marginal edging by means of Sharpei fibers. The fibers of the annulus fibrosus are also attached to the posterior longitudinal ligament of the spine. The peripheral fibers of the fibrous ring make up a strong outer section of the disc, and the fibers closer to the center of the disc are looser, passing into the capsule of the nucleus pulposus. The anterior section of the fibrous ring is denser, more massive than the posterior one. The anterior part of the fibrous ring is 1.5-2 times larger than the posterior one. The main function of the annulus fibrosus is to fix adjacent vertebrae, hold the nucleus pulposus inside the disk, and ensure movement in different planes.

The cranial and caudal (upper and lower, respectively, in the standing position) surface of the intervertebral disc is formed by hyaline cartilage plates, inserted into the limbus (thickening) of the vertebral body. Each of the hyaline plates is equal in size and closely adjacent to the corresponding end plate of the vertebral body; it connects the nucleus pulposus of the disc to the bony end plate of the vertebral body. Degenerative changes in the intervertebral disc extend to the vertebral body through the endplate.

Ligament apparatus of the spinal column

The spinal column is equipped with a complex ligamentous apparatus, which includes: anterior longitudinal ligament, posterior longitudinal ligament, yellow ligaments, transverse ligaments, interspinous ligaments, supraspinous ligament, nuchal ligament and others.

Anterior longitudinal ligament covers the anterior and lateral surfaces of the vertebral bodies. It starts from the pharyngeal tubercle of the occipital bone and reaches the 1st sacral vertebra. The anterior longitudinal ligament consists of short and long fibers and bundles that are firmly fused with the vertebral bodies and loosely connected to the intervertebral discs; over the latter, the ligament is thrown from one vertebral body to another. The anterior longitudinal ligament also performs the function of the periosteum of the vertebral bodies.

Posterior longitudinal ligament starts from the upper edge of the large opening of the occipital bone, lines the posterior surface of the vertebral bodies and reaches the lower part of the sacral canal. It is thicker, but narrower than the anterior longitudinal ligament and richer in elastic fibers. The posterior longitudinal ligament, in contrast to the anterior one, is firmly fused with the intervertebral discs and loosely with the vertebral bodies. Its diameter is not the same: at the level of the discs it is wide and completely covers the posterior surface of the disc, and at the level of the vertebral bodies it looks like a narrow ribbon. On the sides of the midline, the posterior longitudinal ligament passes into a thin membrane that separates the venous plexus of the vertebral bodies from the dura mater and protects the spinal cord from compression.

yellow ligaments consist of elastic fibers and connect the arches of the vertebrae, are especially clearly visualized on MRI in the lumbar spine with a thickness of about 3 mm. Intertransverse, interspinous, supraspinous ligaments connect the corresponding processes.

The height of the intervertebral discs gradually increases from the second cervical vertebra to the seventh, then there is a decrease in height to Th IV and reaches a maximum at the level of the disc L IV -L V . The lowest height is the highest cervical and upper thoracic intervertebral discs. The height of all intervertebral discs located caudal to the body of the Th IV vertebra increases evenly. The presacral disc is very variable both in height and shape, deviations in one direction or another in adults are up to 2 mm.

The height of the anterior and posterior sections of the disc in different sections of the spine is not the same and depends on the physiological curves. So, in the cervical and lumbar regions, the anterior part of the intervertebral discs is higher than the posterior one, and in the thoracic region, inverse relationships are observed: in the middle position, the disc has the shape of a wedge with its apex backward. With flexion, the height of the anterior disc decreases and the wedge-shaped shape disappears, while with extension, the wedge-shaped shape is more pronounced. There are no normal displacements of the vertebral bodies during functional tests in adults.

Vertebral channel

The spinal canal is a container for the spinal cord, its roots and blood vessels, the spinal canal communicates cranially with the cranial cavity, and caudally with the sacral canal. There are 23 pairs of intervertebral foramina for the exit of the spinal nerves from the spinal canal. Some authors divide the spinal canal into a central part (dural canal) and two lateral parts (right and left lateral canals - intervertebral foramina).

In the side walls of the canal there are 23 pairs of intervertebral foramina, through which the roots of the spinal nerves, veins, and radicular-spinal arteries enter the spinal canal. The anterior wall of the lateral canal in the thoracic and lumbar regions is formed by the posterolateral surface of the bodies and intervertebral discs, and in the cervical region, this wall also includes the uncovertebral articulation; the back wall is the anterior surface of the superior articular process and the facet joint, yellow ligaments. The upper and lower walls are represented by cutouts of the legs of the arcs. The upper and lower walls are formed by the lower notch of the pedicle of the arch of the overlying vertebra and the upper notch of the pedicle of the arch of the underlying vertebra. The diameter of the lateral canal of the intervertebral foramina increases in the caudal direction. In the sacrum, the role of the intervertebral foramina is performed by four pairs of sacral foramina, which open on the pelvic surface of the sacrum.

The lateral (radicular) canal is bounded on the outside by the peduncle of the overlying vertebra, in front by the vertebral body and intervertebral disc, and posteriorly by the ventral sections of the intervertebral joint. The radicular canal is a semi-cylindrical groove about 2.5 cm long, having a course from the central canal from above obliquely down and anteriorly. The normal anteroposterior canal size is at least 5 mm. There is a division of the radicular canal into zones: the “entrance” of the root into the lateral canal, the “middle part” and the “exit zone” of the root from the intervertebral foramen.

"Entrance 3" to the intervertebral foramen is a lateral pocket. The causes of root compression here are hypertrophy of the upper articular process of the underlying vertebra, congenital features of the development of the joint (shape, size), osteophytes. The serial number of the vertebra to which the superior articular process belongs in this compression variant corresponds to the number of the pinched spinal nerve root.

The “middle zone” is bounded in front by the posterior surface of the vertebral body, and in the back by the interarticular part of the vertebral arch, the medial sections of this zone are open towards the central canal. The main causes of stenosis in this area are osteophytes at the site of attachment of the yellow ligament, as well as spondylolysis with hypertrophy of the articular bag of the joint.

In the "exit zone" of the spinal nerve root, the underlying intervertebral disc is located in front, and the outer parts of the joint are in the back. The causes of compression in this area are spondylarthrosis and subluxations in the joints, osteophytes in the region of the upper edge of the intervertebral disc.

Spinal cord

The spinal cord begins at the level of the foramen magnum and ends, according to most authors, at the level of the middle of the body of the L II vertebra (rare variants are described at the level of the L I and the middle of the body of the L III vertebra). Below this level is the terminal cisterna containing the roots of the cauda equina (L II -L V, S I -S V and Co I), which are covered by the same membranes as the spinal cord.

In newborns, the end of the spinal cord is located lower than in adults, at the level of the L III vertebra. By the age of 3, the cone of the spinal cord occupies the usual position for adults.

The anterior and posterior roots of the spinal nerves depart from each segment of the spinal cord. The roots are sent to the corresponding intervertebral foramens. Here the posterior root forms the spinal ganglion (local thickening - ganglion). The anterior and posterior roots join immediately after the ganglion to form the spinal nerve trunk. The upper pair of spinal nerves leaves the spinal canal at the level between the occipital bone and the C I vertebra, the lower pair leaves between the S I and S II vertebrae. There are 31 pairs of spinal nerves in total.

Up to 3 months, the roots of the spinal cord are located opposite the corresponding vertebrae. Then the spine begins to grow faster than the spinal cord. In accordance with this, the roots become longer towards the cone of the spinal cord and are located obliquely downward towards their intervertebral foramina.

Due to the lag in the growth of the spinal cord in length from the spine, this discrepancy should be taken into account when determining the projection of the segments. In the cervical region, the segments of the spinal cord are located one vertebra higher than the corresponding vertebra.

There are 8 segments of the spinal cord in the cervical spine. Between the occipital bone and the C I-vertebra there is a segment C 0 -C I where the C I-nerve passes. The spinal nerves corresponding to the underlying vertebra emerge from the intervertebral foramen (for example, nerves C VI emerge from the intervertebral foramen C V -C V I).

There is a discrepancy between the thoracic spine and the spinal cord. The upper thoracic segments of the spinal cord are located two vertebrae higher than their corresponding vertebrae, and the lower thoracic segments are three. The lumbar segments correspond to the Th X-Th XII vertebrae, and all the sacral segments correspond to the Th XII-L I vertebrae.

The continuation of the spinal cord from the level of the L I-vertebra is the cauda equina. The spinal roots arise from the dural sac and diverge downward and laterally to the intervertebral foramina. As a rule, they pass near the posterior surface of the intervertebral discs, with the exception of the roots L II and L III. The spinal root L II emerges from the dural sac above the intervertebral disc, and the root L III emerges below the disc. The roots at the level of the intervertebral discs correspond to the underlying vertebra (for example, the level of the disc L IV -L V corresponds to the L V root). The roots corresponding to the overlying vertebra enter the intervertebral foramen (for example, L IV -L V corresponds to L IV -root).

It should be noted that there are several places where roots can be affected in posterior and posterolateral herniated discs: the posterior intervertebral discs and the intervertebral foramen.

The spinal cord is covered by three meninges: the dura mater ( durmater spinalis), gossamer ( arachnoidea) and soft ( pia mater spinalis). The arachnoid and pia mater, taken together, are also called the lepto-meningeal membrane.

Dura mater consists of two layers. At the level of the foramen magnum of the occipital bone, both layers completely diverge. The outer layer is tightly attached to the bone and is, in fact, the periosteum. The inner layer forms the dural sac of the spinal cord. The space between the layers is called the epidural cavitas epiduralis), epidural or extradural.

The epidural space contains loose connective tissue and venous plexuses. Both layers of the dura mater are connected together when the roots of the spinal nerves pass through the intervertebral foramen. The dural sac ends at the level of the S II-S III vertebrae. Its caudal part continues in the form of a terminal thread, which is attached to the periosteum of the coccyx.

The arachnoid mater consists of a cell membrane to which a network of trabeculae is attached. The arachnoid is not fixed to the dura mater. The subarachnoid space is filled with circulating cerebrospinal fluid.

pia mater lines all surfaces of the spinal cord and brain. The arachnoid trabeculae are attached to the pia mater.

The upper border of the spinal cord is a line connecting the anterior and posterior segments of the arc of the C I vertebra. The spinal cord ends, as a rule, at the level of L I -L II in the form of a cone, below which there is a ponytail. The roots of the cauda equina emerge at an angle of 45° from the corresponding intervertebral foramen.

The dimensions of the spinal cord throughout are not the same, its thickness is greater in the region of the cervical and lumbar thickening. Sizes depending on the spine are different:

at the level of the cervical spine - the anteroposterior size of the dural sac is 10-14 mm, the spinal cord - 7-11 mm, the transverse size of the spinal cord approaches 10-14 mm;
at the level of the thoracic spine - the anteroposterior size of the spinal cord corresponds to 6 mm, the dural sac - 9 mm, except for the level of Th I -Th ll -vertebrae, where it is 10-11 mm;
in the lumbar spine, the sagittal size of the dural sac varies from 12 to 15 mm.

epidural adipose tissue more developed in the thoracic and lumbar spine.

P.S. Additional materials:

1. 15 minute anatomical video atlas video explaining the basics of the spine:

The spinal cord is a section of the central nervous system of the spine, which is a cord 45 cm long and 1 cm wide.

The structure of the spinal cord

The spinal cord is located in the spinal canal. Behind and in front are two furrows, thanks to which the brain is divided into the right and left halves. It is covered with three membranes: vascular, arachnoid and solid. The space between the choroid and arachnoid is filled with cerebrospinal fluid.

In the center of the spinal cord, you can see the gray matter, in the cut, it resembles a butterfly in shape. The gray matter consists of motor and interneurons. The outer layer of the brain is the white matter of axons, collected in descending and ascending pathways.

In the gray matter, two types of horns are distinguished: the anterior, in which motor neurons are located, and the posterior, the location of the intercalary neurons.

In the structure of the spinal cord, there are 31 segments. From each stretch the anterior and posterior roots, which, merging, form the spinal nerve. When leaving the brain, the nerves immediately break up into roots - back and front. The posterior roots are formed with the help of axons of afferent neurons and they are directed to the posterior horns of the gray matter. At this point, they form synapses with efferent neurons, whose axons form the anterior roots of the spinal nerves.

In the posterior roots are the spinal ganglions, in which sensitive nerve cells are located.

The spinal canal runs through the center of the spinal cord. To the muscles of the head, lungs, heart, organs of the chest cavity and upper limbs, the nerves depart from the segments of the upper thoracic and cervical parts of the brain. The organs of the abdominal cavity and the muscles of the trunk are controlled by segments of the lumbar and thoracic parts. The muscles of the lower abdomen and the muscles of the lower extremities are controlled by the sacral and lower lumbar segments of the brain.

Spinal Cord Functions

There are two main functions of the spinal cord:

Conductor;
Reflex.

The conductor function consists in the fact that nerve impulses move along the ascending paths of the brain to the brain, and commands are received along the descending paths from the brain to the working organs.

The reflex function of the spinal cord is that it allows you to perform the simplest reflexes (knee reflex, hand withdrawal, flexion and extension of the upper and lower extremities, etc.).

Under the control of the spinal cord, only simple motor reflexes are carried out. All other movements, such as walking, running, etc., require the mandatory participation of the brain.

Pathologies of the spinal cord

Based on the causes of pathologies of the spinal cord, three groups of its diseases can be distinguished:

Malformations - postpartum or congenital abnormalities in the structure of the brain;
Diseases caused by tumors, neuroinfections, impaired spinal circulation, hereditary diseases of the nervous system;
Spinal cord injuries, which include bruises and fractures, compression, concussions, dislocations and hemorrhages. They can appear both independently and in combination with other factors.

Any disease of the spinal cord has very serious consequences. A special type of disease can be attributed to spinal cord injuries, which, according to statistics, can be divided into three groups:

Car accidents are the most common cause of spinal cord injury. Driving motorcycles is especially traumatic, since there is no rear seat back that protects the spine.
Falling from a height can be either accidental or intentional. In any case, the risk of spinal cord injury is quite high. Often athletes, fans of extreme sports and jumping from a height are injured in this way.
Domestic and extraordinary injuries. Often they occur as a result of a descent and fall in an unfortunate place, falling down stairs or on ice. Knife and bullet wounds and many other cases can also be attributed to this group.

With spinal cord injuries, the conduction function is primarily disrupted, which leads to very deplorable consequences. So, for example, damage to the brain in the cervical region leads to the fact that the functions of the brain are preserved, but lose connection with most organs and muscles of the body, which leads to paralysis of the body. The same disorders occur when the peripheral nerves are damaged. If sensory nerves are damaged, then sensation is impaired in certain areas of the body, and damage to the motor nerves impairs the movement of certain muscles.

Most of the nerves are mixed, and their damage causes both the impossibility of movement and loss of sensation.

Puncture of the spinal cord

Spinal puncture is the introduction of a special needle into the subarachnoid space. A puncture of the spinal cord is performed in special laboratories, where the patency of this organ is determined and the pressure of the cerebrospinal fluid is measured. The puncture is carried out both for therapeutic and diagnostic purposes. It allows you to timely diagnose the presence of a hemorrhage and its intensity, find inflammatory processes in the meninges, determine the nature of a stroke, determine changes in the nature of the cerebrospinal fluid, signaling diseases of the central nervous system.

Often, a puncture is done to introduce radiopaque and medicinal fluids.

For therapeutic purposes, a puncture is performed to extract blood or purulent fluid, as well as to administer antibiotics and antiseptics.

Indications for puncture of the spinal cord:

Meningoencephalitis;
Unexpected hemorrhages in the subarachnoid space due to rupture of the aneurysm;
cysticercosis;
myelitis;
meningitis;
Neurosyphilis;
Traumatic brain injury;
Liquorrhea;
Echinococcosis.

Sometimes during operations on the brain, a spinal cord puncture is used to reduce intracranial pressure parameters, as well as to facilitate access to malignant neoplasms.

The spinal cord (medulla spinalis) is a complex of nuclei of gray matter and nerve white fibers, forming 31 pairs of segments. The spinal cord has a length of 43-45 cm, a mass of about 30-32 g. Each segment includes a part of the spinal cord, its corresponding sensory (sensitive) root, which enters from the dorsal side, and the motor (motor) root that exits from the ventral side of each segment.

The spinal cord is located in the spinal canal, surrounded by membranes, between which the cerebrospinal fluid circulates. In length, the spinal cord occupies the space between the I cervical and the upper edge of the II lumbar vertebra. In the lower part, it has a cerebral cone (conus medullaris), from which the final thread (filum terminale) begins, at the level of the II coccygeal vertebra, attached to the dura mater. The filament is part of the caudal region of the embryonic neural tube. With flexion and extension of the spine, there is a slight displacement of the spinal cord in the spinal canal. When a person is upright during relative rest, the brain takes on the most stable position due to the elasticity of the spinal roots and mainly the dentate ligaments (ligg. dentata). Two pairs of dentate ligaments of each segment - derivatives of the pia mater - start from the lateral surface of the spinal cord, between the anterior and posterior roots of the spinal nerves and attach to the dura mater.

The diameter of the spinal cord along its length is uneven. At the level of IV-VIII cervical and I thoracic segments, as well as in the lumbar and sacral regions, there are thickenings (intumescentiae cervicalis et lumbalis), which are caused by a quantitative increase in gray matter nerve cells involved in the innervation of the upper and lower extremities.

458. External form of the spinal cord.

A - spinal cord with spinal roots and sympathetic trunk (red); B - spinal cord from the ventral side; B - spinal cord from the dorsal side. 1 - fossa rhomboidea; 2 - intumescentia cervicalis; 3 - sulcus medianus posterior; 4 - sulcus lateralis posterior; 5 - fissura mediana anterior; 6 - sulcus lateralis anterior; 7 - intumescentia lumbalis; 8 - filum terminate.

The spinal cord consists of almost two symmetrical halves, separated in front by a deep median fissure (fissura mediana), and behind by a median groove (sulcus medianus) (Fig. 458). On the right and left halves there are anterior and posterior lateral grooves (sulci laterales anterior et posterior), in which, respectively, motor and sensory nerve roots are located. The sulci of the spinal cord limit the three cords of white matter located on the surface of the gray matter. They are formed by nerve fibers, which are grouped according to their functional properties, forming the so-called pathways (Fig. 459). The anterior funiculus (funiculus anterior) is located between the anterior fissure and the anterior lateral groove; the lateral funiculus (funiculus lateralis) is limited by the anterior and posterior lateral grooves; the posterior cord (funiculus posterior) is located between the posterior sulcus and the lateral posterior sulcus.

1 - posterior median sulcus and septum; 2 - thin bundle (Goll): 3 - wedge-shaped bundle (Burdaha): 4 - posterior sensitive root; 5 - marginal zone: 6 - spongy layer; 7 - gelatinous substance; 8 - rear pillar; 9 - spinal cerebellar posterior path (Flexiga); 10- lateral cortical path; 11 - reticular formation; 12 - own bundle of the spinal cord; 13-red nuclear-spinal path; 14 - anterior spinal cerebellar path (Govers); 15 - spinothalamic path; 16- vestibulo-spinal path; 17 - anterior cortical-spinal path; 18 - anterior median fissure; 19 - anterior median nucleus of the anterior column; 20 - anterior motor root; 21 - anterior lateral core of the anterior column; 22 - intermediate-medial nucleus; 23 - intermediate-lateral nucleus of the lateral column; 24 - posterior lateral core of the anterior column; 25 - dorsal nucleus; 26 - own nucleus of the posterior horn.

In the cervical region and the upper thoracic part, between the posterior median and posterior lateral sulci, a barely noticeable posterior intermediate sulcus (sulcus intermedius posterior) passes, dividing the posterior funiculus into two bundles.

The gray matter of the spinal cord (substantia grisea medullae spinalis) occupies a central position in the spinal cord, appearing in a transverse section in the form of the letter "H". It consists of nerve multipolar cells, myelinated, non-myelinated fibers and neuroglia.

Nerve cells form nuclei that merge throughout the spinal cord into the anterior, lateral and posterior columns of gray matter (columnae anterior, lateralis et posterior). These columns * are connected in the middle by anterior and posterior gray commissures (commisurae griseae anterior et posterior), separated by the central spinal canal, which is a reduced canal of the embryonic neural tube.

Central canal of the spinal cord. The central canal represents a reduced remnant of the embryonic neural tube, which communicates with the fourth ventricle at the top and ends with an extension in the cone brain. Contains cerebrospinal fluid. Passes in the center of the spinal cord, has a diameter of 0.5 × 1 mm. In old age, it can be partially obliterated.

segments of the spinal cord. The spinal cord unites 31 pairs of segments: 8 cervical (C I-VIII), 12 thoracic (Th I-VII), 5 lumbar (L I-V), 5 sacral (S I-V) and 1 coccygeal (Co I). Each segment consists of a group of spinal ganglion cells that form the anterior and posterior columns, which come into contact with the fibers of the anterior and posterior roots of the spinal cord. The posterior roots are formed by the processes of sensory cells of the spinal nodes, the anterior roots are formed by the processes of the motor cells of the nuclei of the anterior columns.

Spinal cord diameter

Based on the book:

Rameshvili T.E. , Trufanov G.E., Gaidar B.V., Parfenov V.E.

Normally, the spinal column is a flexible formation, consisting in the middle version of the vertebrae connected in a single chain by intervertebral discs, facet joints and a powerful ligamentous apparatus.

A vertebra (except for the two upper cervical vertebrae) consists of a body, an arch, and processes extending from it. The vertebral bodies are connected by intervertebral discs, and the arches are connected by intervertebral joints. The arcs of adjacent vertebrae, joints, transverse and spinous processes are connected by a powerful ligamentous apparatus.

The dimensions of the vertebral bodies increase in the caudal direction (from top to bottom), reaching a maximum in the lumbar region.

Normally, the vertebral bodies have the same height in the anterior and posterior sections.

An arc departs from the upper lateral sections of the vertebral body, in which two sections are distinguished: the anterior, paired - the leg and the posterior - the plate (Iamina), located between the articular and spinous processes. From the arch of the vertebrae, processes depart: paired - upper and lower articular (zygostomy), transverse and single - spinous.

A feature of the structure of the cervical spine is the presence of holes in the transverse processes of the CII-CVII vertebrae. These holes form a canal in which the vertebral artery passes with the sympathetic plexus of the same name. The medial wall of the canal is the middle part of the semilunar processes. This should be taken into account with an increase in the deformation of the semilunar processes and the occurrence of arthrosis of the uncovertebral joints, which can lead to compression of the vertebral artery and irritation of the sympathetic plexuses.

The intervertebral joints are formed by the lower articular processes of the overlying vertebra and the superior articular processes of the underlying one.

In addition to the facet joints, the true joints of the spine include:

paired atlanto-occipital joint, connecting the occipital bone with the first cervical vertebra;
unpaired median atlanto-axial joint connecting vertebrae CI and CII;
a paired sacroiliac joint that connects the sacrum to the ilium.

The bodies of adjacent vertebrae from II cervical to I sacral are connected by intervertebral discs. The intervertebral disc is a cartilaginous tissue and consists of a gelatinous (pulpous) nucleus (nucleus pulposus), an annulus fibrosus (annulus fibrosis) and two hyaline plates.

The gelatinous nucleus is a spherical formation with an uneven surface, it consists of a gelatinous mass with a high water content - up to 85-90% in the nucleus, its diameter varies between 1-2.5 cm.

The nucleus pulposus tissue is able to release and bind water depending on the load, and therefore, at different times of the day, the height of a normal intervertebral disc is different.

The fibrous ring, consisting of connective tissue fibers located around the nucleus pulposus, forms the anterior, posterior and lateral edges of the intervertebral disc. It is attached to the bone marginal edging by means of Sharpei fibers. The fibers of the annulus fibrosus are also attached to the posterior longitudinal ligament of the spine. The peripheral fibers of the fibrous ring make up a strong outer section of the disc, and the fibers closer to the center of the disc are looser, passing into the capsule of the nucleus pulposus. The anterior section of the fibrous ring is denser, more massive than the posterior one. The anterior part of the fibrous ring is 1.5-2 times larger than the posterior one. The main function of the annulus fibrosus is to fix adjacent vertebrae, hold the nucleus pulposus inside the disk, and ensure movement in different planes.

The cranial and caudal (upper and lower, respectively, in the standing position) surface of the intervertebral disc is formed by hyaline cartilage plates inserted into the limbus (thickening) of the vertebral body. Each of the hyaline plates is equal in size and closely adjacent to the corresponding end plate of the vertebral body; it connects the nucleus pulposus of the disc to the bony end plate of the vertebral body. Degenerative changes in the intervertebral disc extend to the vertebral body through the endplate.

Ligament apparatus of the spinal column

The anterior longitudinal ligament covers the anterior and lateral surfaces of the vertebral bodies. It starts from the pharyngeal tubercle of the occipital bone and reaches the 1st sacral vertebra. The anterior longitudinal ligament consists of short and long fibers and bundles that are firmly fused with the vertebral bodies and loosely connected to the intervertebral discs; over the latter, the ligament is thrown from one vertebral body to another. The anterior longitudinal ligament also performs the function of the periosteum of the vertebral bodies.

The posterior longitudinal ligament starts from the upper edge of the foramen magnum of the occipital bone, lines the posterior surface of the vertebral bodies and reaches the lower part of the sacral canal. It is thicker, but narrower than the anterior longitudinal ligament and richer in elastic fibers. The posterior longitudinal ligament, in contrast to the anterior one, is firmly fused with the intervertebral discs and loosely with the vertebral bodies. Its diameter is not the same: at the level of the discs it is wide and completely covers the posterior surface of the disc, and at the level of the vertebral bodies it looks like a narrow ribbon. On the sides of the midline, the posterior longitudinal ligament passes into a thin membrane that separates the venous plexus of the vertebral bodies from the dura mater and protects the spinal cord from compression.

The yellow ligaments consist of elastic fibers and connect the vertebral arches, they are especially clearly visualized on MRI in the lumbar spine with a thickness of about 3 mm. Intertransverse, interspinous, supraspinous ligaments connect the corresponding processes.

The height of the intervertebral discs gradually increases from the second cervical vertebra to the seventh, then there is a decrease in height to ThIV and reaches a maximum at the level of the LIV-LV disc. The lowest height is the highest cervical and upper thoracic intervertebral discs. The height of all intervertebral discs located caudal to the body of the ThIV vertebra increases evenly. The presacral disc is very variable both in height and shape, deviations in one direction or another in adults are up to 2 mm.

In the side walls of the canal there are 23 pairs of intervertebral foramina, through which the roots of the spinal nerves, veins, and radicular-spinal arteries enter the spinal canal. The anterior wall of the lateral canal in the thoracic and lumbar regions is formed by the posterolateral surface of the bodies and intervertebral discs, and in the cervical region, this wall also includes the uncovertebral articulation; posterior wall - anterior surface of the superior articular process and facet joint, yellow ligaments. The upper and lower walls are represented by cutouts of the legs of the arcs. The upper and lower walls are formed by the lower notch of the pedicle of the arch of the overlying vertebra and the upper notch of the pedicle of the arch of the underlying vertebra. The diameter of the lateral canal of the intervertebral foramina increases in the caudal direction. In the sacrum, the role of the intervertebral foramina is performed by four pairs of sacral foramina, which open on the pelvic surface of the sacrum.

The “middle zone” is limited in front by the posterior surface of the vertebral body, and in the back by the interarticular part of the vertebral arch, the medial sections of this zone are open towards the central canal. The main causes of stenosis in this area are osteophytes at the site of attachment of the yellow ligament, as well as spondylolysis with hypertrophy of the articular bag of the joint.

The spinal cord begins at the level of the foramen magnum and ends, according to most authors, at the level of the middle of the body of the LII vertebra (rare variants are described at the level of the LI and the middle of the body of the LIII vertebra). Below this level is the terminal cisterna containing the cauda equina roots (LII-LV, SI-SV and CoI), which are covered by the same membranes as the spinal cord.

In newborns, the end of the spinal cord is located lower than in adults, at the level of the LIII vertebra. By the age of 3, the cone of the spinal cord occupies the usual position for adults.

The anterior and posterior roots of the spinal nerves depart from each segment of the spinal cord. The roots are sent to the corresponding intervertebral foramens. Here, the posterior root forms the spinal ganglion (local thickening - ganglion). The anterior and posterior roots join immediately after the ganglion to form the spinal nerve trunk. The superior pair of spinal nerves leave the spinal canal at the level between the occipital bone and the CI vertebra, while the inferior pair leaves between the SI and SII vertebrae. There are 31 pairs of spinal nerves in total.

There are 8 segments of the spinal cord in the cervical spine. Between the occipital bone and the CI vertebra there is a C0-CI segment where the CI nerve passes. Spinal nerves exit from the intervertebral foramen, corresponding to the underlying vertebra (for example, CVI nerves exit from the intervertebral foramen CV-CVI).

There is a discrepancy between the thoracic spine and the spinal cord. The upper thoracic segments of the spinal cord are located two vertebrae higher than their corresponding vertebrae, the lower thoracic segments are three. Lumbar segments correspond to ThX-ThXII vertebrae, and all sacral segments correspond to ThXII-LI vertebrae.

The continuation of the spinal cord from the level of the LI-vertebra is the cauda equina. The spinal roots arise from the dural sac and diverge downward and laterally to the intervertebral foramina. As a rule, they pass near the posterior surface of the intervertebral discs, with the exception of the roots of LII and LIII. The LII spinal root emerges from the dural sac above the intervertebral disc, and the LIII root emerges below the disc. The roots at the level of the intervertebral discs correspond to the underlying vertebra (for example, the level of the LIV-LV disc corresponds to the LV root). The intervertebral foramen includes roots corresponding to the overlying vertebra (for example, LIV-LV corresponds to the LIV-root).

It should be noted that there are several places where roots can be affected in posterior and posterolateral herniated discs: the posterior intervertebral discs and the intervertebral foramen.

The spinal cord is covered with three meninges: hard (dura mater spinalis), arachnoid (arachnoidea) and soft (pia mater spinalis). The arachnoid and pia mater, taken together, are also called the lepto-meningeal membrane.

The dura mater consists of two layers. At the level of the foramen magnum of the occipital bone, both layers completely diverge. The outer layer is tightly attached to the bone and is, in fact, the periosteum. The inner layer forms the dural sac of the spinal cord. The space between the layers is called epidural (cavitas epiduralis), epidural or extradural.

The epidural space contains loose connective tissue and venous plexuses. Both layers of the dura mater are connected together when the roots of the spinal nerves pass through the intervertebral foramen. The dural sac ends at the level of the SII-SIII vertebrae. Its caudal part continues in the form of a terminal thread, which is attached to the periosteum of the coccyx.

The pia mater lines all surfaces of the spinal cord and brain. The arachnoid trabeculae are attached to the pia mater.

The upper border of the spinal cord is the line connecting the anterior and posterior segments of the arc of the CI vertebra. The spinal cord ends, as a rule, at the level of LI-LII in the form of a cone, below which there is a ponytail. The roots of the cauda equina emerge at an angle of 45° from the corresponding intervertebral foramen.

The dimensions of the spinal cord throughout are not the same, its thickness is greater in the region of the cervical and lumbar thickening. Sizes depending on the spine are different:

at the level of the cervical spine - the anteroposterior size of the dural sac is mm, the spinal cord is 7-11 mm, the transverse size of the spinal cord is approaching km;
at the level of the thoracic spine - the anteroposterior size of the spinal cord corresponds to 6 mm, the dural sac - 9 mm, except for the level of the ThI-Thll vertebrae, where it is mm;
in the lumbar spine, the sagittal size of the dural sac varies from 12 to 15 mm.

Epidural fatty tissue is more developed in the thoracic and lumbar sections of the spinal canal.

The structure of the human spinal cord and its functions

The spinal cord, along with the brain, is an integral part of the central nervous system. It is difficult to overestimate the work of this organ in the human body. Indeed, with any of its defects, it becomes impossible to carry out a full-fledged connection of the body with the outside world. It is not for nothing that his congenital malformations, which can be detected using ultrasound diagnostics already in the first trimester of bearing a child, are most often an indication for termination of pregnancy. The importance of the functions of the spinal cord in the human body determines the complexity and uniqueness of its structure.

Anatomy

Location

It is localized in the spinal canal, being a direct continuation of the medulla oblongata. Conventionally, the upper anatomical boundary of the spinal cord is considered to be the line of connection of the upper edge of the first cervical vertebra with the lower edge of the foramen magnum.

The spinal cord ends approximately at the level of the first two lumbar vertebrae, where it gradually narrows: first to the cerebral cone, then to the medullary or terminal filament, which, passing through the canal of the sacral spine, is attached to its end.

This fact is important in clinical practice, since during the well-known epidural anesthesia at the lumbar level, the spinal cord is absolutely free from mechanical damage.

Watch a useful video where the structure and location of the spinal cord is shown in an interesting, accessible way.

Spinal membranes

Solid - from the outside it includes the tissues of the periosteum of the spinal canal, then follows the epidural space and the inner layer of the hard shell.
Cobweb - a thin, colorless plate, fused with a hard shell in the region of the intervertebral foramina. Where there are no adhesions, there is a subdural space.
Soft or vascular - separated from the previous shell by the subarachnoid space with cerebrospinal fluid. The soft shell itself adjoins the spinal cord, consists mostly of blood vessels.

The entire organ is completely immersed in the cerebrospinal fluid of the subarachnoid space and “floats” in it. A fixed position is given to it by special ligaments (dentate and intermediate cervical septum), with the help of which the inner part is attached to the shells.

External characteristics

The shape of the spinal cord is a long cylinder, slightly flattened from front to back.
Average length approx. cm, depending

from human growth.

Weight is about one time less than the weight of the brain,

Repeating the outlines of the spine, the spinal structures have the same physiological curves. At the level of the neck and the lower part of the thoracic, beginning of the lumbar, two thickenings are distinguished - these are the exit points of the roots of the spinal nerves, which are responsible for the innervation of the arms and legs, respectively.

Behind and in front, 2 grooves pass along the spinal cord, which divide it into two absolutely symmetrical halves. Throughout the body in the middle there is a hole - the central channel, which at the top connects to one of the ventricles of the brain. Below, towards the region of the cerebral cone, the central canal expands, forming the so-called terminal ventricle.

Internal structure

Consists of neurons (cells of the nervous tissue), the bodies of which are concentrated in the center, form the spinal gray matter. According to scientists, there are only about 13 million neurons in the spinal cord - thousands of times less than in the brain. The location of the gray matter within the white is by no means somewhat different in shape, which in the cross section vaguely resembles a butterfly.

The front horns are rounded and wide. Consist of motor neurons that transmit impulses to the muscles. From here begin the anterior roots of the spinal nerves - the motor roots.
The posterior horns are long, narrow, and consist of intermediate neurons. They receive signals from the sensory roots of the spinal nerves - the posterior roots. There are also neurons that, through nerve fibers, carry out the interconnection of different parts of the spinal cord.
Lateral horns - found only in the lower segments of the spinal cord. They contain the so-called vegetative nuclei (for example, centers of pupil dilation, innervation of the sweat glands).

Gray matter is surrounded by white matter on the outside - these are essentially processes of neurons from gray matter or nerve fibers. The diameter of the nerve fibers is not more than 0.1 mm, but their length sometimes reaches one and a half meters.

The functional purpose of nerve fibers can be different:

ensuring the interconnection of different levels of the spinal cord;
transmission of data from the brain to the spinal cord;
ensuring the delivery of information from the spinal to the head.

Nerve fibers, integrating into bundles, are located in the form of conducting spinal tracts along the entire length of the spinal cord.

A modern effective method of treating back pain is pharmacopuncture. Minimal doses of drugs injected into active points work better than tablets and regular injections: http://pomogispine.com/lechenie/farmakopunktura.html.

What is better for diagnosing spinal pathologies: MRI or computed tomography? We tell here.

spinal nerves

The spinal nerve, by its nature, is neither sensory nor motor - it contains nerve fibers of both types, since it combines the anterior (motor) and posterior (sensory) roots.

It is these mixed spinal nerves that emerge in pairs through the intervertebral foramens.

on the left and right sides of the spine.

In total, a pair of them, of which:

The area of the spinal cord, which is the "launching pad" for one pair of nerves, is called a segment or neuromer. Accordingly, the spinal cord consists of only

from segments.

It is interesting and important to know that the spinal segment is not always located in the region of the spine with the same name due to the difference in the length of the spine and spinal cord. But on the other hand, the spinal roots still come out of the corresponding intervertebral foramens.

For example, the lumbar spinal segment is located in the thoracic spine, and the corresponding spinal nerves exit from the intervertebral foramina in the lumbar spine.

Spinal Cord Functions

And now let's talk about the physiology of the spinal cord, about what "duties" are assigned to it.

Segmental or working nerve centers are localized in the spinal cord, which are directly connected with the human body and control it. It is through these spinal working centers that the human body is subject to control by the brain.

At the same time, certain spinal segments control well-defined parts of the body by receiving nerve impulses from them along sensory fibers and transmitting response impulses to them along motor fibers:

Some vegetative or complex motor reflexes are carried out by the spinal cord without the intervention of the brain at all, thanks to its two-way connection with all parts of the human body - this is how the spinal cord performs its reflex functions. For example, the reflex centers of urination or erection are located in 3-5 sacral segments, and with spinal injury in this place, these reflexes may be lost.

The conductive spinal function is ensured by the fact that in the white matter all the conducting paths connecting parts of the nervous system are localized to each other. Information from tactile, temperature, pain receptors and movement receptors from muscles (proprioreceptors) is transmitted along ascending pathways first to the spinal cord and then to the corresponding parts of the brain. Descending pathways connect the brain and spinal cord in reverse order: with their help, the brain controls the activity of human muscles.

Risk of damage and injury

Any spinal cord injury threatens a person's life.

Serious injuries to other spinal segments located below may not cause death, but they will lead to partial or complete disability in almost 100% of cases. Therefore, nature has designed it so that the spinal cord is under reliable protection of the spine.

The expression "healthy spine" in most cases is equivalent to the expression "healthy spinal cord", which is one of the necessary conditions for a high-quality full-fledged human life.

We offer another interesting video that will help you understand the anatomy of the spinal structures and their functioning.

There is only one reason - the spine.

All materials on the site are for informational purposes only.

Introduction

The average diameter of the spinal canal in the cervical spine ranges from 14 to 25 mm J.G. Arnold (1955), the size of the spinal cord ranges from 8 to 13 mm, and the thickness of the soft tissues (sheaths and ligaments) ranges from 2 to 3 mm. Thus, the average reserve space in the ventrodorsal direction, in the cervical spine, is approximately 3 mm. Given the above, we can conclude that a decrease in the diameter of the spinal canal by 3 mm leads to compression of the spinal cord, respectively, this condition is regarded as spinal canal stenosis. With more than 30% narrowing of the diameter of the spinal canal, cervical myelopathy develops. At the same time, in some patients with significant narrowing of the spinal canal, myelopathy is not observed. The diagnosis of stenosis of the cervical spine is made when the anteroposterior size of the latter is reduced to 12 mm or less. Narrowing of the spinal canal to 12 mm is considered relative stenosis, while a decrease in this size to 10 mm is considered absolute stenosis. In turn, the average size of the spinal canal in patients with cervical myelopathy is 11.8 mm. Patients with a spinal canal diameter of 14mm are at risk. With a decrease in the size of the spinal canal to 10 mm, myelopathy is inevitable. Myelopathy rarely develops in patients with a spinal canal diameter of 16mm. Clinical picture of cervical myelopathy

Table 1

cervical myelopathy
Myelopathy and radiculopathy
hyperreflexia
Babinski's reflex
Hofmann reflex
Conduction disturbances of senses
Radicular sensory disturbances
Deep Sense Disorders
Instability in the Romberg position
Monoparesis of the hand
Paraparesis
Hemiparesis
tetraparesis
Brown-Sequard Syndrome
Muscle atrophy
Fascicular twitches
Radicular pain in the arms
Radicular pain in the legs
Cervicalgia
Muscular spasticity
Pelvic organ dysfunction

is very diverse and is represented in the late stage by syndromes resembling many neurological diseases: multiple sclerosis, spinal cord tumors, spinocerebellar degeneration. In 50 percent of patients with severe clinical manifestations of spinal stenosis, as a rule, there is a constant progression of symptoms. Conservative treatment, according to a number of authors, with this disease is little effective or not at all effective. The frequency of various symptoms in stenosis of the cervical spine is given in Table. 1.

All this variety of symptoms develops into 5 main clinical syndromes with stenosis of the cervical spine - a syndrome of transverse spinal cord injury, pyramidal syndrome with a primary lesion of the main corticospinal tract, centromedullary syndrome with motor and sensory disorders in the upper limbs, Brown-Séquard syndrome (damage to half of the diameter spinal cord) and cervical dyscalgia.

The goal of surgical treatment for spinal stenosis is to eliminate compression of the spinal cord, the roots of their vessels. Positive results of surgical treatment, according to different authors, range from 57-96 percent, however, some authors believe that surgical intervention for spinal canal stenosis, at best, stops the progression of neurological deficit, but does not lead to complete recovery. The results of surgical treatment for absolute cervical stenosis are even more inconclusive.

Purpose of the study

Determining the feasibility of surgical treatment of absolute stenosis of the cervical spinal canal.

Material and methods

From 2001-2011 at the Department of Neurosurgery of the Mikaelyan Institute of Surgery. operated on 33 patients (29 men, 4 women) aged 34 to 71 years, diagnosed with stenosis of the cervical spinal canal, cervical myelopathy. The diagnosis was made on the basis of complaints, anamnesis, clinical picture, MRI examination of the cervical spine, ENMG. According to the neurological picture, they are divided into 3 groups (Table 2).

table 2

The anterior-posterior size of the spinal canal varied from 4 to 8 mm (Table 3), and the extent of compression varied from one level to three (Table 4).

Table 3

S/m channel size	3 mm	4 mm	5 mm	6 mm	7 mm	12 mm
Number of patients

Table 4

Spinal cord decompression was performed by anterior or posterior approach, depending on the compressing agent. Anterior decompression - discectomy according to Cloward followed by spinal fusion with an autograft and fixation with a metal plate was performed if the compressing agent was the anterior wall of the spinal canal, namely, a herniated disc and an ossified posterior longitudinal ligament, posterior decompression - laminectomy at stenotic levels, was performed in the presence of hypertrophied vertebral arches and ossified yellow ligament - the posterior wall of the spinal canal.

Research results

The result was evaluated as follows. Excellent - no neurological deficit, or minimal sensory disturbances. Good - an increase in muscle strength by 1-2 points, minimal sensory disorders, while the muscle strength of the limbs after treatment should be at least 4 points. Satisfactory - increase in muscle strength by 1 point, sensory disorders, neuropathic pain in the extremities. Unsatisfactory - lack of effect from surgical treatment, dysfunction of the pelvic organs (acute urinary retention, constipation). Bad - aggravation of neurological deficit, respiratory failure, death. An excellent result was obtained in 1 patient, good in 12, satisfactory in 13, unsatisfactory in 6, and poor in 1 patient (Table 5).

Table 5

Size sp \ k. mm	1 bad	2 failed	3 beats	4 choir.	5 ex.

Discussion of results and conclusions

In group 1 with a poor result, we have one lethal outcome due to ascending edema of the spinal cord and trunk. This patient had stenosis of the spinal canal at the level of C3 up to 3 mm due to the disc osteophyte complex, anterior decompression was performed - discectomy followed by spinal fusion with an autograft and fixation with a metal plate. In group 2, with an unsatisfactory result, we have 6 patients with a spinal canal size less than 5 mm, in 2 of them the spinal canal was stenosed due to the disc osteophyte complex at two levels, they underwent discectomy followed by spinal fusion with an autograft at two levels.

Thus, the risk factor for the surgical treatment of spinal stenosis is the upper cervical region and the narrowing of the spinal canal to 3 mm. An unsatisfactory result can be expected with narrowing of the spinal canal up to 5 mm, as well as multilevel narrowing of the spinal canal due to the anterior wall - herniated intervertebral discs and ossified posterior longitudinal ligament.

Bibliography

Livshits A.V. Surgery of the spinal cord. Moscow, “Medicine”, 1990. pp. 179-190.
Adams CBT, Logue V: Studies in Cervical Spondylotic Myelopathy: II. The Movement and Contour of the Spine in Relation to the Neural Complications of Cervical Spondylosis. Brain 94: 569-86, 1971.
Cooper PR: Cervical Spondylotic Myelopathy. Contemp Neurosurg 19(25): 1-7, 1997.
Crandall PH, Batrdorf U: Cervical Spondylotic Myelopathy. J Neurosurg 25:57-66, 1966.
Epstein JA, Marc JA. Total Myelography in the Evaluation of Lumbar Disks Spine 4: 121-8, 1979.
England JD, Hsu CY, Vera CL. Spondylotic High Cervical Spinal Cord Compression Presenting with Hand Complaints. Surg Neurol 25: 299-303 1986.
Houser OW, Onofrio BM, Miller GM. Cervical Spondylotic Stenosis and Myelopathy: Evaluation with Computed Tomographis Myelography. Mayo Clin Proc 557-63, 1994.
Johnsson K., Posen I., Uden A. Acta Orthopedic Scand, 1993, Vol. 64, P67-6.
Krauss WE, Ebersold MJ, Quast LM: Cervical Spondylotic Myelopathy: Surgical Indications and Technique. Contemp Neurosurg 20(10): 1-6, 1998.
Lunstord LD, Bissonette DJ, Zorub DS: Anterior Surgery for Cervical Disc Disease. Part 2: Treatment of Cervical Spondylotis Myelopathy in 32 Cases J Neurosurg 53: 12-9,1980.
Turner J., Ersek M., Herron L.// Ibid, 1992, Vol/17, P1-8.
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The spinal cord is a strand of nervous tissue located inside the bone canal of the spine. In an adult, its length is 41–45 cm, and its diameter is 1–1.5 cm. The spinal cord and brain are the central links of the nervous system.

At the top, the spinal cord merges with the medulla oblongata. Its lower extremity at the 2nd lumbar vertebra becomes thinner, turning into a cerebral cone. Further, the rudimentary spinal cord in the form of a terminal thread penetrates the sacral canal, attaching to the periosteum of the coccyx. In places where the spinal nerves exit to the upper and lower extremities, cervical and lumbar enlargements of the brain are formed.
The anterior concave surface of the medullary cord along its length forms the anterior median fissure. Behind the surface of the brain is divided by a narrow median sulcus. These lines divide it into symmetrical halves. Motor anterior and sensory posterior nerve roots emerge from the lateral surfaces of the brain. The posterior nerve roots consist of processes of sensory neurons. They enter the brain along the posterolateral groove. The anterior roots are formed by axons of motor cells - motor neurons. The processes emerge from the substance of the brain in the anterolateral groove. Before leaving the limits of the spinal canal, sensory and motor nerve roots are connected, forming symmetrical pairs of mixed spinal nerves. These nerves, leaving the bone canal between 2 adjacent vertebrae, are sent to the periphery. The length of the bony canal of the spine exceeds the length of the medullary cord. The reason for this is the high intensity of bone growth in comparison with the nervous tissue. Therefore, in the lower parts of the spine, the nerve roots are located vertically.

The anterior and posterior spinal arteries, as well as the spinal branches of the segmental branches of the descending aorta - the lumbar and intercostal arteries, supply blood to the structures of the spinal cord and spine.
On the cut, you can distinguish the internal structure of the brain tissue. In the center, in the form of a butterfly or a capital letter H, there is gray matter surrounded by white matter. Along the entire length of the nerve cord there is a central canal containing cerebrospinal fluid - cerebrospinal fluid. Lateral protrusions of gray matter form gray pillars. On section, the pillars are visible as posterior horns, formed by the bodies of sensory neurons, and anterior horns, consisting of bodies of motor cells. The halves of the "butterfly" are connected by a bridge from the central intermediate substance. The area of the brain with a pair of roots is called the spinal segment. The human has 31 spinal segments. The segments are grouped by location: 8 are in the cervical region, 12 in the thoracic region, 5 in the lumbar region, 5 in the sacral region, and 1 in the coccygeal region.

The white matter of the brain is made up of processes of nerve cells - sensory dendrites and motor axons. Surrounding the gray matter, it also consists of 2 halves connected by a thin white adhesion - the commissure. The bodies of the neurons themselves can be located in any part of the nervous system.

Bundles of processes of nerve cells that carry signals in one direction ( only to centers or only from centers) are called pathways. The white matter in the spinal cord is combined into 3 pairs of cords: anterior, posterior, lateral. The anterior cords are limited by the anterior pillars. The lateral funiculi are delimited by the posterior and anterior pillars. The lateral and anterior cords carry conductors of 2 types. Ascending pathways carry signals to the CNS - the central parts of the nervous system. And the descending paths go from the nuclei of the central nervous system to the motor neurons of the anterior horns. The posterior cords run between the posterior columns. They represent ascending pathways that carry signals to the brain - the cerebral cortex. This information forms a joint-muscular feeling - an assessment of the location of the body in space.

Embryonic development

The nervous system is laid in the embryo at the age of 2.5 weeks. On the dorsal side of the body, a longitudinal thickening of the ectoderm is formed - the neural plate. Then the plate bends along the median line, becomes a groove bounded by neural folds. The groove closes into the neural tube, separating itself from the skin ectoderm. The anterior end of the neural tube thickens, becoming the brain. The spinal cord develops from the rest of the tube.

The length of the spinal cord of newborns in relation to the size of the spinal canal is greater than that of an adult. In children, the spinal cord reaches the 3rd lumbar vertebra. Gradually, the growth of the nervous tissue lags behind the growth of the bone tissue of the spine. The lower end of the brain moves upward. At the age of 5–6 years, the ratio of the length of the spinal cord to the size of the spinal canal in a child becomes the same as in an adult.

In addition to conducting nerve impulses, the purpose of the spinal cord is the closure of unconditioned motor reflexes at the level of the spinal segments.

Diagnostics

The spinal reflex is the contraction of a muscle in response to a stretch in its tendon. The severity of the reflex is checked by tapping the muscle tendon with a neurological hammer. According to the state of individual reflexes, the location of the lesion in the spinal cord is specified. When a segment of the spinal cord is damaged, there is a violation of deep and superficial sensitivity in the corresponding areas of the body - dermatomes. Spinal vegetative reflexes also change - visceral, vascular, urinary.

The movements of the limbs, their muscle tone, the severity of deep reflexes characterize the work of the descending conductors in the anterior and lateral cords of the brain. Determining the area of violation of tactile, temperature, pain and joint-muscular sensitivity helps to find the level of damage to the posterior and lateral cords.

To clarify the localization of the lesion in the brain, determine the nature of the disease ( inflammation, hemorrhage, swelling) more research is needed. Spinal puncture will help assess CSF pressure, the condition of the meninges. The resulting liquor is examined in the laboratory.

The state of sensory and motor neurons is assessed by electroneuromyography. The method determines the speed of passage of impulses along the motor and sensory fibers, registers the electrical potentials of the brain.

X-ray studies reveal lesions of the spinal column. In addition to plain radiography of the spine, X-ray tomography is performed to find cancer metastases. This allows you to detail the structure of the vertebrae, the state of the spinal canal, to identify decalcification of the meninges, their tumors and cysts. Former X-ray methods ( pneumomyelography, contrast myelography, spinal angiography, venospondylography) today have given way to painless, safe and high-precision methods - magnetic resonance and computed tomography. The anatomical structures of the spinal cord and spine are clearly visible on MRI.

Diseases and injuries

A spinal injury can result in concussion, bruising, or tearing of the spinal cord. The most severe consequences are a rupture - a violation of the integrity of the brain tissue. Symptoms of damage to the substance of the brain - paralysis of the muscles of the trunk and limbs below the level of injury. After concussions and bruises of the spinal cord, it is possible to treat and restore the function of temporarily paralyzed muscles of the trunk and limbs.

Inflammation of the soft lining of the spinal cord is called meningitis. Treatment of infectious inflammation is carried out with antibiotics, taking into account the sensitivity of the identified pathogen.

With the loss of a hernia of the intervertebral cartilaginous disc, compression of the nerve root develops - its compression. Symptoms of root compression in everyday life are called sciatica. These are severe pains and disturbances of sensitivity along the corresponding nerve. The root is freed from compression during the neurosurgical operation to remove the intervertebral hernia. Now such operations are performed by a sparing endoscopic method.

About transplant

The current level of medicine does not allow transplanting the spinal cord. With its traumatic ruptures, patients remain chained to a wheelchair. Scientists are developing methods for restoring the function of the spinal cord after a severe injury using stem cells. While the work is in the experimental stage.

Most severe spinal cord and spinal injuries are the result of road traffic accidents or suicide attempts. As a rule, such events occur against the background of alcohol abuse. By refusing immoderate libations and observing the rules of the road, you can protect yourself from serious injuries.