The posterolateral sulcus on each side of the posterior surface marks where the posterior rootlets of spinal nerves enter the cord.
Internally, the cord has a small central canal surrounded by gray and white matter:
The gray matter is rich in nerve cell bodies, which form longitudinal columns along the cord, and in cross section these columns form a characteristic H-shaped appearance in the central regions of the cord.
The white matter surrounds the gray matter and is rich in nerve cell processes, which form large bundles or tracts that ascend and descend in the cord to other spinal cord levels or carry information to and from the brain.
The arterial supply to the spinal cord comes from two sources (Fig. 2.55). It consists of: longitudinally oriented vessels, arising superior to the cervical portion of the cord, which descend on the surface of the cord; and feeder arteries that enter the vertebral canal through the intervertebral foramina at every level; these feeder vessels, or segmental spinal arteries, arise predominantly from the vertebral and deep cervical arteries in the neck, the posterior intercostal arteries in the thorax, and the lumbar arteries in the abdomen.
After entering an intervertebral foramen, the segmental spinal arteries give rise to anterior and posterior radicular arteries (Fig. 2.55). This occurs at every vertebral level. The radicular arteries follow, and supply, the anterior and posterior roots. At various vertebral levels, the segmental spinal arteries also give off segmental medullary arteries (Fig. 2.55). These vessels pass directly to the longitudinally oriented vessels, reinforcing these.
The longitudinal vessels consist of: a single anterior spinal artery, which originates within the cranial cavity as the union of two vessels that arise from the vertebral arteries—the resulting single anterior spinal artery passes inferiorly, approximately parallel to the anterior median fissure, along the surface of the spinal cord; and two posterior spinal arteries, which also originate in the cranial cavity, usually arising directly from a terminal branch of each vertebral artery (the posterior inferior cerebellar artery)—the right and left posterior spinal arteries descend along the spinal cord, each as two branches that bracket the posterolateral sulcus and the connection of posterior roots with the spinal cord.
The anterior and posterior spinal arteries are reinforced along their length by eight to ten segmental medullary arteries (Fig. 2.55). The largest of these is the arteria radicularis magna or the artery of Adamkiewicz (Fig. 2.55). This vessel arises in the lower thoracic or upper lumbar region, usually on the left side, and reinforces the arterial supply to the lower portion of the spinal cord, including the lumbar enlargement.
Veins that drain the spinal cord form a number of longitudinal channels (Fig. 2.56):
Two pairs of veins on each side bracket the connections of the posterior and anterior roots to the cord.
One midline channel parallels the anterior median fissure.
One midline channel passes along the posterior median sulcus.
These longitudinal channels drain into an extensive internal vertebral plexus in the extradural (epidural) space of the vertebral canal, which then drains into segmentally arranged vessels that connect with major systemic veins, such as the azygos system in the thorax. The internal vertebral plexus also communicates with intracranial veins.
The spinal dura mater is the outermost meningeal membrane and is separated from the bones forming the vertebral canal by an extradural space (Fig. 2.59). Superiorly, it is continuous with the inner meningeal layer of cranial dura mater at the foramen magnum of the skull. Inferiorly, the dural sac dramatically narrows at the level of the lower border of vertebra SII and forms an investing sheath for the pial part of the filum terminale of the spinal cord. This terminal cord-like extension of dura mater (the dural part of the filum terminale) attaches to the posterior surface of the vertebral bodies of the coccyx.