As spinal nerves and their roots pass laterally, they are surrounded by tubular sleeves of dura mater, which merge with and become part of the outer covering (epineurium) of the nerves.
The arachnoid mater is a thin delicate membrane against, but not adherent to, the deep surface of the dura mater (Fig. 2.59). It is separated from the pia mater by the subarachnoid space. The arachnoid mater ends at the level of vertebra SII (see Fig. 2.53).
The subarachnoid space between the arachnoid and pia mater contains CSF (Fig. 2.59). The subarachnoid space around the spinal cord is continuous at the foramen magnum with the subarachnoid space surrounding the brain. Inferiorly, the subarachnoid space terminates at approximately the level of the lower border of vertebra SII (see Fig. 2.53).
Delicate strands of tissue (arachnoid trabeculae) are continuous with the arachnoid mater on one side and the pia mater on the other; they span the subarachnoid space and interconnect the two adjacent membranes. Large blood vessels are suspended in the subarachnoid space by similar strands of material, which expand over the vessels to form a continuous external coat.
The subarachnoid space extends farther inferiorly than the spinal cord. The spinal cord ends at approximately the disc between vertebrae LI and LII, whereas the subarachnoid space extends to approximately the lower border of vertebra SII (see Fig. 2.53). The subarachnoid space is largest in the region inferior to the terminal end of the spinal cord, where it surrounds the cauda equina. As a consequence, CSF can be withdrawn from the subarachnoid space in the lower lumbar region without endangering the spinal cord.
The spinal pia mater is a vascular membrane that firmly adheres to the surface of the spinal cord (Fig. 2.59). It extends into the anterior median fissure and reflects as sleeve-like coatings onto posterior and anterior rootlets and roots as they cross the subarachnoid space. As the roots exit the space, the sleeve-like coatings reflect onto the arachnoid mater.
On each side of the spinal cord, a longitudinally oriented sheet of pia mater (the denticulate ligament) extends laterally from the cord toward the arachnoid and dura mater (Fig. 2.59).
Medially, each denticulate ligament is attached to the spinal cord in a plane that lies between the origins of the posterior and anterior rootlets.
Laterally, each denticulate ligament forms a series of triangular extensions along its free border, with the apex of each extension being anchored through the arachnoid mater to the dura mater.
The lateral attachments of the denticulate ligaments generally occur between the exit points of adjacent posterior and anterior rootlets. The ligaments function to position the spinal cord in the center of the subarachnoid space.
Arrangement of structures in the vertebral canal
The vertebral canal is bordered: anteriorly by the bodies of the vertebrae, intervertebral discs, and posterior longitudinal ligament (Fig. 2.60); laterally, on each side by the pedicles and intervertebral foramina; and posteriorly by the laminae and ligamenta flava, and in the median plane the roots of the interspinous ligaments and vertebral spinous processes.
Between the walls of the vertebral canal and the dural sac is an extradural space containing a vertebral plexus of veins embedded in fatty connective tissue.
The vertebral spinous processes can be palpated through the skin in the midline in thoracic and lumbar regions of the back. Between the skin and spinous processes is a layer of superficial fascia. In lumbar regions, the adjacent spinous processes and the associated laminae on either side of the midline do not overlap, resulting in gaps between adjacent vertebral arches.