Cauda Equina
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Cauda Equina
The cauda equina () is a bundle of spinal nerves and spinal nerve rootlets, consisting of the second through fifth lumbar nerve pairs, the first through fifth sacral nerve pairs, and the coccygeal nerve, all of which arise from the lumbar enlargement and the conus medullaris of the spinal cord. The cauda equina occupies the lumbar cistern, a subarachnoid space inferior to the conus medullaris. The nerves that compose the cauda equina innervate the pelvic organs and lower limbs to include motor innervation of the hips, knees, ankles, feet, internal anal sphincter and external anal sphincter. In addition, the cauda equina extends to sensory innervation of the perineum and, partially, parasympathetic innervation of the bladder. Structure In adulthood, the cauda equina is made of lumbosacral spinal nerve roots. Development In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third lumbar vertebra, or L3, at birth. Because the ...
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Filum Terminale
The filum terminale ("terminal thread") is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris. It is one of the modifications of pia mater. It gives longitudinal support to the spinal cord and consists of two parts: * The upper part, or filum terminale internum, is about 15 cm long and reaches as far as the lower border of the second sacral vertebra. It is continuous above with the pia mater and contained within a tubular sheath of the dura mater. In addition, it is surrounded by the nerves forming the cauda equina, from which it can be easily recognized by its bluish-white color. * The lower part, or filum terminale externum, closely adheres to the dura mater. It extends downward from the apex of the tubular sheath and is attached to the back of the first segment of the coccyx in a structure sometimes referred to as the ''coccygeal ligament''. The most inferior of the spinal nerves, the coccygeal nerve l ...
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Sphincter Ani Externus Muscle
The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus. Anatomy The external anal sphincter measures about 8 to 10 cm in length, from its anterior to its posterior extremity, and is about 2.5 cm opposite the anus, the sphincter muscle retracts on defecating. It consists of two layers: ''superficial'' and ''deep''. * The superficial layer, constitutes the main portion of the muscle, and arises from a narrow tendinous band, the anococcygeal raphe, which stretches from the tip of the coccyx to the posterior margin of the anus; it forms two flattened planes of muscular tissue, which encircle the anus and meet in front to be inserted into the central tendinous point of the perineum, joining with the superficial transverse perineal muscle, the levator ani, and the bulbospongiosus muscle also known as the bulbocavernosus. * The deeper layer f ...
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Cauda Equina Syndrome
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual. The cause is usually a disc herniation in the lower region of the back. Other causes include spinal stenosis, cancer, trauma, epidural abscess, and epidural hematoma. The diagnosis is suspected based on symptoms and confirmed by medical imaging such as MRI or CT scan. CES is generally treated surgically via laminectomy. Sudden onset is regarded as a medical emergency requiring prompt surgical decompression, with delay causing permanent loss of function. Permanent bladder problems, sexual dysfunction or numbness may occur despite surgery. A poor outcome occurs in about 20% of people despite treatment. About 1 in 70,000 people is affected every year. It was f ...
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Lumbar Puncture
Lumbar puncture (LP), also known as a spinal tap, is a medical procedure in which a needle is inserted into the spinal canal, most commonly to collect cerebrospinal fluid (CSF) for diagnostic testing. The main reason for a lumbar puncture is to help diagnose diseases of the central nervous system, including the brain and spine. Examples of these conditions include meningitis and subarachnoid hemorrhage. It may also be used therapeutically in some conditions. Increased intracranial pressure (pressure in the skull) is a contraindication, due to risk of brain matter being compressed and pushed toward the spine. Sometimes, lumbar puncture cannot be performed safely (for example due to a bleeding diathesis, severe bleeding tendency). It is regarded as a safe procedure, but post-dural-puncture headache is a common side effect if a small atraumatic needle is not used. The procedure is typically performed under local anesthesia using a aseptic technique, sterile technique. A hypodermic ...
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Cerebrospinal Fluid
Cerebrospinal fluid (CSF) is a clear, colorless body fluid found within the tissue that surrounds the brain and spinal cord of all vertebrates. CSF is produced by specialised ependymal cells in the choroid plexus of the ventricles of the brain, and absorbed in the arachnoid granulations. There is about 125 mL of CSF at any one time, and about 500 mL is generated every day. CSF acts as a shock absorber, cushion or buffer, providing basic mechanical and immunological protection to the brain inside the skull. CSF also serves a vital function in the cerebral autoregulation of cerebral blood flow. CSF occupies the subarachnoid space (between the arachnoid mater and the pia mater) and the ventricular system around and inside the brain and spinal cord. It fills the ventricles of the brain, cisterns, and sulci, as well as the central canal of the spinal cord. There is also a connection from the subarachnoid space to the bony labyrinth of the inner ear via the perilymphat ...
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Subarachnoid Space
In anatomy, the meninges (, ''singular:'' meninx ( or ), ) are the three membranes that envelop the brain and spinal cord. In mammals, the meninges are the dura mater, the arachnoid mater, and the pia mater. Cerebrospinal fluid is located in the subarachnoid space between the arachnoid mater and the pia mater. The primary function of the meninges is to protect the central nervous system. Structure Dura mater The dura mater ( la, tough mother) (also rarely called ''meninx fibrosa'' or ''pachymeninx'') is a thick, durable membrane, closest to the skull and vertebrae. The dura mater, the outermost part, is a loosely arranged, fibroelastic layer of cells, characterized by multiple interdigitating cell processes, no extracellular collagen, and significant extracellular spaces. The middle region is a mostly fibrous portion. It consists of two layers: the endosteal layer, which lies closest to the skull, and the inner meningeal layer, which lies closer to the brain. It contains large ...
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Cistern (neuroanatomy)
The subarachnoid cisterns are spaces formed by openings in the subarachnoid space, an anatomic space in the meninges of the brain. The space is situated between the two meninges, the arachnoid mater and the pia mater. These cisterns are filled with cerebrospinal fluid. Structure Although the pia mater adheres to the surface of the brain, closely following the contours of its gyri and sulci, the arachnoid mater only covers its superficial surface, bridging across the gyri. This leaves wider spaces between the pia and arachnoid and the cavities are known as the subarachnoid cisterns. Although they are often described as distinct compartments, the subarachnoid cisterns are not truly anatomically distinct. Rather, these subarachnoid cisterns are separated from each other by a trabeculated porous wall with various-sized openings. Cisterns There are many cisterns in the brain with several large ones noted with their own name. At the base of the spinal cord is another subarachnoid ciste ...
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Thoracic Vertebrae
In vertebrates, thoracic vertebrae compose the middle segment of the vertebral column, between the cervical vertebrae and the lumbar vertebrae. In humans, there are twelve thoracic vertebra (anatomy), vertebrae and they are intermediate in size between the cervical and lumbar vertebrae; they increase in size going towards the lumbar vertebrae, with the lower ones being much larger than the upper. They are distinguished by the presence of Zygapophysial joint, facets on the sides of the bodies for Articulation (anatomy), articulation with the head of rib, heads of the ribs, as well as facets on the transverse processes of all, except the eleventh and twelfth, for articulation with the tubercle (rib), tubercles of the ribs. By convention, the human thoracic vertebrae are numbered T1–T12, with the first one (T1) located closest to the skull and the others going down the spine toward the lumbar region. General characteristics These are the general characteristics of the second throu ...
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Vertebral Column
The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordata, chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. Individual vertebrae are named according to their region and position, and can be used as anatomical landmarks in order to guide procedures such as Lumbar puncture, lumbar punctures. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord. There are about 50,000 species of animals that have a vertebral column. The human vertebral column is one of the most-studied examples. Many different diseases in humans can affect the spine, with spina bifida and scoliosis being recognisable examples. The general structure of human vertebrae is fairly typical of that found in mammals, reptiles, and birds. Th ...
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Lumbar Vertebrae
The lumbar vertebrae are, in human anatomy, the five vertebrae between the rib cage and the pelvis. They are the largest segments of the vertebral column and are characterized by the absence of the foramen transversarium within the transverse process (since it is only found in the cervical region) and by the absence of facets on the sides of the body (as found only in the thoracic region). They are designated L1 to L5, starting at the top. The lumbar vertebrae help support the weight of the body, and permit movement. Human anatomy General characteristics The adjacent figure depicts the general characteristics of the first through fourth lumbar vertebrae. The fifth vertebra contains certain peculiarities, which are detailed below. As with other vertebrae, each lumbar vertebra consists of a ''vertebral body'' and a ''vertebral arch''. The vertebral arch, consisting of a pair of ''pedicles'' and a pair of ''laminae'', encloses the ''vertebral foramen'' (opening) and sup ...
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Spinal Nerve Root
Spinal nerve root may refer to: * Posterior root of spinal nerve * Anterior root of spinal nerve In anatomy and neurology, the ventral root of spinal nerve, anterior root, or motor root is the efferent motor root of a spinal nerve. At its distal end, the ventral root joins with the dorsal root The dorsal root of spinal nerve (or posterior ... Back anatomy Peripheral nervous system {{Short pages monitor ...
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Vertebral Column
The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordata, chordates has been replaced by a segmented series of bone: vertebrae separated by intervertebral discs. Individual vertebrae are named according to their region and position, and can be used as anatomical landmarks in order to guide procedures such as Lumbar puncture, lumbar punctures. The vertebral column houses the spinal canal, a cavity that encloses and protects the spinal cord. There are about 50,000 species of animals that have a vertebral column. The human vertebral column is one of the most-studied examples. Many different diseases in humans can affect the spine, with spina bifida and scoliosis being recognisable examples. The general structure of human vertebrae is fairly typical of that found in mammals, reptiles, and birds. Th ...
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