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Immediately distal to the spinal ganglia, ventral and dorsal roots unite to form spinal nerves (see Fig. 43.5, Fig. 15.15). These very soon divide into dorsal and ventral rami, both of which receive fibres from both roots. At all levels above the sacral, this division occurs within the intervertebral foramen. Division of the sacral spinal nerves occurs within the sacral vertebral canal, and the dorsal and ventral rami exit separately through posterior and anterior sacral foramina at each level. Spinal nerves trifurcate at some cervical and thoracic levels, in which case the third branch is called a ramus intermedius. At or distal to its origin each ventral ramus gives off recurrent meningeal (sinuvertebral) branches and receives a grey ramus communicans from the corresponding sympathetic ganglion. The thoracic and first and second lumbar ventral rami each contributes a white ramus communicans to the corresponding sympathetic ganglia. The second, third and fourth sacral nerves also supply visceral branches, unconnected with sympathetic ganglia, which carry a parasympathetic outflow direct to the pelvic plexuses.

Cervical spinal nerves enlarge from the first to the sixth nerve. The seventh and eighth cervical and the first thoracic nerve are similar in size to the sixth cervical nerve. The remaining thoracic nerves are relatively small. Lumbar nerves are large, increasing in size from the first to the fifth. The first sacral is the largest spinal nerve, thereafter the sacral nerves decrease in size. The coccygeal nerves are the smallest spinal nerves. The size of the spinal nerve and its associated structures within the intervertebral foramen is not in direct relation to the size of the foramen. At lumbar levels, though L5 is the largest nerve, its foramen is smaller than those of L1–4, which renders this nerve particularly liable to compression.

In the radicular (‘root’) canal and intervertebral foramen, the spinal nerve is related to the spinal artery of that level and its radicular branch, and to a small plexus of veins. At the outer end of the foramen the nerve may lie above or below transforaminal ligaments.

Meningeal nerves

Recurrent meningeal (or sinuvertebral) nerves (Fig. 43.7) occur at all vertebral levels. They are mixed sensory and sympathetic nerves, represented by numerous fine filaments amongst which one, or two to four, larger trunks may be evident. At cervical levels the autonomic roots arise from the grey rami that form the vertebral nerve (p. 461). At thoracic and lumbar levels, each nerve is formed by a somatic root from the ventral ramus and by an autonomic root from the grey ramus communicans of that segment. Each nerve pursues a recurrent course through the intervertebral foramen, passing ventral to the spinal nerve, to enter the vertebral canal, where it divides into ascending, descending, and transverse branches. These branches communicate with corresponding branches from the segments above and below, and from the opposite side, forming arcades along the floor of the vertebral canal. Meningeal branches of the arcades form a plexus on the ventral surface of the dural sac and nerve root sleeves which attenuates laterally; the posterior paramedian dura is devoid of nerve endings. Skeletal branches are distributed to the posterior longitudinal ligament, the periosteum of the vertebral bodies, and to the posterior and posterolateral aspects of the intervertebral discs. Vascular branches accompany the veins and arteries of the vertebral canal and those of the vertebral bodies. The upper three cervical meningeal nerves ascend through the foramen magnum into the posterior cranial fossa, where they innervate the dura mater that covers the clivus. En route, they innervate the median atlanto-axial joint and its ligaments.


Fig. 43.7  The course and skeletal distribution of the lumbar sinuvertebral nerves. Each nerve supplies the intervertebral disc at its level of entry into the vertebral canal, the disc above, and the intervening posterior longitudinal ligament. In about one-third of cases, the nerve at a particular level may be represented by more than one filament.

Functional components of spinal nerves

A typical spinal nerve contains somatic efferent fibres and somatic and visceral afferent fibres. Some, but not all, spinal nerves also contain preganglionic autonomic fibres.

Somatic components

Somatic efferent fibres innervate skeletal muscles and are axons of α, β and γ neurones in the spinal ventral grey column. Somatic afferent fibres convey impulses into the CNS from receptors in the skin, subcutaneous tissue, muscles, tendons, fasciae and joints: they are peripheral processes of unipolar neurones in the spinal ganglia.

Visceral components

Preganglionic visceral efferent sympathetic fibres are axons of neurones in the spinal intermediolateral grey column throughout the thoracic and upper two or three lumbar segments: they join the sympathetic trunk via corresponding white rami communicantes and synapse with postganglionic neurones which are distributed to smooth muscle, myocardium or exocrine glands. The preganglionic visceral efferent parasympathetic fibres are axons of neurones in the spinal lateral grey column of the second to fourth sacral segments: they leave the ventral rami of corresponding sacral nerves and synapse in pelvic ganglia. The postganglionic axons are distributed mainly to smooth muscle or glands in the walls of the pelvic viscera. Visceral afferent fibres have cell bodies in the spinal ganglia. Their peripheral processes pass through white rami communicantes and, without synapsing, through one or more sympathetic ganglia to end in the walls of the viscera. Some visceral afferent fibres may enter the spinal cord in the ventral roots.

Central processes of ganglionic unipolar neurones enter the spinal cord by dorsal roots and synapse on somatic or sympathetic efferent neurones, usually through interneurones, completing reflex paths. Alternatively, they may synapse with other neurones in the spinal or brain stem grey matter which give origin to a variety of ascending tracts.

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