Classification of the nervous system. Prof. Dr. Nikolai Lazarov 2
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1 1 1. Formation and general organization 2. Spinal ganglia 3. Zonal and segmental innervation 4. Dorsal rami of the spinal nerves 5. Ventral rami of the spinal nerves 6. Cervical plexus
2 Classification of the nervous system Prof. Dr. Nikolai Lazarov 2
3 General organization 31 pairs of segmentally arranged nerves: 8 cervical C1-C8 12 thoracic Th1-Th12 5 lumbar L1-L5 5 sacral S1-S5 1 coccygeal Co1 corresponds to a pair of embryonic somites emerges through the intervertebral foramen mixed spinal nerve (common nerve trunk) topographic relationships between spinal nerves, segments and vertebrae Prof. Dr. Nikolai Lazarov 3
4 Spinal nerve formation ventral (motor) root: axons of neurons in anterior and lateral grey columns motor and autonomic (sympathetic and parasympathetic) dorsal (sensory) root: central processes of the dorsal ganglion cells convey somatic and visceral sensory information Prof. Dr. Nikolai Lazarov 4
5 Spinal ganglion spindle-shaped aggregations on the dorsal roots dorsal root ganglion (pseudo)unipolar neurons ovoid or spherical (primary afferent neurons) satellite cells (capsular cells, amphicytes) Schwann cells and blood vessels Prof. Dr. Nikolai Lazarov 5
6 Spinal ganglion embryonic origin neural crest cells location in intervertebral foramina axons (afferents) proximal and distal processes functional modalities: mechanoreception nociception proprioception Prof. Dr. Nikolai Lazarov 6
7 Formation of a dermatome Dermatome a localized area of skin supplied by a single nerve from a single nerve root of the spinal cord herringbone pattern the width of the cutaneous field of innervation thorax&abdomen like a stack of discs arms&legs longitudinally along the limbs Peripheral nerve field a territory supplied by a peripheral nerve from more than one somite Prof. Dr. Nikolai Lazarov 7
8 Dermatome vs. skin innervation Prof. Dr. Nikolai Lazarov 8
9 Zonal innervation Sensory nerve innervation regions: autonomic anesthesia mixed hypoesthesia maximal no loss in sensibility Prof. Dr. Nikolai Lazarov 9
10 Segmental innervation Segmental innervation: organs or muscles innervated by one spinal segment corresponds to the general metamerism of the body Embryonic somites (metamere): myotome muscle sclerotome skeleton dermatome skin Neuromere somite Prof. Dr. Nikolai Lazarov 10
11 Spinal nerve trunks Spinal nerve functional components: somatic components efferent and afferent fibers visceral components sympathetic or parasympathetic Spinal nerve branches: meningeal branch at all vertebral levels (recurrent meningeal nerve) white ramus communicans myelinated preganglionic fibers all thoracic and L1-L2 to corresponding sympathetic ganglion S2-S4 nerves to the parasympathetic pelvic plexus grey ramus communicans unmyelinated postganglionic fibers from paravertebral sympathetic ganglia ventral (anterior) ramus thicker ventrolateral muscles skin of the trunk and extremities dorsal (posterior) ramus thinner intrinsic dorsal muscles of the back and neck overlying skin from vertex to coccyx Prof. Dr. Nikolai Lazarov 11
12 Dorsal rami of the spinal nerves divide into medial and lateral branches (exception C1) have a typical segmental distribution cervical dorsal rami: suboccipital nerve (C1) purely motor greater occipital nerve (C2) mixed C3 medial cutaneous branch, third occipital nerve thoracic dorsal rami: Th1-Th6 medial (mixed) and lateral (motor) branch Th7-Th12 medial (motor) and lateral (mixed) lumbar dorsal rami: L1-L3 lateral cutaneous branches superior clunial nerves sacral dorsal rami: S1-S3 lateral cutaneous branches medial clunial nerves Prof. Dr. Nikolai Lazarov 12
13 Dorsal rami of the spinal nerves divide into medial and lateral branches (exception C1) have a typical segmental distribution cervical dorsal rami: suboccipital nerve (C1) purely motor greater occipital nerve (C2) mixed C3 medial cutaneous branch, third occipital nerve thoracic dorsal rami: Th1-Th6 medial (mixed) and lateral (motor) branch Th7-Th12 medial (motor) and lateral (mixed) lumbar dorsal rami: L1-L3 lateral cutaneous branches superior clunial nerves sacral dorsal rami: S1-S3 lateral cutaneous branches medial clunial nerves Prof. Dr. Nikolai Lazarov 13
14 Ventral rami of the spinal nerves Thoracic ventral rami 12 pairs: segmental distribution intercostal nerves Th12 subcostal nerve anterior cutaneous branches lateral cutaneous branches Prof. Dr. Nikolai Lazarov 14
15 Ventral rami of the spinal nerves Thoracic ventral rami 12 pairs: segmental distribution intercostal nerves Th12 subcostal nerve anterior cutaneous branches lateral cutaneous branches Prof. Dr. Nikolai Lazarov 15
16 Cervical plexus, plexus cervicalis Formation and segmental origin: a loop of nerves ventral rami of C1-C4 nerves three arcuate loops ansae cervicales communicationg branches with: hypoglossal nerve ansa cervicalis accessory nerve (ramus externus) sympathetic trunk Prof. Dr. Nikolai Lazarov 16
17 Branches: Cervical plexus, plexus cervicalis superficial (sensory) branches: lesser occipital nerve, n. occipitalis minor great auricular nerve, n. auricularis magnus transverse colli nerve, n. transversus colli supraclavicular nerves, nn. supraclaviculares deep (motor) branches Prof. Dr. Nikolai Lazarov 17
18 Branches: Cervical plexus, plexus cervicalis superficial (sensory) branches: deep (motor) branches: muscular branches, rr. musculares inferior root of the ansa cervicalis, radix inferior ansae cervicalis trapezius root, ramus trapezius sternocleidomastoid root, r. sternocleidomastoideus phrenic nerve, n. phrenicus Prof. Dr. Nikolai Lazarov 18
19 Thank you Prof. Dr. Nikolai Lazarov 19
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