Dalley, 10th Edition

107

Vertebral Column

Two to four of these ne meningeal branches arise on each side at all vertebral levels. Close to their origin, the meningeal branches receive communicating branches from the nearby gray rami communicantes. As the spinal nerves exit the IV foramina, most of the meningeal branches run back through the foramina into the vertebral canal (hence, the alternate term recurrent meningeal nerves ). However, some branches remain outside the canal and are distrib uted to the anterolateral aspect of the vertebral bodies and IV discs. They also supply the periosteum and especially the anuli brosi and anterior longitudinal ligament. Inside

the vertebral canal, transverse, ascending, and descending branches distribute nerve bers to the following structures: • Periosteum (covering the surface of the posterior verte bral bodies, pedicles, and laminae) • Ligamenta ava • Anuli brosi of the posterior and posterolateral aspect of the IV discs • Posterior longitudinal ligament • Spinal dura mater • Blood vessels within the vertebral canal Anuli brosi of the posterior and posterolateral aspect of

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Ligamentum flavum

Periosteum of lamina of vertebral arch

Epidural space/fat

Dura–arachnoid interface (exaggerated) Subarachnoid space (occupied by CSF )

Arachnoid mater

Dura mater

Pia mater on surface of spinal cord

Denticulate ligament

Intervertebral veins

Spinal branches of posterior intercostal artery & vein

IV foramen ( dashed line )

Spinal ganglion

Recurrent meningeal nerve

Spinal nerve

Posterior ramus

Anterior ramus

Communicating branch to meningeal nerve White ramus communicans Gray ramus communicans

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Sympathetic trunk

Posterior longitudinal ligament

Internal vertebral venous plexus

Anterolateral view

Periosteum

FIGURE 2.30. Innervation of periosteum and ligaments of vertebral column and of meninges. Except for the zygapophysial joints and external elements of the vertebral arch, the broskeletal structures of the vertebral column (and the meninges) are supplied by the (recurrent) meningeal nerves. Although usually omitted from diagrams and illustrations of spinal nerves, these ne nerves are the rst branches to arise from all 31 pairs of spinal nerves and are the nerves that initially convey localized pain sensation from the back produced by acute herniation of an IV disc or from sprains, contusions, fractures, or tumors of the vertebral column itself.