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. 2024 Jun 11;38(1):35–42. doi: 10.1002/ca.24196

Upper end of the central canal of the human spinal cord: Quantitative anatomical study and 3D modeling

Etienne Lefevre 1,2, Megane Le Quang 3, Guillaume Chotard 3, Steven Knafo 4, Pierre Mengelle 5, Yanis Taupin 2, Dominique Liguoro 2,6, Vincent Jecko 2,6, Jean‐Rodolphe Vignes 6, Paul Roblot 2,6,✉
PMCID: PMC11652813  PMID: 38860594

Abstract

The upper end of the central canal of the human spinal cord has been repeatedly implicated in the pathogenesis of various diseases, yet its precise normal position in the medulla oblongata and upper cervical spinal cord remains unclear. The purpose of this study is to describe the anatomy of the upper end of the central canal with quantitative measurements and a three‐dimensional (3D) model. Seven formalin‐embalmed human brainstems were included, and the central canal was identified in serial axial histological sections using epithelial membrane antigen antibody staining. Measurements included the distances between the central canal (CC) and the anterior medullary fissure (AMF) and the posterior medullary sulcus (PMS). The surface and perimeter of the CC and the spinal cord were calculated, and its anterior–posterior and maximum lateral lengths were measured for 3D modeling. The upper end of the CC was identified in six specimens, extending from the apertura canalis centralis (ACC) to its final position in the cervical cord. Positioned on the midline, it reaches its final location approximately 15 mm below the obex. No specimen showed canal dilatation, focal stenosis, or evidence of syringomyelia. At 21 mm under the ACC in the cervical cord, the median distance from the CC to the AMF was 3.14 (2.54–3.15) mm and from the CC to the PMS was 5.19 (4.52–5.43) mm, with a progressive shift from the posterior limit to the anterior third of the cervical spinal cord. The median area of the CC was consistently less than 0.1 mm2. The upper end of the CC originates at the ACC, in the posterior part of the MO, and reaches its normal position in the anterior third of the cervical spinal cord less than 2 cm below the obex. Establishing the normal position of the upper end of this canal is crucial for understanding its possible involvement in cranio‐cervical junction pathologies.

Keywords: brainstem anatomy, central canal, histology, spinal cord, syringomyelia

1. INTRODUCTION

The normal anatomy of the central canal (CC) of the human spinal cord has been extensively studied (Saker et al., 2016). Despite well‐documented variations in the morphology of its caudal part, including dilatation, forking and outpouchings, the description of the cranial part of the central canal remains imprecise (Choi et al., 1992; Klekamp, 2018; Milhorat et al., 1993; Pearson & Sauter, 1971; Petit‐Lacour et al., 2000; Saker et al., 2016). However, dilatation, displacement, occlusion or distortion of the upper end of the CC have been repeatedly implicated in the pathogenesis of various diseases (Del Maestro et al., 2014; D'Osvaldo et al., 2002; Yardim et al., 2023; Zhang et al., 2012).

Despite advances in imaging quality over recent decades, the resolution of routine magnetic resonance imaging (MRI) sequences is still inadequate for describing the anatomy of a thin structure such as the CC precisely (Tomsick et al., 2017, 2021; Zhao et al., 2014). Moreover, the upper emergence of the central canal, the apertura canalis centralis (ACC), is not easily identifiable on routine MRI scans either (Middlebrooks et al., 2015; Milhorat & Miller, 1994; Rhoton, 2000). The sole known anatomical description of the ACC was obtained from in vivo endoscopic observations (Longatti et al., 2022).

To the best of our knowledge, there is no precise quantitative anatomical description of the upper end of the central canal. Therefore, our objective is to provide a detailed description of the normal anatomy and orientation of the initial upper segment of the central canal from the ACC to its normal position in the cervical cord in adult human cadavers.

2. MATERIALS AND METHODS

2.1. Anatomical preparations

This study included seven adult human formalin‐embalmed cadavers obtained from the Department of Anatomy at Bordeaux University of Medicine. The cadavers were placed in the prone position and a large occipital craniotomy was performed. Posterior openings into C1 and C2 were made in a standard fashion. The dura was removed, and the cerebellar tentorium was split until the tentorial notch was opened. The brainstem was isolated and separated from the cerebrum by sectioning the upper part of the mesencephalon. The upper part of the cerebellar hemispheres was removed, leaving the vermis, cerebellar tonsils, and cerebellar peduncles intact. The arachnoid layer covering the cisterna magna at the posterior part of the ponto‐medullary junction was retained (Figure 1).

FIGURE 1.

FIGURE 1

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Posterior view of the cervicomedullary junction after section of the cerebellar peduncles and the upper part of the cerebellar vermis.

Each cranial nerve was conserved and left intact from its brainstem entry zone or emergence to its osseous foramen. In contrast, the first and second spinal nerves were sectioned at the level of their foramina.

Following the dissection of the cerebellopontine angle, the cranial nerves were sectioned next to their respective osseous foramina and the arachnoid sheath around the basilar artery was removed. We harvested the entire brainstem “en‐bloc” from the midbrain to the medulla under the C2 posterior arch. Each piece was then formalin‐fixed.

2.2. Histological preparations

Before any histological staining, each side was color‐coded for identification. The brainstem was sectioned into 3 mm thick cuts, spanning from the origin of the CC to 21 mm below (Figure 2A). The origin of the CC was identified as the ACC, and the upper part of the ACC, defining the transition point between the spinal cord and the medulla oblongata, was labeled as the obex. Each section underwent formalin fixation and paraffin embedding. Samples 4 μm thick were stained with hematoxylin–eosin. Epithelial membrane antigen (EMA) antibody (E29, 1:200; Dako) was used to stain the specimens immunochemically to identify ependymal structures.

FIGURE 2.

FIGURE 2

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Illustration of the initial course of the central canal. (A) Sagittal cut of the medulla oblongata passing though the central canal. (B) Axial cut of the medulla oblongata, 9 mm under the origin of the central canal, illustrating the reported measurements.

2.3. Histological outcomes

The central canal, marked by the EMA antibody, was identified as the sole ependymal structure discernible in front of the fourth ventricle. We quantified several parameters on each axial histological slice: the distances from the anterior limit of the CC to the anterior fissure of the MO and to the AMF; the surfaces and perimeters of the MO and cervical spinal cord; the CC surface and perimeter, including its wall defined by the ependymal cells; the distance from the anterior limit of the central canal to the AMF; and the distance from the posterior median sulcus (PMS) to the posterior limit of the central canal (Figure 2B).

2.4. Three‐dimensional modeling

A three‐dimensional (3D) representation of the central canal's position within the medulla oblongata and upper cervical spinal cord was generated using Grasshopper software (February 2021/Build 1.0.0007; Rhino v7.4.21047.11002.). The shape of the spinal cord and medulla oblongata was approximated using a schematic representation of the upper axial slice (Figure 2B). It was scaled to the medullar perimeter of each axial slice, and its surface was obtained by interpolating curves using the “Loft” function. The position of the central canal was taken as the mean of its distances to the PMS and AMF on each axial slice. The shape of the central canal was constructed as a center‐centered ellipse.

2.5. Statistical analysis

GraphPad Prism software (version 9.0.0) was used for statistical analyses. Data were expressed as medians (InterQuartile Range). A non‐parametric Wilcoxon test was used to compare experimental measurements. p‐values or adjusted p‐values below 0.05 were considered statistically significant.

3. RESULTS

Among the seven harvested brainstems, one was considered unsuitable for analysis owing to lesions formed during histological preparation. The median age of the remaining six specimens was 79 years (74–83), and the CC was consistently identified on the midline of each histological slice from its origin to its inferior cervical course. The anti‐EMA antibody selectively labeled the CC on each slice, precluding confusion with other neural structures. Beyond 6 mm from the origin of the central canal, the ependymal cells were anti‐EMA positive without clear ciliation or a real central cavity (Figure 3).

FIGURE 3.

FIGURE 3

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Histological axial cut 6 mm below the origin of the central canal after hematoxylin–eosin coloration (A) and magnification of the central canal (×10) after immunohistochemical staining with anti‐EMA (B). Distal (12 mm) axial cut of the central canal with intracellular anti‐EMA staining without ciliation (C).

3.1. Measurements

At the level of the obex, the median distance from the CC to the AMF was 9.26 (9.15–9.37) mm and to the PMS was 0.91 (0–0.91) mm. The median area of the CC was 0.085 (0.08–0.27) mm2, its median perimeter was 1.36 (1.36–1.99) mm, its median anterior–posterior axis was 0.37 (0.37–0.68) mm and its median left–right axis was 0.15 (0.15–0.52) mm. The median medullar area was 161 (161–166) mm2 and the median perimeter was 48.7 (48.7–50.5) mm.

3.2. Processing downwards from the obex

Three millimeters below, the median distance from the CC to the AMF was 7.39 (7.36–7.98) mm and to the PMS was 2.04 (1.71–3.41) mm. The median area of the CC was 0.034 (0.031–0.057) mm2, the median perimeter was 0.94 (0.90–1.06) mm, the median anterior–posterior axis was 0.36 (0.30–0.43) mm and the median left–right axis was 0.064 (0.057–0.12) mm. The median medullar area was 147 (138–172) mm2 and the median perimeter was 46.2 (44.4–49.1) mm.

At 6 mm below, the median distance from the CC to the AMF was 7.15 (6.23–7.25) mm and to the PMS was 3.67 (3.0–4.30) mm. The median area of the CC was 0.028 (0.027–0.042) mm2, the median perimeter was 0.94 (0.93–0.99) mm, the median anterior–posterior axis was 0.39 (0.36–0.40) mm and the median left–right axis was 0.060 (0.058–0.064) mm. The median medullar area was 145 (110–147) mm2 and the median perimeter was 44.6 (38.7–45.3) mm.

At 9 mm, the median distance from the CC to the AMF was 5.73 (5.02–6.85) mm and to the PMS was 4.35 (3.57–4.53) mm. The median area of the CC was 0.039 (0.029–0.10) mm2, the median perimeter was 0.92 (0.70–1.05) mm, the median anterior–posterior axis was 0.28 (0.26–0.38) mm and median left–right axis was 0.071 (0.069–0.18) mm. The median medullar area was 109 (95.9–137) mm2 and the median perimeter was 38.3 (35.9–43.6) mm.

Twelve millimeters below, the median distance from the CC to the AMF was 4.8 (4.27–4.94) mm and to the PMS was 4.54 (4.08–4.78) mm. The median area of the CC was 0.028 (0.024–0.028) mm2, the median perimeter was 0.80 (0.72–0.80) mm, the median anterior–posterior axis was 0.27 (0.22–0.28) mm and the median left–right axis was 0.26 (0.21–0.33) mm. The median medullar area was 84.1 (79.3–112) mm2 and the median perimeter was 33.5 (32.7–39.5) mm.

At 15 mm, the median distance from the CC to the AMF was 3.99 (3.20–4.13) mm and to the PMS was 4.48 (4.42–4.57) mm. The median area of the CC was 0.037 (0.031–0.068) mm2, the median perimeter was 0.89 (0.81–1.03) mm, the median anterior–posterior axis was 0.33 (0.29–0.36) mm and the median left–right axis was 0.098 (0.096–0.11) mm. The median medullar area was 80.3 (71.8–92.4) mm2 and the median perimeter was 32.7 (31.1–34.8) mm.

Eighteen millimeters down, the median distance from the CC to the AMF was 3.04 (2.62–3.32) mm and to the PMS was 4.78 (4.61–5.41) mm. The median area of the CC was 0.040 (0.035–0.064) mm2, the median perimeter was 0.90 (0.81–1.02) mm, the median anterior–posterior axis was 0.27 (0.19–0.36) mm and the median left–right axis was 0.145 (0.103–0.187) mm. The median medullar area was 74.1 (67.5–80.8) mm2 and the median perimeter was 31.5 (30.9–32.6) mm.

Twenty‐one millimeters below the obex, the median distance from the CC to the AMF was 3.14 (2.54–3.15) mm and to the PMS was 5.19 (4.52–5.43) mm. The median area of the CC was 0.055 (0.046–0.074) mm2, the median perimeter was 0.91 (0.86–1.09) mm, the median anterior–posterior axis was 0.28 (0.23–0.36) mm and the median left–right axis was 0.195 (0.168–0.231) mm. The median medullar area was 82.9 (65.3–85.8) mm2 and the median perimeter was 33.8 (29.9–34.4) mm.

The median area of the central canal was consistently less than 0.1 mm2, with no discernible real cavity. The median axis from the anterior to the posterior part of this canal remained stable from the ACC to the inferior limit of our slices, from 0.37 (0.37–0.68) mm to 0.28 (0.23–0.36) mm. It was systematically less than 0.2 mm in the medial‐lateral axis. The final anterior–posterior position of the central canal in the cervical spinal cord was reached 15 mm below the obex (Figure 4). The results are summarized in Table 1.

FIGURE 4.

FIGURE 4

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Graphic representation of the obtained measurements. (A) Distance (mm) between the posterior medullary sulcus and the central canal on every axial slice from the obex to the cervical spinal cord. (B) Distance (mm) between the anterior medullary fissure and the central canal on every axial slice from the obex to the cervical spinal cord. (C) Area of the central canal (mm2) on every axial slice from the obex to the cervical spinal cord.

TABLE 1.

Histological features of the central canal in the cervicomedullary junction.

Spinal cord area (mm2) Spinal cord perimeter (mm) Distance CC to AMF (mm) Distance CC to PMS (mm) CC area (mm2) CC perimeter (mm) CC anterior–posterior size (mm) CC left–right size (mm)
Origin of the CC (Obex) 161 (161; 166) 48.7 (48.7; 50.5) 9.26 (9.15; 9.37) 0.91 (0; 0.91) 0.085 (0.08; 0.27) 1.36 (1.36; 199) 0.37 (0.37;0.68) 0.15 (0.15; 0.52)
3 mm 147 (138; 172) 46.2 (44.4; 49.1) 7.39 (7.36; 7.98) 2.04 (1.71; 3.41) 0.034 (0.031; 0.057) 0.94 (0.90; 1.06) 0.36 (0.30; 0.43) 0.064 (0.057; 0.12)
6 mm 145 (110; 147) 44.6 (38.7; 45.3) 7.15 (6.23; 7.25) 3.67 (3.0; 4.30) 0.028 (0.027; 0.042) 0.94 (0.93; 0.99) 0.39 (0.36; 0.40) 0.060 (0.058; 0.064)
9 mm 109 (95.9; 137) 38.3 (35.9; 43.6) 5.73 (5.02; 6.85) 4.35 (3.57; 4.53) 0.039 (0.029; 0.10) 0.92 (0.70; 1.05) 0.28 (0.26; 0.38) 0.071 (0.069; 0.18)
12 mm 84.1 (79.3; 112) 33.5 (32.7; 39.5) 4.8 (4.27; 4.94) 4.54 (4.08; 4.78) 0.028 (0.024; 0.028) 0.80 (0.72; 0.8) 0.27 (0.22; 0.28) 0.26 (0.21; 0.33)
15 mm 80.3 (71.8; 92.4) 32.7 (31.1; 34.8) 3.99 (3.20; 4.13) 4.48 (4.42; 4.57) 0.037 (0.031; 0.068) 0.89 (0.81; 1.03) 0.33 (0.29; 0.36) 0.098 (0.096; 0.11)
18 mm 74.1 (67.5; 80.8) 31.5 (30.9;32.6) 3.04 (2.62; 3.32) 4.78 (4.61; 5.41) 0.040 (0.035; 0.064) 0.90 (0.81; 1.02) 0.27 (0.19; 0.36) 0.145 (0.103; 0.187)
21 mm 82.9 (65.3; 85.8) 33.8 (29.9; 34.4) 3.14 (2.54; 3.15) 5.19 (4.52; 5.43) 0.055 (0.046; 0.074) 0.91 (0.86;1.09) 0.28 (0.23; 0.36) 0.195 (0.168; 0.231)
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Abbreviations: AMF, anterior medullary fissure; CC, central canal; PMS, posterior medullary sulcus.

A 3D model was generated, illustrating the initial course of the upper end of the central canal (Figure 5).

FIGURE 5.

FIGURE 5

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Right anterior‐lateral view of the 3D model representing the initial course of the upper end of the central canal within the left hemicord. Ant, anterior; AMF, anterior medullary fissure; CC, central canal; PMS, posterior medullary sulcus; SC, spinal cord.

4. DISCUSSION

The upper segment of the central canal, extending from the ACC to its final position in the cervical cord, consistently aligns along the midline and attains its ultimate position ~15 mm below the obex (Figure 4).

4.1. Anatomical description

The anti‐EMA staining of the central canal validated the persistent ependymal barrier surrounding it, even when the canal was closed (Kasantikul et al., 1979; Milhorat et al., 1995). This technique made it possible to measure the position of the central canal objectively from the AMF to its anterior limit and from the PMS to its posterior limit (Figure 4). The central canal of the human spinal cord originates from the ACC, situated below the obex, and traverses the medulla oblongata horizontally toward its final location at the junction of the middle and anterior thirds of the spinal cord ~15 mm below the ACC. Subsequently, the CC descends vertically in the cervical spinal cord. The surface characteristics of the central canal remained consistent across every axial slice in this study, and there were no instances of focal stenosis. The uniformly elliptical shape of the central canal described in the rest of the cord (Saker et al., 2016) was also evident throughout its upper cranial segment.

4.2. Possible implications in pathologies

The central canal is recognized to undergo progressive closure with age, and its function in adults remains incompletely understood (Milhorat et al., 1994). Radiological studies have described persistent filiform intramedullary cavities in 1.5% of adult patients (Petit‐Lacour et al., 2000). These could indicate a persistent canal or delayed normal obliteration and should be considered normal anatomical variants. Nevertheless, the CC has been repeatedly implicated in the pathogenesis of various diseases, notably syringomyelia (Del Maestro et al., 2014; D'Osvaldo et al., 2002; Heiss, 2023; Milhorat et al., 1993; Zhang et al., 2012). Extensive descriptions of variations in the morphology of the caudal part of the CC have prompted speculation about a potential functional connection between the canal and the spinal subarachnoid space, suggesting a role in the pathogenesis of syringomyelia (Storer et al., 1998).

Several hypotheses have been proposed to elucidate the development of syringomyelia at the upper end of the central canal (Klekamp, 2002). Interestingly, some authors distinguish noncommunicating syringomyelia, resulting from obstruction of the upper end of the central canal or its continuity with the subarachnoid space, from communicating syringomyelia (i.e., hydromyelia), resulting from an accumulation of CSF in the central canal when there is hydrocephalus with obstruction of all three outlets from the fourth ventricle (Klekamp, 2002; Milhorat et al., 1993, 1995; Williams, 1980). However, anatomical studies have refuted this by confirming physiological obturation of the central canal in adults older than 20 years (Kasantikul et al., 1979; Netsky, 1953). Furthermore, an alternative explanation has been suggested, involving a CSF pathway through the perivascular spaces into the spinal cord. This is thought to result from the piston‐like action of the cerebellar tonsils pushing CSF into the spinal subarachnoid space and promoting syrinx progression by inducing longitudinal oscillation of syrinx fluid during cardiac systole (Heiss, 2023; Heiss et al., 2019).

The exact location of the origin of the upper central canal (ACC) has been described, but the normal position of the canal inside the medulla oblongata and the cervical spinal cord remains unclear (Klekamp, 2018; Longatti et al., 2022; Petit‐Lacour et al., 2000). In our view, a comprehensive understanding of its physiological shape, orientation, surface, and position inside the medulla oblongata is essential before the pathogenesis of syringomyelia can be investigated further. Consequently, we aimed to describe the normal anatomy and orientation of its initial medullary segment precisely in healthy subjects.

To the best of our knowledge, the initial course of the upper central canal has never been described in patients with syringomyelia secondary to craniovertebral junction malformations. Therefore, further in vivo high‐definition radiological investigations of patients with secondary syrinxes are warranted. These could be compared to our physiological measurements with the aim of finding correlations between anatomical variations and clinical outcomes.

4.3. Limitations of the study

This study has inherent bias owing to its cadaveric design. The axial cutting of the MO is susceptible to variation among brainstems, introducing a potential source of bias. Additionally, the study design does not allow for definitive conclusions regarding the closed or open status of the canal in the context of cadaveric dissection. The relatively advanced age of the patients probably affected the canal perimeter, consistently measured at less than 0.1 mm2 (Yasui et al., 1999). Furthermore, the exploratory nature of our study and the preliminary stage of our quantitative measurements preclude any direct application to specific clinical cases.

Moreover, the relatively low number of cadavers included in this study raises concerns about the generalizability of our results. However, the 3D model appears reliable, as indicated by the relatively narrow interquartile ranges of the median distances to the PMS and AMF, despite the small sample size. It is important to note that the immunohistochemical staining of the central canal served to eliminate any potential confusion about the identification of the canal, enhancing the reliability of our findings. Despite these limitations, our study provides insights into the normal anatomy and orientation of the initial medullary segment of the upper central canal in healthy subjects.

5. CONCLUSION

The cranial segment of the human central canal initiates it course at the ACC in the posterior part of the medulla oblongata. It consistently aligns along the midline, progressing toward its final position at the junction of the middle and anterior thirds of the spinal cord ~15 mm below the ACC. Subsequently, the central canal descends vertically down to the cervical spinal cord.

To validate our physiological description, further radiological studies employing more precise MRI sequences are needed. These studies should encompass a larger cohort of healthy volunteers and explore the anatomy of individuals with secondary sizing, providing a more comprehensive understanding of the course of the upper central canal and its potential implications for pathological conditions.

Lefevre, E. , Quang, M. L. , Chotard, G. , Knafo, S. , Mengelle, P. , Taupin, Y. , Liguoro, D. , Jecko, V. , Vignes, J.‐R. , & Roblot, P. (2025). Upper end of the central canal of the human spinal cord: Quantitative anatomical study and 3D modeling. Clinical Anatomy, 38(1), 35–42. 10.1002/ca.24196

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