This comprehensive review examines the complex anatomical organization and functional significance of the spinal cord, emphasizing its critical role in neural transmission and motor control. The spinal cord demonstrates sophisticated structural differentiation with three distinct meningeal layers: the dura mater, arachnoid membrane, and pia mater, which provide protection and support for neural tissues. The internal architecture of the spinal cord exhibits precise laminar organization, with white matter containing specific ascending and descending tracts arranged in ventral, lateral, and dorsal funiculi. The white matter volume shows a characteristic craniocaudal reduction pattern, reflecting the progressive decrease in fiber numbers. The gray matter, organized according to Rexed laminae (I–X), contains functionally distinct neuronal populations arranged in specific columns. The text details the developmental segmentation of the spinal cord, including the formation of dermatomes and myotomes, which establish the foundation for sensory and motor organization. This segmental arrangement influences both the distribution of neural elements and the patterns of clinical manifestations in various pathological conditions. This chapter provides an extensive analysis of the spinal cord’s vascular supply, highlighting the significance of the anterior spinal artery and paired posterior spinal arteries, along with their supplementary radicular arteries. Special attention is given to the artery of Adamkiewicz and its critical role in thoracolumbar blood supply. The study encompasses a detailed examination of spinal roots and nerves, describing their formation, course, and functional significance. It elaborates on the complex organization of nerve roots, including their anatomical relationships within the vertebral canal and their role in sensory and motor functions. The review also addresses the intricate arrangement of ascending and descending tracts, emphasizing their roles in sensory perception and motor control. The anterolateral system, dorsal column–medial lemniscal system, and cerebellar input system are thoroughly examined, along with their clinical implications. This anatomical framework is essential for understanding spinal cord pathology and clinical manifestations of various neurological conditions. The text emphasizes the relationship between structural organization and functional outcomes, providing crucial insights for clinical practice in spinal cord medicine and rehabilitation medicine. This chapter concludes by highlighting the clinical significance of these anatomical relationships, particularly in the context of spinal cord injuries and neurological disorders. This comprehensive understanding of spinal cord anatomy serves as a fundamental basis for diagnostic evaluation and therapeutic intervention in clinical practice.