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Spinal Cord

Welke, Ph.D.
Anatomy: Spinal
Cord
31 pairs of spinal
nerves
31 spinal cord
segments
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
33 vertebral bodies
Spinal Nerves
Dorsal and ventral roots coalesce
to form spinal nerves after
receiving fibers from the
sympathetic ganglia

The dorsal root has two divisions:


1-Medial
axons here are large diameter and
myelinated. They carry touch, two
point discrimination, position
sense, vibratory sensation and
acute, sharp pain and temperature
into the spinal cord.
Dorsal
Root
2-Lateral
axons here are small diameter and
usually unmyelinated. They carry Ventral
Root
chronic, aching pain and itch. Spinal
Nerve
Dermatomes
The receptive fields of all the dorsal root ganglion
neurons make up a single dermatome
Spinal Cord Morphology

5 Levels each with a


specific morphology
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
Spinal Cord Morphology

The basic pattern of the


spinal cord white and grey
matter is altered according
to the relative amount and
density of body innervated
more neurons are located
where extremities are
located!

Cervical enlargement:
C5-T1
Lumbar enlargement:
L1-S3
Growth of spinal cord
& vertebral column
Conus medullaris in newborns
ends at L3
Conus medullaris in adults
ends at L 1
The spinal root fibers
(lumbar and sacral fibers)
that exit the spinal cord
caudal to L1 form the cauda
equina
These fibers still exit the
vertebral canal at their
appropriate intervertebral
foramina
Lumbar puncture is safe in
adults caudal to L3
Spinal Cord - Orientation

posterior dorsal

R White Matter L
Grey Matter

anterior ventral
Spinal Cord Morphology

Thoracic
Coccygeal Sacral Lumbar (Lower)
(Enlargement)

Thoracic Cervical Cervical


(Upper) (Enlargement) (Upper)
Spinal Cord Cervical Enlargement

Enlargements

Bulbous Ventral Horns


Cervical (C5-T1)
Brachial Plexus
Upper Limbs Lumbar Enlargement
Lumbar (L1-S3)
Lumbosacral Plexus
Lower Limbs
Major Landmarks
Posterior Median Sulcus
Posterior Intermediate
Sulcus

Posterior Lateral
Sulcus

Spinal Canal

Anterior Median Fissure


Major Landmarks
Posterior Funiculus
Lateral Funiculus (Dorsal Column)
(Lateral Column)

Anterior Funiculus
(Anterior Column)
Major Landmarks
Posterior Intermediate Fasciculus Gracilis
Sulcus

Fasciculus Cuneatus
Dorsal Horn

Intermediate Zone

Ventral Horn

Anterior White Commissure


Information Flow

Sensory Input

Sympathetic Motor Output

Skeletal Motor Output


Information Flow

TS Spinal cord detailing components of spinal nerve


Copyright 2008 Dr. Akintola B. Odutola, MBBS, PhD, FRCSEd.


Spinal Cord Gray Matter
Spinal Cord Gray Matter
Has a typical - H or butterfly appearance
Is organized into divisions referred to as horns (the embryonic plates)
Dorsal horn (Alar plate) Sensory!
Ventral horn (Basal plate) Motor!
Intermediate (lateral) horn (in thoracic and upper lumbar segments only)

Dorsal Horn

Intermediate Zone

Ventral Horn
Organization of Spinal Cord Gray Matter
Organization of Spinal Cord Gray Matter
Nuclear groups: Rexeds Laminae:
-Named by location and cell -10 cytoarchitectonic layers or regions
body morphology -I-VI in dorsal horn; VII intermediate zone;
-Leaves much of grey matter IX motor cell columns; X central grey
-Accounts for all of grey matter
unaccounted for
C
A

A

A

A

A
C
A

Lamina I (marginal layer-posteromarginal nucleus) = mostly nociceptive-specific neurons


Lamina II (substantia gelatinosa) = almost exclusively interneurons
Lamina III, IV, V (nucleus proprius) = nonnoxious stimuli
Lamina VI = Lateral neurons receives corticospinal and rubrospinal fibers and medial neurons receive
afferent from muscle spindles and joints.
Lamina VII (nucleus dorsalis & Clarkes nucleus) = neurons that respond to non-noxious joint receptors for
manipulation of joints
Lamina VII (intermediolateral nuclei) = neurons that respond to noxious & more complex properties
(sympathetic neurons! C8-L2)
VIII (interneurons) = neurons that respond to noxious & more complex properties
Lamina IX = alpha motor neurons
Lamina X = neurons around the central canal
Gray Matter Dorsal Horn
Nucleus posteromarginalis
Substantia gelatinosa
(all levels)
(all levels)

Nucleus proprius
(all levels)
Gray Matter Lateral Horn
-Intermediate gray and
lateral horn = only from
C8- L2 (Lamina VII)

-Contain preganglionic
sympathetic neuron cell
bodies in lateral horn

-Also, in intermediate
zone sacral autonomic
nuclei S2 S4

-Clarkes Column (nucleus


dorsalis & Clarkes
nucleus)= send
unconscious propioception
to cerebellum
Gray Matter Ventral Horn
Ventral horn (Basal plate) Ventral Horn
-contains mainly motor
neurons called alpha and
gamma motoneurons
-Alpha motoneurons supply
skeletal muscles (extrafusal
fibers)
-Gamma motoneurons supply
muscle spindles

-Cells supplying proximal


musculature are medial to
those supplying distal limbs

-Cells supplying flexor


muscles are dorsal to those
supplying extensor muscles
Corticospinal Nuclear Groups (2)

Medial Motor Cell Column


(all levels)

Lateral Motor Cell Column


(C3-T2 and L1-S3)

WHY?
Somatotopic Organization
of Ventral Horn Neurons

The neuronal cell


bodies in the
anterior horn
are located
according to the
muscles they
innervate.
Upper & Lower Motor Neurons
Upper Motor Neurons (UMN)
-control lower motor neurons
-cell bodies are located in the brain stem
and cerebral cortex
-axons descend to reach spinal cord and
synapse on LMN or interneurons on the
side opposite to their side of origin
-most UMN fibers reach the spinal cord
in the corticospinal tract.
-Other UMN arise from red nucleus,
reticular formation and vestibular nuclei.

Lower Motor Neurons (LMN)


-are located in ventral horn of spinal cord
and cranial nerve nuclei of the brain stem
-Axons exit the spinal cord from the
ventral root and join spinal nerves to
synapse on skeletal muscle at
neuromuscular junction
Upper Vs. Lower Motor Neurons: Injury

Corticospinal Tract:

-Lower motor neuron (LMN) lesion produces flaccid paralysis


-Hypotonicity of muscle (paralysis)
-Absent or hypotonic reflexes
-Fasciculations (twitching of muscle fibers)
-Muscle atrophy

-Upper motor neuron (UMN) lesion produces spastic paralysis


-Weakness of muscles (paresis)
-Hypereflexia
-Hypertonia with spasticity
-Babinski sign present
Upper Vs. Lower Motor Neuron Lesions
(chronic NOT spinal shock)

Characteristics Upper motor neuron Lower motor neuron


lesion lesion
Paralysis Spastic Flaccid
Reflexes Hyper-reflexia Areflexia
Muscle tone Increased Reduced with fasciculation
Muscle power Weak Very weak
Atrophy Disuse Pronounced
Speed of movement Decreased Lost
Area of coverage Large Localized
Babinski reflex Present Absent
Babinski Sign
-abnormal fanning of toes is usually a
sign of Corticospinal or Upper Motor
Neuron Damage

Normal

UMN
Lesion
UMN
Lesion
Spinal Cord White Matter
Organization of Spinal Cord White Matter
5 Categories of Fibers:

1-Long ascending tracts

2-Long descending tracts

3-Propriospinal fibers

4-Motor neuron fibers that


exit via the ventral spinal
roots

5-Dorsal root ganglion


afferent fibers which enter
the spinal cord
Organization of Spinal Cord White Matter
Fasciulus
Lateral
Fasciulus Gracilus
Corticospinal
Cuneatus Tract
Lissauers Rubrospinal
Tract Tract

Posterior
Spinocerebellar
Tract
AC
Anterior Lateral
Spinocerebellar MLF Reticulospinal
Tract Tract

Vestibulospinal
Tract
Medial
Anterior Reticulospinal
Spinothalamic Corticospinal Tectospinal Tract
Tract Tract Tract
Spinal Cord Syndromes
Complete transection
Brown-Squard syndrome
Syringomyelia
Friedrichs ataxia
Subacute combined degeneration
Amyotrophic Lateral Sclerosis
Tabes Dorsalis
Organization of Spinal Cord White Matter
Dorsal
Lateral
Columns
Corticospinal
Tract

Spinothalamic
Tract
Corticospinal Tract
Medial
Lemniscus
System
Spinothalamic /
Anterolateral
System
Transverse Cord
Section

Compression or
transverse lesion of
entire cord
Loss of
vibratory /
positional sense,
pain/temp, &
motor loss from
below the lesion
Brown-Squard
Syndrome
Compression or
lesion of one-half of
spinal cord
Ipsilateral
motor loss
Ipsilateral loss of
proprioception
and discriminative
touch
Contralateral loss
of pain and
temperature
Syringomyelia
Results from formation
of a cyst in the central
portion of the spinal
cord
Loss of Pain/
Temperature at or
just below cavity
due to
compression of
anterior white
commissure
restricted to
region of lesion
Friedrichs Ataxia
A hereditary disease with degeneration of
specific regions of spinal cord white matter
Spinocerebellar tracts
dorsal columns
corticospinal tracts
Subacute Combined Degeneration

Commonly seen
with vitamin B12
deficiency
bilateral spastic
paralysis
bilateral loss of
proprioception and
discriminative
touch
Amyotrophic Lateral Sclerosis
A motor system
disease that affects
both UMNs and LMNs
Begins in upper limbs
(40%), lower limbs
(40%) or brainstem
(20%)
Flaccid paralysis at
the level of the
lesion, spastic
paralysis below level
of the lesion
Tabes Dorsalis
one manifestation of neurosyphilis
destroys large diameter dorsal root fibers and
cell bodies in DRG usually in lumbrosacral
regions
Common symptoms:
1-sensory loss
2-tabetic gait
3-incontinence
End!