SPINAL CORD

PROF DR NASARUDDIN ABDUL AZIZ

Management & Science University
dr_nasaruddin@msu.edu.my
 OBJECTIVES
• describe the external structure of the spinal
cord,
• draw and describe the internal structure of
the spinal cord,
• draw and describe the ascending and
descending tracts within the spinal cord,
• describe the meninges surrounding the
spinal cord,
• describe the blood supply of the spinal cord,
• explain the clinical correlations of &
applications related to the spinal cord
 Gross Appearance
• Cylindrical in shape
• Foramen magnum  L1/L2 (adult)
• L3 (newborn)
• Occupies upper ⅔ of vertebral canal
• Surrounded by 3 layers of meniges:
– dura mater
– arachnoid mater
– pia mater
• CSF in subarachnoid space
• Enlargements: cervical & lumbar
• Conus medullaris
• Filum termniale
• Anterior median fissure
• Posterior median sulcus
• 31 pairs of spinal nerves attached to it by
the anterior roots & posterior roots
Structure Of The Spinal Cord
 Gray Matter
• H-shaped pillar with anterior & posterior gray
horns
• United by gray commissure containing the
central canal
• Lateral gray column (horn) present in
thoracic & upper lumbar segments
• Amount of gray matter related to the amount
of muscle innervated
• Consists of nerve cells, neuroglia, blood
vessels
Nerve cells in the anterior gray columns
• Large & multipolar
• Axons pass out in the anterior nerve roots
as α-efferents
• Smaller nerve cells are multipolar
• Axons pass out in anterior roots as ɣ-
efferents
Nerve cells in the posterior gray columns
• 4 nerve cell groups
• Substantia gelatinosa
– situated at the apex
– throughout the length of spinal cord
– composed mainly of Golgi Type II neurons
– receives afferent fibres concerning with pain,
temperature & touch from posterior root
• Nucleus proprius
– anterior to substantia gelatinosa
– present throughout the whole length of spinal
cord
– main bulk of cells in posterior gray column
– receives fibers from posterior white column
that are assoc with proprioception, 2-point
discrimination & vibration
• Nucleus dorsalis (Clark’s column)
– base of posterior column
– C8 – L3 / L4
– associated with proprioceptive endings
(neuromuscular spindles & tendon spindles)
• Visceral afferent nucleus
– lateral to nucleus dorsalis
– T1 – L3
– receives visceral afferent info
• Nerve cells in the lateral gray columns
• Formed by the intermediolateral group of
cells
• T1 – L2 / L3
• Cells give rise to preganglionic
sympathetic fibres
• In S2, S3, S4; they give rise to
preganglionic parasympathetic fibres
• The gray commissure & central canal
– connects the gray on each side
– central canal in the centre
– posterior gray commissure
– anterior gray commissure
– central canal present throughout
– superiorly continuous with the central canal of
medulla oblongata
– inferiorly, expands as terminal ventricle
– terminates within the root of filum terminale
 White Matter
• Divided into
– anterior white column
– lateral white column
– posterior white column
• Consists of nerve fibres, neuroglia, blood
vessels
• White due to myelinated fibres
 Tracts
• Ascending
• Descending
• Intersegmental
 Ascending Tracts
• Fibres that ascend from spinal cord to
higher centres
• Conduct afferent information which may or
may not reach consciousness
• Information may be
– exteroceptive (pain, Tº, touch)
– proprioceptive (from muscles & joints)
 Organization
• Ascending pathway that reach
consciousness consists of 3 neurons:
– 1st-order neuron
– 2nd-order neuron
– 3rd-order neuron
• Branch to reticular formation
(wakefulness)
• Branch to motor neurons (reflex activity)
• Lateral spinothalamic tract
– pain & Tº
• Anterior spinothalamic tract
– light (crude) touch & pressure
• Fasciculus cuneatus
• Fasciculus gracilis
– discriminatory touch, vibration, info from muscles &
joints
• Anterior spinocerebellar tract
• Posterior spinocerebellar tract
– unconscious info from muscles, joints, skin, subcut
• Spinotectal tract
– spinovisual reflexes
• Spinoreticular tract
– info from muscles, joints & skin to reticular
formation
• Spino-olivary tract
– indirect pathway to cerebellum
 Lateral spinothalamic tract
• Pain & temp pathways
• 1st-order neurons
• Pain conducted by δ A-type fibres & C-type
fibres
• 2nd-order neurons
– decussate to the opposite side
– ends in thalamus (ventral posterolateral nucleus
• 3rd-order neurons
– ends in sensory area in postcentral gyrus
 Anterior spinothalamic tracts
• Light (crude) touch & pressure pathways
 Posterior white column
• Discriminative touch, vibratory sense,
conscious muscle joint sense (conscious
proprioception)
 Posterior spinocerebellar tract
• Muscle joint sense pathways to
cerebellum
• Unconscious proprioception
• Muscle joint info from muscle spindles,
GTO, joint receptors of the trunk & lower
limbs
• Info is used by the cerebellum in the
coordination of movements & maintenance
of posture
 Anterior spinocerebellar tract
• Majority of 2nd-order neurons cross to the
opposite side
• Enter cerebellum through superior
cerebellar peduncle
• Info from trunk, upper & lower limbs
• Also carries info from skin & subcut tissue
 Descending Tracts
• Lower motor neurons
• Upper motor neurons
• Corticospinal tracts
– concerned with voluntary, discrete, skilled
movements
• Reticulospinal tract
– facilitates or inhibits voluntary movement or reflex
activity
• Tectospinal tract
– reflex postural movements in response to visual
stimuli
• Rubrospinal tract
– facilitates activity of flexor muscles & inhibits
activity of extensor muscles
• Vestibulospinal tract
– facilitates extensor muscles, inhibits flexor
muscles
 Meninges
• Dura mater
• Arachnoid mater
• Pia mater
 Dura mater
• Dense, strong fibrous membrane
• Encloses the spinal cord & cauda equina
• Continuous above with meningeal layer of
dura covering the brain
• Ends at the level of S2
• Separated from wall of vertebral canal by
the extradural space
• Contains loose areolar tissue & internal
vertebral venous space
 Arachnoid mater
• Delicate impermeable membrane
• Lies between pia and dura mater
• Separated from pia mater by subarachnoid
space
• Continuous above with arachnoid mater
covering the brain
• Ends on filum terminale at level of S2
 Pia mater
• Vascular membrane
• Closely covers spinal cord
• Thickened on either side between nerve
roots to form the ligamentum denticulatum
 Blood supply
Arteries of the spinal cord
• Anterior spinal artery
• Posterior spinal artery
• Segmental spinal arteries
 Anterior spinal artery
• Formed by the union of 2 arteries
• From vertebral artery
• Supply anterior ⅔ of spinal cord
Posterior spinal arteries
• Arise from vertebral artery or posterior
inferior cerebellar arteries (PICA)
• Descend close to the posterior roots
• Supply posterior ⅓ of spinal cord
 Segmental spinal arteries
• Branches of arteries outside the vertebral
column
• Gives off the anterior & posterior radicular
arteries
• Great anterior medullary artery of
Adamkiewicz
• Arise from lateral intercostal artery or
lumbar artery at any level from T8 – L3
 Clinical correlations
Spinal shock
• Follows acute severe damage to the spinal
cord
• All cord functions below the level of the
lesion become depressed or lost
• Sensory impairment and flaccid paralysis
occur
• Segmental spinal reflexes are depressed
• Persists for less than 24 hours (may be as
long as 1 – 4 weeks)
 Poliomyelitis
• Acute viral infection of the neurones of
anterior gray column
• Motor nuclei of cranial nerves
• Death of motor neurone cells → paralysis
& wasting of muscles
• Muscles of lower limb more often affected
• Spinal anaesthesia
• Extradural anaesthesia