Neuroanatomy Learning Objectives

THE SPINAL CORD

The Gross Structure of the Spinal Cord in Situ
Lies within vertebral canal formed by foramina of vertebral column. Extends from medulla oblongata (lower half of brainstem). Spinal cord begins at occipital bone and ends between 1st and 2nd lumbar vertebrae. The diameter of the spinal cord varies as follows (thickest to thinnest): 1. Cervical. The cervical enlargement extends from C3-T2. It corresponds with the brachial plexus nerves, which innervate upper limb and 6th pair of cervical nerves. 2. Thoracic 3. Lumbar (note lumbar cord basically consists of the lumbar enlargement, which is thicker than thoracic cord). It extends from T11-L1, below which it tapers rapidly into conus medullaris. It corresponds to lumbosacral plexus nerves, which innervate lower limb. The enlargements are where sensory and motor neurons enter and exit. The spinal cord is divided into segments (31 spinal segments based on origins of spinal nerves): 1. There are 33 spinal cord nerve segments. Axons in CNS are grouped into tracts (not nuclei). a. Cervical (C3-C8): 8 segments 8 pairs of cervical nerves (excluding C1 and C2. C1 spinal nerves exit column between occiput and C1 vertebra. C2 nerves exit between posterior arch of C1 vertebra and lamina of C2 vertebra). b. Thoracic (T1-T12): 12 segments 12 pairs of thoracic nerves. c. Lumbar (L1-L5): 5 segments 5 pairs of lumbar nerves. d. Sacral (S1-S5): 5 segments 5 pairs of cranial nerves. e. Coccygeal: 3 segments 3 segments join to form 1 segment 1 pair of nerves (exit through sacral hiatus). 2. Motor nerve rootlets branch out of R. and L. ventro-lateral sulci. 3. Sensory nerve rootlets branch out of R. and L. dorsal lateral sulci. 4. Rootlets form nerve roots and are part of peripheral nervous system. 2 Ventral (motor) + 2 dorsal (sensory) roots= spinal nerve (one on each side of cord). 5. Spinal nerves (except C1 and C2) form inside and exit through inter-vertebral foramen below corresponding vertebra.

Spinal nerves: 1. Upper part of vertebral column: Spinal nerves exit directly from cord. 2. Lower part of vertebral column: Spinal nerves pass further down column before exiting. Terminal portion of cord is called conus medullaris. The pia mater continues as an extension called the filum terminale, which anchors cord to the coccyx. The cauda equina is a dangling collection of nerve roots in the vertebral column that continue to travel through the vertebral column below the conus medullaris. The cauda equina forms because the spinal cord stops growing in length at ~4yo, even though the vertebral column continues to lengthen until adulthood. This results in the fact that sacral spinal nerves actually originate in upper lumbar region. Ganglia and Roots: Each segment of the spinal cord is associated with a pair of ganglia, called dorsal root ganglia, which are situated just outside spinal cord. Dorsal root ganglia contain cell bodies of sensory neurons. Axons of these sensory neurons travel into the spinal cord via the dorsal roots. Ventral roots consist of axons from motor neurons, which bring information to periphery from cell bodies in CNS. Grey and White Matter of the Spinal Cord

The Gross Structure of the Vasculature of the Spinal Cord

Three arteries run longitudinally along the spinal cord: 1. One anterior (ventral) artery 2. Two posterior (dorsal) arteries Spinal arteries arise from the segmental or root (radicular) arteries that follow dorsal and ventral spinal roots. They interconnect in the pial plexus which then supplies the deep tissue of the spinal cord. The other connections to the spinal arterial supply are: 1. Vertebral artery (cervical region) 2. Intercostal arteries (thoracic region) 3. Lumbar arteries (lumbar region) 4. Lateral sacral artery (sacral region) Venous drainage of the spinal cord occurs from veins running parallel with the dorsal and ventral spinal arteries and then into the large and complex epidural venous network.

The Internal Structure of the Spinal Cord

Internally, the spinal cord consists of:

1. White matter: Tracts of myelinated nerve fibres. Lies around outside of grey matter. Is divided into dorsal (posterior), lateral and ventral (anterior) funiculi. The white matter is located outside of the grey matter and consists of myelinated motor and sensory axons. Columns of white matter carry information up or down the cord. 2. Grey matter: Nerve cell bodies and their neuropil. Lies centrally in the spinal cord. In cross section looks like a H or a butterfly. Contains a central canal which is continuous with ventricular system of brain. The grey matter consists of interneurons and motor neurons. It also consists of neuroglia cells and unmyelinated axons. Projections of the grey matter (wings) are called horns. The grey horns and grey commissure form the grey H.

Neurons of the Spinal Cord

The Dorsal Roots of the Spinal Cord Bear the dorsal root ganglia (sensory). The Ventral Roots of the Spinal Cord: 1. Somatic motor fibres arise from final motor neurons in ventral horns striated muscle. 2. Autonomic preganglionic fibres arise from spinal preganglionic neurons. They are in the intermediolateral columns (below) and project to final motor neurons in peripheral autonomic ganglia: a. Thoracic and upper lumbar cord (sympathetic). b. Sacral cord (parasympathetic). 3. Paravertebral sympathetic chain ganglia are linked to the ventral roots by communicating rami. Lateral Horn The lateral horn is found at thoracic, upper lumbar and sacral levels, which contain autonomic preganglionic neurons.

Descending [upper] motor tracts of the WHITE MATTER (all end in various regions of ventral horns)
1. Cortico-spinal (pyramidal) Tract a. Crossed = lateral funiculus. b. Uncrossed = ventral funiculus. 2. Extra-pyramidal Tracts a. Rubrospinal = descends in lateral funiculus Small and rudimentary. Responsible for large muscle movement and fine motor control. b. Medullary Reticulospinal = descends in ventral/lateral funiculus Excites anti-gravity extensor muscles. The fibres of this tract arise from caudal pontine reticular nucleus and the oral pontine reticular nucleus. Fibres of this tract project to interneurons of lamina VII and VIII of cord. c. Pontine (lateral) reticulospinal = descends in ventral funiculus Inhibits excitatory axial extensor muscles of movement. The fibres of this tract arise from the medullary reticular formation, mostly from the gigantocellular nucleus, and descend the length of the cord in the anterior part of the lateral column. This tract terminates in the grey spinal laminae. d. Vestibulospinal = descends in ventral funiculus Maintain balance and posture of body and head based on information from the inner ear (via vestibulocochlear nerve). The fibres of this tract arise from the lateral vestibular nucleus. This tract terminates at the interneurons of lamina VII and VIII.

Ascending [lower] sensory tracts of the WHITE MATTER (via the dorsal horns)
1. Fasciculus gracilis (carries information from below T6) = Ascends in medial part of dorsal funiculus Bundle of axon fibres in posterior column of cord. Carries proprioceptive information from middle thoracic and lower limbs of the body to the brain stem. Also carries deep touch, vibrational and visceral pain sensations to the brain stem. 2. Fasciculus cuneatus (carries information from T6 and up) = Ascends in lateral part of dorsal funiculus Nerves running in posterior column of cord. Sensation from spinal nerves in C1 and T6 dermatomes. Carries fine touch, fine pressure, vibration and proprioceptive information. Carries sensation to the brain stem. 3. Spinothalamic tract = Ascends in ventral and lateral funiculi Transmits pain, temperature, itch and crude touch information to thalamus. This pathway decussates at spinal cord level, not the brainstem. There are two main parts of this tract: a. Lateral tract: Pain and temperature. b. Anterior (ventral) tract: Crude touch. 4. Dorsal spinocerebellar tract = Ascends in dorsal part of lateral funiculus Transmits proprioceptive information from muscles to cerebellum. This tract runs in parallel with ventral tract. Transmits information from ipsilateral caudal aspect of the body and legs. 5. Ventral spinocereballar tract = Ascends in ventral part of lateral funiculus Transmits proprioceptive information from muscles to cerebellum. Transmits information from ipsilateral caudal aspect of body and legs.

The Relative Sizes of the Spinal Fibre Tract Varies with Spinal Level
Spinal Level Sacral Grey Matter Dorsal horn prominent. Lateral horn prominent. Ventral horn large. Dorsal horn prominent. Lateral horn small/absent. Ventral horn large. Dorsal horn slender. Lateral horn small. Ventral horn modest. Dorsal horn slender. Lateral horn absent. Ventral horn large. White Matter Small

Lumbar

Large

Thoracic

Large

Cervical

Large (especially lateral and dorsal)

The various sizes in the table above vary in accordance with the amount of sensory and motor information that needs to be transmitted. ????????????????????????????????????????????????????????????????????????????????????????????

The Gross Structure of the Meninges

The meninges consists of three principal layers and enclose a space containing the CSF (superficial to deep): 1. Dura 2. Arachnoid 3. Pia The epidural space is external to the dura and carries the epidural veins of the spinal cord. The CSF itself is in the subarachnoid space. The spinal cord is suspended in the dural sheath by the denticulate ligaments that run from the inner surface of the dura between the dorsal and ventral rootlets.

Other Aspects of the Spinal Cord

Be able to identify: Dorsal sulcus Ventral Medial Fissure Conus Medullaris (tapering caudal end of spinal cord) Filum Terminale (pial extension beyond spinal cord) Cauda Equina (spinal nerves arising caudal to L2)