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Spinal Cord
- Comparable to Input-Output (IO) System of the Computer - Spinal Nerve (C8, T12, L5, S5, Cx1)
Anterior (Ventral) Root Posterior (Dorsal) Root Dorsal Root (Spinal) Ganglion Root - Rootlets
Spinal Cord
External Figure
Spinomedullary Junction
- Foramen Magnum, Pyramidal decussation, C1 ventral root
Enlargements
- cervical (C5-T1) & lumbosacral (L1-L4)
Longitudinal Fissures
- anterior median fissure - anterolateral fissure - posterior median sulcus - posterolateral sulcus
Posterior median sulcus Posterolateral sulcus Posterior intermediate sulcus Fasciculus cuneatus Fasciculus gracilis Posterior surface of the spinal cord
Spinal Cord
Meninges
Periosteum of Vertebra
- Epidural Space ----------------- epidural anesthesia
Denticulate ligament
- specilization of the pia mater
- landmark for cordotomy
Spinal Cord
Vascular Supply
Arterial Supply
- Spinal Arteries Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery - Radicular Arteries ----- Segmental arteries from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery
Venous Drainage
- Longitudinal & Radicular Veins to Intervertebral veins ---- to Internal Vertebral Venous Plexus to external vertebral venous plexus ---- to segmental veins
5. Adamkiwicz artery
segmental arteries
Spinal Cord
Internal Structure
White Matter
Anterior Funiculus (Anterior White Column) Posterior Funiculus (Posterior White Column)
Fasciculus Gracilis & Fasciculus Cuneatus
Gray Matter
Anterior Horn ------------ --Posterior Horn -------------Lateral Horn ----------------Gray Commissure -------motor sensory autonomic (sympathetic) anterior and posterior
1. posterior horn
2. anterior horn
3. intermediate zone (intermediate gray) 4. lateral horn 5. posterior funiculus 6. anterior funiculus 7. lateral funiculus
9. anterior median fissure 10. posterior median sulcus 11. anterolateral sulcus 12. posterolateral sulcus 13. Posterior intermediate sulcus
8. Lissauer's tract
Spinal Cord
Internal Structure
2) Transverse Arrangement
Afferent & Efferent Fibers Crossing (Commissural and Decussating) Fibers
3) Somatotopical Arrangement
Columnnar arrangement
somatotopical arrangement
Spinal Cord
Internal Structure
Lamina of Rexed
Lamina I ---------- posteromarginal nucleus Lamina II ---------- substantia gelatinosa of Rolando Lamina III, IV ----- nucleus proprius Lamina V, VI Lamina VII --------- intermediate gray intermediolateral cell column (ILM) Clarkes column (Nucleus dorsalis) intermediomedial cell column (IMM) Lamina VIII Lamina IX ---------- anterior horn (motor) cell Lamina X ----------- gray commissure
Lamina of Rexed
Spinal Cord
Tracts
Ascending Tracts
Modality: Touch, Pain, Temperature, Kinesthesia Receptor: Exteroceptor, Interoceptor, Proprioceptor Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion) Secondary Neuron: Spinal Cord or Brain Stem (Tertiary Neuron): Thalamus (Ventrobasal Nuclear Complex) Termination: Cerebral Cortex, Cerebellar Cortex, or Brain Stem
Spinal Cord
Tracts
Ascending Tracts
Posterior White Column-Medial Lemniscal Pathway Spinothalamic Tract Spinoreticular or Spinoreticulothalamic Tract Spinocerebellar Tract Spinomedullothalamic Tract Cervicothalamic or Spinocervicothalamic Tract Spino-olivary Tract Spinotectal Tract
Spinal Cord
Ascending Tracts
medial lemniscus
lemniscal decussation internal arcuate fiber posterior white column posterior root
Spinal Cord
Ascending Tracts
Spinothalamic Tract
Modality: Pain & Temperature Sensation, Light Touch Receptor: Free Nerve Ending
spinothalamic tract
decussation
posterior root
Spinothalamic Tract
- contralateral loss of pain and temperature sensation below the level of lesion
NeoSTT
Primary Motor Area (M I)
PaleoSTT
Widespread cortical region
VPLc (ventrobasal CL (intralaminar nuclear complex) thalamic nuclei) (spinal lemniscus) reticulothalamic pathways spinothalamic tract spinoreticular tract
thalamus
reticular formation
Fast Pain
Sharp, pricking Group III (A) fiber Short latency Well localized Short duration Less emotional Not blocked by morphine Neospinothalamic Tract
Slow Pain
Dull, burning Group IV (C) fiber Slower onset Diffuse Long duration Emotional, autonomic response Blocked by morphine Paleospinothalamic Tract
Spinal Cord
Ascending Tracts
Spinocerebellar Tract
Modality: Unconscious Proprioception Receptor: Muscle spindle, Golgi tendon organ
3. Posterior Horn
Anterior Spinocerebellar r Tract
Anterior SCbllT (superior cerebellar peduncle) anterior spinocerebellar tract anterior white commissure posterior root
Posterior SCbllT Inferior cerebellar peduncle cuneocerebellar tract (upper body) posterior white column posterior root
posterior spinocerebellar tract Clarkes column posterior white column posterior root
Spinocerebellar Tract
Spinocerebellar Tract
Spinal Cord
Descending Tracts
Corticospinal Tract
Corona Radiata lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Longitudinal Pontine Fiber Pyramid - pyramidal decussation Corticospinal Tract - Lateral and Anterior
Corona Radiata
lnternal Capsule, Posterior Limb Crus Cerebri, Middle Portion Longitudinal Pontine Fiber
Pyramid
Pyramidal Decussation Corticospinal Tract
CR
IC
Corticospinal Tract
Pyr PD LCST
ACST
Spinal Cord
Descending Tracts
ventromedial pathway
dorolateral pathway
VOLUNTARY CONTROL
LMN
Pyramidal Tract
REFLEX
Spinal Cord
Syndrome
ipsilateral to lesion
contralateral to lesion
Increase
Positive Babinski Sign Absent Absent
Absent DTR
Absent Present Could be Present
Spinal Cord
Syndrome
Spinal Cord
Syndrome
1. corticospinal tract
Spinal Cord
Syndrome
Tabes Dorsalis
- common variety of neurosyphilis - posterior colum and spinal posterior root lesion - loss of discriminative touch sensation and conscious proprioception below the level of lesion - posterior column ataxia - lancinating pain - loss of deep tendon reflex (DTR)
Spinal Cord
Syndrome
Spinal Cord
Syndrome
1. corticospinal tract
Spinal Cord
Syndrome
Syringomyelia, Hematomyelia
Lesion - central canal of spinal cord - gradually extended to peripheral part of the cord Symptom - initial symptom is bilateral loss of pain (compression of anterior white commissure) - variety of symptoms appear according to the lesion extended from central canal
Spinal Cord
Syndrome
Spinal Cord
Syndrome
Brown-Sequard syndrome
(spinal cord hemisection)
Major Symptoms 1. ipsilateral UMN syndrome below the level of lesion 2. ipsilateral LMN syndrome at the level of lesion 3. ipsilateral loss of discriminative touch sensation and conscious proprioception below the level of lesion (posterior white column lesion) 4. contralateral loss of pain and temperature sensation below the level of lesion (spinothalamic tract lesion)
Spinal Cord
Syndrome
3'
3 1 2 4
5'
5 1' 3 3 1