THE SPINAL CORD

Extends from foramen magnum to

second lumbar vertebra
Spinal Cord Segmented
Cervical
Thoracic
Lumbar
Sacral
Connected to 31 pairs of spinal nerves
All are mixed nerves; I.e., contain both
sensory and motor fibers
Not uniform in diameter throughout
length
Cervical enlargement: supplies
upper limbs
Lumbar enlargement: supplies
lower limbs
Conus medullaris: tapered inferior
end.
Cauda equina: origins of spinal nerves
extending inferiorly from lumbosacral
enlargement and conus medullaris.
12-2
 Spinal Meninges
Dura mater: outermost layer;
continuous with epineurium of the
spinal nerves
No firm connections to vertebrae
Epidural space: external to the
dura; anesthesia injected here in sc.
Contains blood vessels, areolar
connective tissue and fat.
Arachnoid mater: delicate net-
work of collagen and elastic fibers
Subarachnoid space: between pia
and arachnoid
CSF and blood vessels within web-
like strands of arachnoid tissue
Fluid functions as a shock absorber
Pia mater: thin layer of elastic and
collagen fibers bound tightly to
surface of brain and spinal cord
Denticulate ligaments extend from
pia through arachnoid to dura;
prevent lateral movement
Forms the filum terminale, which
anchors spinal cord to coccyx and
the denticulate ligaments that
attach the spinal cord to the dura
mater 12-3
 Location of Ascending and
Descending Tracts of the Spinal Cord
Spinal Nerves

12-6
 Ascending
Tracts
Carry sensory signals up to
the spinal cord
Typically uses 3 neurons
1st order neuron -
detects stimulus and
carries it to spinal cord
2nd order neuron - within
s.c.; continues to the
thalamus (the sensory
relay station)
3rd order neuron -
carries signal from
thalamus to sensory
region of cerebral cortex
Most have names with
prefix spino- 12-7
 Major Sensory or Ascending Tracts
Name Location Function
Fasciculus Posterior Discriminative touch,
gracilis Column proprioception
Weight discrimination
Fasciculus Posterior Same as FG
Cuneatus Column
Lateral Lateral Pain and Thermal
Spinothalamic Column sensations
Anterior Anterior Itch, Tickle, Pressure, Crude
Spinothalamic Column touch sensations
Posterior and Lateral Proprioceptors
Anterior Column
Spinocerebellar
 Medial
Lemniscus
System
Also called
posterior
column system.
Carries
sensations for
two-point
sensation (fine
touch),
pressure, and
vibration.
 Medial
Lemniscus
System
Primary fibers
ascend entire
length of spinal
cord and
synapse with
secondary
neurons in
medulla:
Fasciculus gracilis
Fasciculus
cuneatus
 Fibers of
fasciculus gracilis
synapse in
nucleus gracilis:
Convey sensations from
below midthoracic level.
Fibers of
fasciculus
cuneatus synapse
in nucleus
cuneatus:
Convey sensations from
above midthoracic level.
Also conveys
proprioceptive sensation
from arms to
cerebellum.
 Medial
Lemniscus
System
Secondary
fibers
decussate.
Secondary
fibers ascend
to synapse in
VPL of
thalamus.
Tertiary fibers
ascend
through
internal
capsule to
primary
sensory cortex.
Spinothala
mic System
Lateral
spinothalamic
tract
Anterior
spinothalamic
tract
 Lateral
Spinothalam
ic Tract
Carries pain
and
temperature
Primary fibers
ascend or
descend 1-2
spinal cord
segments
before
synapsing with
secondary
fibers.
 Lateral
Spinothala
mic Tract
Secondary
axons decussate
through anterior
gray and white
commissures.
Secondary
axons make up
the lateral
spinothalamic
tract traveling in
the lateral
column of the
spinal cord.
 Lateral
Spinothala
mic Tract
Secondary
fibers are
joined in
brainstem by
fibers of the
trigeminothala
mic tract:
(Pain and
temperature
from face and
teeth.)
 Lateral Spinothalamic Tract
Secondary fiber collaterals project to
reticular formation:
Stimulate wakefulness and
consciousness.
Secondary fibers project to ventral
posterolateral (VPL) nucleus of
thalamus.
 Lateral Spinothalamic Tract
Secondary fibers synapse with
tertiary fibers in VPL.
Tertiary fibers (corticopetal fibers)
synapse in postcentral gyrus:
Somatic sensory areas 3, 1, 2
Tertiary fibers form part of internal
capsule.
 Anterior
Spinothalami
c Tract
Carries light touch
(crude touch),
pressure, tickle, itch
Primary neurons
may ascend 8-10
spinal cord
segments before
synapsing with
secondary neurons.
Secondary fibers
decussate in
anterior gray or
white commissures.
 Anterior
Spinothalam
ic Tract
Secondary fibers
ascend to
synapse with
tertiary fibers in
VPL nucleus of
thalamus.
Tertiary fibers
ascend through
internal capsule
to primary
sensory cortex.
 Posterior Spinocerebellar
Tract
Originates in thoracic and upper
lumbar regions.
Consists of uncrossed fibers that
enter cerebellum through inferior
cerebellar peduncles.
Transmits ipsilateral proprioceptive
information to cerebellum.
 Anterior Spinocerebellar
Tract
Originates in lower trunk and lower
limbs.
Consists of crossed fibers that
recross in pons and enter cerebellum
through superior cerebellar
peduncles.
Transmits ipsilateral proprioceptive
information to cerebellum.
 Spino-Olivary Tracts
Project to accessory olivary nuclei
and cerebellum.
Contribute to movement coordination
associated primarily with balance.
 Spinotectal Tracts
Project to superior colliculi of
midbrain.
Involved in reflexive turning of the
head and eyes toward a point of
cutaneous stimulation.
 Spinoreticular Tracts
Involved in arousing consciousness in
the reticular activating system
through cutaneous stimulation.
 Spinoreticular Tract
Pain signals from tissue injury
Decussate in spinal cord and ascend
with spinothalamic fibers
End in reticular formation (medulla
and pons)
3rd and 4th order neurons continue to
thalamus and cerebral cortex

12-27
 Descending (Motor)
Pathways
Descending tracts deliver efferent
impulses from the brain to the spinal
cord, and are divided into two groups
Direct pathways equivalent to the pyramidal
tracts
Indirect pathways, essentially all others
Motor pathways involve two neurons
Upper motor neuron (UMN)
Begins with soma in cerebral cortex or brainstem
Its axon terminates ON the LMN in anterior horn
Lower motor neuron (LMN)
Soma in anterior horn; axon leads to muscle
aka anterior horn motor neuron (also, final
common pathway)
12-28
Motor or Descending Tracts of the
Spinal Cord
Name Location Function
Lateral Lateral Muscles of the limbs,
Corticospinal Column hands, and feet
Anterior Anterior Muscles of the axial
Corticospinal Column skeleton
Corticobulbar Cerebral Skeletal muscles of the
Peduncle head and neck via cranial
nerves
Rubrospinal Lateral Skeletal muscles of the
Column limbs, hands, and feet
Tectospinal Anterior Skeletal muscles of the
Column head and eyes in response
to visual stimuli
Motor or Descending Tracts of the
Spinal Cord
Name Location Function
Vestibulospinal Anterior Muscle for maintaining
column balance in response to head
movements
Lateral Anterior Facilitates flexor reflexes
reticulospinal column Inhibits extensor reflexes
Medial Anterior Facilitates extensor reflexes
reticulospinal column Inhibits Flexor reflexes
 The Direct
(Pyramidal)
System
Direct pathways originate
with the pyramidal neurons
in the precentral gyri (aka,
primary motor area).
Pyramidal neuron is the
UMN; it forms the
corticospinal tract (cortico
=cortex; spinal - s.c.)
UMN synapses in the
anterior horn with LMN
LMN (anterior horn motor
neurons) activates skeletal
muscles
The direct pathway
regulates fast and fine
(skilled) movements
Lateral corticospinal tracts:
UMN decussates in
pyramids of medulla
Anterior corticospinal tracts:
UMN decussates at the
spinal cord level 12-31
 Indirect (Extrapyramidal)
System
Upper motor neuron (UMN) originates in nuclei
deep in cerebrum (not in cerebral cortex); .e., in
brain stem,
UMN does not pass through the pyramids
LMN is an anterior horn motor neuron
This system includes the rubrospinal,
vestibulospinal, reticulospinal, and tectospinal
tracts
These motor pathways are complex and
multisynaptic

12-32
C1-C4 May need breathing
assistance

C5- No wrist or hand control,

some shoulder and bicep
control

C6- Includes some wrist control,

no hand control

C7 and T1- Can straighten

arms, lacking in hand and
finger control

T1-T8- Most often include hand

control, lack of trunk control

T9-T12- Have most trunk

control, can balance sitting up

Lumbar and Sacral- Loss

includes hip flexor and leg
control
Diseases of the Spinal
Cord
 Basic Features of Spinal Cord
Disease
UMN findings below the lesion
Hyperreflexia and Babinskis
Sensory and motor involvement that
localizes to a spinal cord level
Bowel and Bladder dysfunction
common
Remember that the spinal cord ends
at about T12-L1
 History
Onset
Acute, subacute, chronic
Symptoms
Pain
Weakness
Sensory
Autonomic
Past history
Family history
Tempo of Spinal Cord
Disease
 Motor Exam
Strength - helps to localize the lesion
Upper cervical
Quadriplegia with impaired respiration
Lower cervical
Proximal arm strength preserved
Hand weakness and leg weakness
Thoracic
Paraplegia
Can also see paraplegia with a midline lesion in
the brain
Tone
Increased distal to the lesion
 Sensory Exam
Establish a sensory level
Dermatomes
Nipples: T4-5
Umbilicus: T8-9
Posterior columns
Vibration
Joint position sense (proprioception)
Spinothalamic tracts
Pain
Temperature
 Autonomic disturbances
Neurogenic bladder
Urgency, incontinence, retention
Bowel dysfunction
Constipation more frequent than
incontinence
With a high cord lesion, loss of blood
pressure control
Alteration in sweating
 Investigation of Spinal Cord
Disease
Radiographic exams
Plain films
Myelography
CT scan with myelography
MRI
Spinal tap
If you suspect: inflammation, MS,
rupture of a vascular malformation
Etiology of Spinal Cord
Disease
 Traumatic Spinal Cord
Disease
10,000 new spinal cord injuries per year
MVA, sports injuries the most common
Victims under 30 yrs old, male>>females
Fx/dislocation of vertabrae most likely to
occur at:
C5,6
T12, L1
C1,2
 Tumors
Metastatic or primary
Extramedullary
Extradural - most common
Bony - breast, prostate
Intradural - very rare
Meninges - meningioma
Nerve root - schwannoma
Intramedullary - very rare
Metastatic
Primary - astrocytoma or ependymoma
 B12 Deficiency
Subacute combined degeneration of
the cord
B12 deficiency
malabsorption of B12 secondary to
pernicious anemia or surgery
insufficient dietary intake - vegan
Posterior columns and CST
involvement with a superimposed
peripheral neuropathy
 Transverse myelitis
Inflammation of the spinal cord
Post-infectious
Post-vaccinial
Multiple sclerosis
Pain at level of lesion may preceed
onset of weakness/sensory
change/b&b disturbance
Spinal tap may help with diagnosis
 Infections Involving the
Spinal Cord
Polio
only the anterior horn cells are infected
Tabes dorsalis
dorsal root ganglia and dorsal columns are
involved
tertiary syphillis
sensory ataxia, lightening pains
HIV myelopathy
mimics B12 deficiency
HTLV-1 myelopathy -
tropical spastic paraparesis
 Multiple Sclerosis
Demyelination is the underlying
pathology
Cord disease can be presenting feature
of MS or occur at any time during the
course of the disease
Lesion can be at any level of the cord
Patchy
Transverse
Devics syndrome or myelitis optica
Transverse myelitis with optic neuritis
 Vascular Diseases of the
Spinal Cord
Infarcts
Anterior spinal artery infarct
from atherosclerosis, during surgery in
which the aorta is clamped, dissecting
aortic aneurysm
less often, chronic meningitis or following trauma
posterior columns preserved (JPS, vib)
weakness (CST) and pain/temperature loss
(spinothalamic tracts)
Artery of Adamkiewicz at T10-11
Watershed area
upper thoracic
Vascular Diseases of the Spinal
Cord, cont
Arteriovenous malformation (AVM) and
venous angiomas
Both occur in primarily the thoracic cord
May present either acutely, subacutely or
chronically (act as a compressive lesion)
Can cause recurrent symptoms
If they bleed
Associated with pain and bloody CSF
Notoriously difficult to diagnose
Hematoma - trauma, occasionally tumor
Other Disease of the Spinal
Cord
Hereditary spastic paraparesis
Usually autosomal dominant
Infectious process of the vertabrae
TB, bacterial
Herniated disc with cord compression
Most herniated discs are lateral and only
compress a nerve root
Degenerative disease of the vertabrae
Cervical spondylosis with a myelopathy
Spinal stenosis
 Classical spinal cord
syndromes
Anterior spinal artery infarct
Brown Sequard syndrome
Syringomyelia
Conus medullaris/caude equina
lesions
Brown Sequard Syndrome

Cord hemisection
Trauma or tumor
Dissociated sensory loss
loss of pain and temperature contralateral to
lesion, one or 2 levels below
crossing of spinothalamic tracts 1-2 segments above
where they enter
loss of vibration/proprioception ipsilateral to the
lesion
these pathways cross at the level of the brainstem
Weakness and UMN findings ipsilateral to lesion
 Syringomyelia
Fluid filled cavitation in the center of the
cord
Cervical cord most common site
Loss of pain and temperature related to the
crossing fibers occurs early
cape like sensory loss
Weakness of muscles in arms with atrophy
and hyporeflexia (AHC)
Later - CST involvement with brisk reflexes in
the legs, spasticity, and weakness
May occur as a late sequelae to trauma
Can see in association with Arnold Chiari
malformation
 Conus Medullaris vs. Cauda
Equina Lesion
Finding Conus CE

Motor Symmetric Asymmetric

Sensory loss Saddle Saddle
Pain Uncommon Common
Reflexes Increased Decreased
Bowel/bladder Common
Uncommon