Spinal Cord Anatomy

1. AP 150 Chapter 12 Spinal Cord Anatomy

2. Spinal Cord • Runs through the vertebral canal • Extends from foramen magnum to second lumbar vertebra • Regions • Cervical • Thoracic • Lumbar • Sacral • Coccygeal • Gives rise to 31 pairs of spinal nerves • All are mixed nerves • Not uniform in diameter • Cervical enlargement: supplies upper limbs • Lumbar enlargement: supplies lower limbs • Conus medullaris- tapered inferior end • Ends between L1 and L2 • Cauda equina - origin of spinal nerves extending inferiorly from conus medullaris.

3. Meninges • Connective tissue membranes • Dura mater: outermost layer; continuous with epineurium of the spinal nerves • Arachnoid mater: thin and wispy • Pia mater: bound tightly to surface • Forms the filum terminale • anchors spinal cord to coccyx • Forms the denticulate ligaments that attach the spinal cord to the dura • Spaces • Epidural: external to the dura • Anesthestics injected here • Fat-fill • Subdural space: serous fluid • Subarachnoid: between pia and arachnoid • Filled with CSF

4. Cross Section of Spinal Cord • Anterior median fissure and posterior median sulcus • deep clefts partially separating left and right halves • Gray matter: neuron cell bodies, dendrites, axons • Divided into horns • Posterior (dorsal) horn • Anterior (ventral) horn • Lateral horn • White matter • Myelinated axons • Divided into three columns (funiculi) • Ventral • Dorsal • lateral • Each of these divided into sensory or motor tracts

5. Cross section of Spinal Cord • Commissures: connections between left and right halves • Gray with central canal in the center • White • Roots • Spinal nerves arise as rootlets then combine to form dorsal and ventral roots • Dorsal and ventral roots merge laterally and form the spinal nerve

6. Organization of Spinal Cord Gray Matter • Recall, it is divided into horns • Dorsal, lateral (only in thoracic region), and ventral • Dorsal half – sensory roots and ganglia • Ventral half – motor roots • Based on the type of neurons/cell bodies located in each horn, it is specialized further into 4 regions • Somatic sensory (SS) - axons of somatic sensory neurons • Visceral sensory (VS) - neurons of visceral sensory neur. • Visceral motor (VM) - cell bodies of visceral motor neurons • Somatic motor (SM) - cell bodies of somatic motor neurons

7. Gray Matter: Organization Figure 12.31

8. White Matter in the Spinal Cord • Divided into three funiculi (columns) – posterior, lateral, and anterior • Columns contain 3 different types of fibers (Ascend., Descend., Trans.) • Fibers run in three directions • Ascending fibers - compose the sensory tracts • Descending fibers - compose the motor tracts • Commissural (transverse) fibers - connect opposite sides of cord

9. White Matter Fiber Tract Generalizations • Pathways decussate (most) • Most consist of a chain of two or three neurons • Most exhibit somatotopy (precise spatial relationships) • All pathways are paired • one on each side of the spinal cord

10. White Matter: Pathway Generalizations

11. Descending (Motor) Pathways • Descending tracts deliver motor instructions from the brain to the spinal cord • Divided into two groups • Pyramidal, or corticospinal, tracts • Indirect pathways, essentially all others • Motor pathways involve two neurons • Upper motor neuron (UMN) • Lower motor neuron (LMN) • aka ‘anterior horn motor neuron” (also, final common pathway)

12. Pyramidal (Corticospinal) Tracts • Originate in the precentral gyrus of brain (aka, primary motor area) • I.e., cell body of the UMN located in precentral gyrus • Pyramidal neuron is the UMN • Its axon forms the corticospinal tract • UMN synapses in the anterior horn with LMN • Some UMN decussate in pyramids = Lateral corticospinal tracts • Others decussate at other levels of s.c. = Anterior corticospinal tracts • LMN (anterior horn motor neurons) • Exits spinal cord via anterior root • Activates skeletal muscles • Regulates fast and fine (skilled) movements

13. Corticospinal tracts Location of UMN cell body in cerebral cortex Decussation of UMN axon in pyramids or at level of exit of LMN Synapse of UMN and LMN occurs in anterior horn of s.c. LMN axon exits via anterior root

14. Extrapyramidal Motor Tracts • Includes all motor pathways not part of the pyramidal system • Upper motor neuron (UMN) originates in nuclei deep in cerebrum (not in cerebral cortex) • UMN does not pass through the pyramids! • LMN is an anterior horn motor neuron • This system includes • Rubrospinal • Vestibulospinal • Reticulospinal • Tectospinal tracts • Regulate: • Axial muscles that maintain balance and posture • Muscles controlling coarse movements of the proximal portions of limbs • Head, neck, and eye movement

15. Extrapyramidal Tract Note:1. UMN cell body location2. UMN axon decussates in pons3. Synapse between UMN and LMN occurs in anterior horn of sc 3. LMN exits via ventral root 4. LMN axon stimulates skeletal muscle

16. Extrapyramidal (Multineuronal) Pathways • Reticulospinal tracts – originates at reticular formation of brain; maintain balance • Rubrospinal tracts – originate in ‘red nucleus’ of midbrain; control flexor muscles • Tectospinal tracts - originate in superior colliculi and mediate head and eye movements towards visual targets (flash of light)

17. Main Ascending Pathways • The central processes of first-order neurons branch diffusely as they enter the spinal cord and medulla • Some branches take part in spinal cord reflexes • Others synapse with second-order neurons in the cord and medullary nuclei

18. Three Ascending Pathways • The nonspecific and specific ascending pathways send impulses to the sensory cortex • These pathways are responsible for discriminativetouch (2 pt. discrimination) and conscious proprioception (body position sense). • The spinocerebellar tracts send impulses to the cerebellum and do not contribute to sensory perception

19. Nonspecific Ascending Pathway • Include the lateral and anterior spinothalamic tracts • Lateral: transmits impulses concerned with pain and temp. to opposite side of brain • Anterior: transmits impulses concerned with crude touch and pressure to opposite side of brain • 1st order neuron: sensory neuron • 2nd order neuron: interneurons of dorsal horn; synapse with 3rd order neuron in thalamus • 3rd order neuron: carry impulse from thalamus to postcentral gyrus

20. Specific and Posterior Spinocerebellar Tracts • Dorsal Column Tract • 1. AKA Medial lemniscal pathway • 2. Fibers run only in dorsal column • 3. Transmit impulses from receptors in • skin and joints • 4. Detect discriminative touch and • body position sense =proprioception • 1st O.N.- a sensory neuron • synapses with 2nd O.N. in nucleus gracilis and nucleus cuneatus of medulla • 2nd O.N.- an interneuron • decussate and ascend to thalamus where it synapses with 3rd O.N. • 3rd-order (thalamic neurons) • transmits impulse to somato- • sensory cortex (postcentral gyrus) • Spinocerebellar Tract • Transmit info. about trunk and lower limb muscles and tendons to cerebellum • No conscious sensation

21. Spinal Cord Trauma and Disorders • Severe damage to ventral root results in flaccid paralysis (limp and unresponsive) • Skeletal muscles cannot move either voluntarily or involuntarily • Without stimulation, muscles atrophy. • When only UMN of primary motor cortex is damaged • spastic paralysis occurs - muscles affected by persistent spasms and exaggerated tendon reflexes • Muscles remain healthy longer but their movements are no longer • subject to voluntary control. • Muscles commonly become permanently shortened. • Transection (cross sectioning) at any level results in total motor and • sensory loss in body regions inferior to site of damage. • If injury in cervical region, all four limbs affected (quadriplegia) • If injury between T1 and L1, only lower limbs affected (paraplegia)

22. Spinal Cord Trauma and Disorders • Spinal shock - transient period of functional loss that follows the injury • Results in immediate depression of all reflex activity caudal to lesion. • Bowel and bladder reflexes stop, blood pressure falls, and all muscles (somatic and visceral) below the injury are paralyzed and insensitive. • Neural function usually returns within a few hours following injury • If function does not resume within 48 hrs, paralysis is permanent. • Amyotrophic Lateral Sclerosis (aka, Lou Gehrig’s disease) • Progressive destruction of anterior horn motor neurons and fibers of the • pyramidal tracts • Lose ability to speak, swallow, breathe. • Death within 5 yrs • Cause unknown (90%); others have high glutamate levels • Poliomyelitis • Virus destroys anterior horn motor neurons • Victims die from paralysis of respiratory muscles • Virus enters body in feces-contaminated water (public swimming pools)