The Spinal Cord The Spinal Cord
Structure of the spinal cordStructure of the spinal cord
Tracts of the spinal cordTracts of the spinal cord
Spinal cord syndromes Spinal cord syndromes
The Spinal Cord The Spinal Cord
Structure of the spinal cordStructure of the spinal cord
Tracts of the spinal cordTracts of the spinal cord
Spinal cord syndromes Spinal cord syndromes
Nabeel Kouka, Nabeel Kouka, MD, MBA, FABMISSMD, MBA, FABMISSwww.brain101.infowww.brain101.info
Nabeel Kouka, Nabeel Kouka, MD, MBA, FABMISSMD, MBA, FABMISSwww.brain101.infowww.brain101.info
- Comparable to- Comparable to Input-Output (IO) System of the ComputerInput-Output (IO) System of the Computer
- Spinal Nerve (C8, T12, L5, S5, Cx1)- Spinal Nerve (C8, T12, L5, S5, Cx1)
- Segmental Structure of Neural Tube Origin- Segmental Structure of Neural Tube Origin
- Comparable to- Comparable to Input-Output (IO) System of the ComputerInput-Output (IO) System of the Computer
- Spinal Nerve (C8, T12, L5, S5, Cx1)- Spinal Nerve (C8, T12, L5, S5, Cx1)
- Segmental Structure of Neural Tube Origin- Segmental Structure of Neural Tube Origin
Spinal CordSpinal CordSpinal CordSpinal Cord
Spinal segment Spinal segment
C8, T12, L5, S5, Cx1C8, T12, L5, S5, Cx1
Anterior (Ventral) RootAnterior (Ventral) RootPosterior (Dorsal) RootPosterior (Dorsal) Root Dorsal Root (Spinal) GanglionDorsal Root (Spinal) Ganglion
Root - RootletsRoot - Rootlets
Conus Medullaris Conus Medullaris (L1-2)(L1-2)
Cauda EquinaCauda Equina
Anterior median fissureAnterior median fissureAnterolateral fissureAnterolateral fissure
Posterior Posterior median sulcusmedian sulcus
PosterolateralPosterolateral
sulcussulcus
Posterior Posterior intermediate intermediate sulcussulcus
FasciculusFasciculus
cuneatuscuneatus
FasciculusFasciculus
gracilisgracilis
Posterior surface of the spinal cordPosterior surface of the spinal cord
Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane - - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis - Denticulate Ligament- Denticulate Ligament --------- --------- CordotomyCordotomy
- Filum Terminale- Filum Terminale
Periosteum of VertebraPeriosteum of Vertebra
- - Epidural Space Epidural Space ----------------- ----------------- epidural anesthesiaepidural anesthesia
Dura Mater Spinalis Dura Mater Spinalis
Arachnoid MembraneArachnoid Membrane - - Subarachnoid Space --------Subarachnoid Space -------- Lumbar Puncture Lumbar Puncture
Spinal AnesthesiaSpinal Anesthesia
Pia Mater SpinalisPia Mater Spinalis - Denticulate Ligament- Denticulate Ligament --------- --------- CordotomyCordotomy
- Filum Terminale- Filum Terminale
Spinal Cord MeningesSpinal Cord Meninges Spinal Cord MeningesSpinal Cord Meninges
Meninges of Meninges of the spinal cordthe spinal cord
• Dura materDura mater• Arachnoid membraneArachnoid membrane• Pia materPia mater
Denticulate ligamentDenticulate ligament
- specialization of the pia mater- specialization of the pia mater
- landmark for cordotomy- landmark for cordotomy
Meninges of the spinal cordMeninges of the spinal cord
Meninges of the spinal cordMeninges of the spinal cord
Lumbar Puncture – lumbar (terminal) cisternLumbar Puncture – lumbar (terminal) cistern
Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery
Venous DrainageVenous Drainage - - Longitudinal & Radicular Veins Longitudinal & Radicular Veins
toto Intervertebral veins Intervertebral veins ---- to ---- to Internal Vertebral Venous PlexusInternal Vertebral Venous Plexus
to to external vertebral venous plexus external vertebral venous plexus ---- to ---- to segmental veinssegmental veins
Arterial SupplyArterial Supply
- Spinal Arteries- Spinal Arteries
Anterior (1) & Posterior (2) Spinal ArteryAnterior (1) & Posterior (2) Spinal Artery
from from Vertebral arteryVertebral artery
- Radicular Arteries ----- Segmental arteries- Radicular Arteries ----- Segmental arteries
from from Vertebral, Ascending Cervical, Intercostal andVertebral, Ascending Cervical, Intercostal and
Lumbar Artery Lumbar Artery
Venous DrainageVenous Drainage - - Longitudinal & Radicular Veins Longitudinal & Radicular Veins
toto Intervertebral veins Intervertebral veins ---- to ---- to Internal Vertebral Venous PlexusInternal Vertebral Venous Plexus
to to external vertebral venous plexus external vertebral venous plexus ---- to ---- to segmental veinssegmental veins
Spinal Cord Spinal Cord Vascular SupplyVascular Supply Spinal Cord Spinal Cord Vascular SupplyVascular Supply
anterior spinal arteryanterior spinal artery segmental arteries segmental arteries
5. Adamkiwicz artery5. Adamkiwicz artery
Spinal Cord Spinal Cord External FigureExternal Figure Spinal Cord Spinal Cord External FigureExternal Figure
Conus Medullaris Conus Medullaris (L1-2)(L1-2)
Spinomedullary JunctionSpinomedullary Junction - Foramen Magnum, Pyramidal decussation, C1 ventral root
EnlargementsEnlargements - Cervical (C4-T1) & Lumbosacral (L1-L4)
Longitudinal FissuresLongitudinal Fissures - anterior median fissure - anterolateral fissure - posterior median sulcus - posterolateral sulcus
Conus Medullaris Conus Medullaris (L1-2)(L1-2)
Spinomedullary JunctionSpinomedullary Junction - Foramen Magnum, Pyramidal decussation, C1 ventral root
EnlargementsEnlargements - Cervical (C4-T1) & Lumbosacral (L1-L4)
Longitudinal FissuresLongitudinal Fissures - anterior median fissure - anterolateral fissure - posterior median sulcus - posterolateral sulcus
Spinal Cord Spinal Cord External FigureExternal Figure Spinal Cord Spinal Cord External FigureExternal Figure
cervical enlargement (C8)cervical enlargement (C8) thoracic cord (T8) thoracic cord (T8)
lumbar enlargement (L3)lumbar enlargement (L3) sacral cord (S1) sacral cord (S1)
• Cervical levelCervical level- Wide flat cord, lots of white matter, ventral horn enlargements.
• Lumbar levelLumbar level - Round cord, ventral horn enlargements.
• Sacral levelSacral level - Small round cord, lateral Horn.
• Tthoracic levelTthoracic level - Notice the pointed tips which stick out between the small dorsal and ventral horns. This extra cell column is called the intermediate horn (AKA: IntermediolateralIntermediolateral
Cell ColumnCell Column). It is the source of all of the sympathetics in the body & occurs only in the Thoracic sections T 1 - L 2
• Cervical levelCervical level- Wide flat cord, lots of white matter, ventral horn enlargements.
• Lumbar levelLumbar level - Round cord, ventral horn enlargements.
• Sacral levelSacral level - Small round cord, lateral Horn.
• Tthoracic levelTthoracic level - Notice the pointed tips which stick out between the small dorsal and ventral horns. This extra cell column is called the intermediate horn (AKA: IntermediolateralIntermediolateral
Cell ColumnCell Column). It is the source of all of the sympathetics in the body & occurs only in the Thoracic sections T 1 - L 2
White MatterWhite Matter Anterior Funiculus (Anterior White Column)Anterior Funiculus (Anterior White Column)
Posterior Funiculus (Posterior White Column)Posterior Funiculus (Posterior White Column) Fasciculus Gracilis & Fasciculus CuneatusFasciculus Gracilis & Fasciculus Cuneatus
Lateral Funiculus (Lateral White Column)Lateral Funiculus (Lateral White Column)
Gray MatterGray Matter Anterior Horn ------------Anterior Horn ------------------ motormotor
Posterior Horn --------------Posterior Horn -------------- sensorysensory
Lateral Horn -----------------Lateral Horn ----------------- autonomic (sympathetic)autonomic (sympathetic)
Gray Commissure -------- Gray Commissure -------- anterior and posterior anterior and posterior
White MatterWhite Matter Anterior Funiculus (Anterior White Column)Anterior Funiculus (Anterior White Column)
Posterior Funiculus (Posterior White Column)Posterior Funiculus (Posterior White Column) Fasciculus Gracilis & Fasciculus CuneatusFasciculus Gracilis & Fasciculus Cuneatus
Lateral Funiculus (Lateral White Column)Lateral Funiculus (Lateral White Column)
Gray MatterGray Matter Anterior Horn ------------Anterior Horn ------------------ motormotor
Posterior Horn --------------Posterior Horn -------------- sensorysensory
Lateral Horn -----------------Lateral Horn ----------------- autonomic (sympathetic)autonomic (sympathetic)
Gray Commissure -------- Gray Commissure -------- anterior and posterior anterior and posterior
Spinal Cord Spinal Cord Internal StructureInternal Structure Spinal Cord Spinal Cord Internal StructureInternal Structure
1. posterior horn 1. posterior horn
2. anterior horn 2. anterior horn
3. intermediate zone 3. intermediate zone
(intermediate gray) (intermediate gray)
4. lateral horn 4. lateral horn
5. posterior funiculus5. posterior funiculus
6. anterior funiculus6. anterior funiculus
7. lateral funiculus 7. lateral funiculus
8. Lissauer's tract 8. Lissauer's tract
9. anterior median 9. anterior median
fissure fissure
10. posterior median 10. posterior median
sulcus sulcus
11. anterolateral 11. anterolateral
sulcus sulcus
12. posterolateral 12. posterolateral
sulcus sulcus
13. Posterior13. Posterior
intermediate intermediate sulcus sulcus
Principles of Cord OrganizationPrinciples of Cord Organization
1) Longitudinal Arrangement1) Longitudinal Arrangement Fibers (White Matter) ------------- White ColumnFibers (White Matter) ------------- White Column
Cell Groups (Gray Matter) ------- Gray ColumnCell Groups (Gray Matter) ------- Gray Column
2) Transverse Arrangement2) Transverse Arrangement Afferent & Efferent FibersAfferent & Efferent Fibers
Crossing (Commissural and Decussating) FibersCrossing (Commissural and Decussating) Fibers
3) Somatotopical Arrangement3) Somatotopical Arrangement
Principles of Cord OrganizationPrinciples of Cord Organization
1) Longitudinal Arrangement1) Longitudinal Arrangement Fibers (White Matter) ------------- White ColumnFibers (White Matter) ------------- White Column
Cell Groups (Gray Matter) ------- Gray ColumnCell Groups (Gray Matter) ------- Gray Column
2) Transverse Arrangement2) Transverse Arrangement Afferent & Efferent FibersAfferent & Efferent Fibers
Crossing (Commissural and Decussating) FibersCrossing (Commissural and Decussating) Fibers
3) Somatotopical Arrangement3) Somatotopical Arrangement
Spinal Cord Spinal Cord Internal StructureInternal Structure Spinal Cord Spinal Cord Internal StructureInternal Structure
Columnar arrangement Somatotopical arrangementColumnar arrangement Somatotopical arrangement
Lamina of RexedLamina of RexedLamina of RexedLamina of Rexed
Lamina I Lamina I Posteromarginal NucleusPosteromarginal Nucleus
Lamina II Lamina II Substantia Gelatinosa of RolandoSubstantia Gelatinosa of Rolando
Lamina IIILamina III
Lamina IV, V, VI ----- Lamina IV, V, VI ----- Nucleus PropriusNucleus Proprius
Lamina VIILamina VII
- Intermediate Gray- Intermediate Gray
- I- Intermediolateral cell column (ILM)ntermediolateral cell column (ILM)
- - Clarke’s column (Nucleus dorsalis)Clarke’s column (Nucleus dorsalis)- I- Intermediomedial cell column (IMM)ntermediomedial cell column (IMM)
Lamina VIIILamina VIII
Lamina IX ---------- Lamina IX ---------- Anterior Horn (Motor) CellAnterior Horn (Motor) Cell
Lamina X ----------- Lamina X ----------- Gray CommissureGray Commissure
Lamina I Lamina I Posteromarginal NucleusPosteromarginal Nucleus
Lamina II Lamina II Substantia Gelatinosa of RolandoSubstantia Gelatinosa of Rolando
Lamina IIILamina III
Lamina IV, V, VI ----- Lamina IV, V, VI ----- Nucleus PropriusNucleus Proprius
Lamina VIILamina VII
- Intermediate Gray- Intermediate Gray
- I- Intermediolateral cell column (ILM)ntermediolateral cell column (ILM)
- - Clarke’s column (Nucleus dorsalis)Clarke’s column (Nucleus dorsalis)- I- Intermediomedial cell column (IMM)ntermediomedial cell column (IMM)
Lamina VIIILamina VIII
Lamina IX ---------- Lamina IX ---------- Anterior Horn (Motor) CellAnterior Horn (Motor) Cell
Lamina X ----------- Lamina X ----------- Gray CommissureGray Commissure
Lamina of RexedLamina of RexedLamina of RexedLamina of Rexed
• AKA: lamina marginalislamina marginalis or the layer of Waldeyer
• Receives incoming dorsal root fibers and collateral branches as well
• Larger neurons contribute axons to Contralateral Spinothalamic TractSpinothalamic Tract
• AKA: lamina marginalislamina marginalis or the layer of Waldeyer
• Receives incoming dorsal root fibers and collateral branches as well
• Larger neurons contribute axons to Contralateral Spinothalamic TractSpinothalamic Tract
Lamina ILamina ILamina ILamina I
• AKA: Substantia GelatinosaSubstantia Gelatinosa
• Involved in PainPain interpretation• Receives incoming inputincoming input from dorsaldorsal
rootroot axons & descending inputdescending input from
reticular formationreticular formation of the medulla • Efferent axons travel up & down several segments to make contact with other areas of the dorsal horn
• AKA: Substantia GelatinosaSubstantia Gelatinosa
• Involved in PainPain interpretation• Receives incoming inputincoming input from dorsaldorsal
rootroot axons & descending inputdescending input from
reticular formationreticular formation of the medulla • Efferent axons travel up & down several segments to make contact with other areas of the dorsal horn
Lamina IILamina IILamina IILamina II
• Contains larger, less densely packed cells than lamina II
• Receives primary afferents from dorsal rootdorsal root fibers
• Neurons considered as a part of nucleus propriusnucleus proprius
• Contains larger, less densely packed cells than lamina II
• Receives primary afferents from dorsal rootdorsal root fibers
• Neurons considered as a part of nucleus propriusnucleus proprius
Lamina IIILamina IIILamina IIILamina III
Lamina IVLamina IVLamina IVLamina IV
• Contains a variety of cell types that have more myelinmore myelin than any other lamina
• Some tract cellstract cells originate here, axons cross the midline and enter the contralateral Spinothalamic TractSpinothalamic Tract, also sends contacts to layers II and III
• Receives afferents from dorsal roots via the dorsal funiculusdorsal funiculus
• At rostral end of spinal cord, laminas I-IV become continuous with the spinal spinal trigeminal nucleustrigeminal nucleus
Lamina V - VILamina V - VILamina V - VILamina V - VI
• Origination of tract cellstract cells, similar to lamina IV, these tracts cells are also known as the Nucleus Proprius Nucleus Proprius (e.g. spinal thalamic tractspinal thalamic tract or anterolateral systemanterolateral system; pain and temperature, some tactile)
• Receives afferent input from dorsal roots and descending fibers, most importantly CorticospinalCorticospinal
Laterally, gray matter at base of dorsal horn mixes withwhite matter from lateral funiculus, this region is calledreticular formationreticular formation. It is noticeable in the cervical region
Laterally, gray matter at base of dorsal horn mixes withwhite matter from lateral funiculus, this region is calledreticular formationreticular formation. It is noticeable in the cervical region
Lamina V - VILamina V - VILamina V - VILamina V - VI
reticular formationreticular formation ---------------->---------------->
C7C7
• The largest region, occupies most of ventral horn &intermediate zone
• Projects long axons that connect to other gray matter segments of the cord
• Some columns do not fit into the lamina scheme, and have individual designations:
a. Nucleus dorsalis (ClarkeClarke)b. Intermediolateral cell columnc. Intermediomedial cell columnd. Sacral autonomic nucleus
• The largest region, occupies most of ventral horn &intermediate zone
• Projects long axons that connect to other gray matter segments of the cord
• Some columns do not fit into the lamina scheme, and have individual designations:
a. Nucleus dorsalis (ClarkeClarke)b. Intermediolateral cell columnc. Intermediomedial cell columnd. Sacral autonomic nucleus
Lamina VIILamina VIILamina VIILamina VII
Lamina VIILamina VIILamina VIILamina VII
• Nucleus dorsalisNucleus dorsalis of of ClarkClark AKA nucleus thoracicusnucleus thoracicus is located medial & ventral to the dorsal horn in T1-L3
• Composed of large neurons & axons that form the dorsal spinocerebellar tractdorsal spinocerebellar tract on the ipsilateral side
• Nucleus dorsalisNucleus dorsalis of of ClarkClark AKA nucleus thoracicusnucleus thoracicus is located medial & ventral to the dorsal horn in T1-L3
• Composed of large neurons & axons that form the dorsal spinocerebellar tractdorsal spinocerebellar tract on the ipsilateral side
T5
Lamina VIILamina VIILamina VIILamina VII
• Intermediolateral cell columnIntermediolateral cell column is located at the lateral portion of the intermediate zone.
• Responsible for the formation of the lateral hornlateral horn in T1 - L2T1 - L2
• Consists of cell bodies of sympatheticsympathetic preganglionic neurons
• Intermediolateral cell columnIntermediolateral cell column is located at the lateral portion of the intermediate zone.
• Responsible for the formation of the lateral hornlateral horn in T1 - L2T1 - L2
• Consists of cell bodies of sympatheticsympathetic preganglionic neurons
T5
Lamina VIILamina VIILamina VIILamina VII
• Intermediomedial cell columnIntermediomedial cell column is located lateral to lamina X. Not seen in all cord sections.
• Receives primary afferent fibers from dorsal root and has been implicated in visceral reflexesvisceral reflexes
• Intermediomedial cell columnIntermediomedial cell column is located lateral to lamina X. Not seen in all cord sections.
• Receives primary afferent fibers from dorsal root and has been implicated in visceral reflexesvisceral reflexes
T5
Lamina VIILamina VIILamina VIILamina VII
• Sacral autonomic nucleusSacral autonomic nucleus is located in the lateral part of lamina VII in S2-S4 segments
• Consists of preganglionic para-para- sympatheticsympathetic neurons
• Sacral autonomic nucleusSacral autonomic nucleus is located in the lateral part of lamina VII in S2-S4 segments
• Consists of preganglionic para-para- sympatheticsympathetic neurons
S2
• Located on the medial aspect of the ventral horn
• Efferent projections both ipsilaterally and contralaterally to the same and nearby segmental levels to lamina VII & IX
• Site of termination for descending fibers, including the vestibulospinalvestibulospinal and reticulospinal tractsreticulospinal tracts
• Located on the medial aspect of the ventral horn
• Efferent projections both ipsilaterally and contralaterally to the same and nearby segmental levels to lamina VII & IX
• Site of termination for descending fibers, including the vestibulospinalvestibulospinal and reticulospinal tractsreticulospinal tracts
Lamina VIIILamina VIIILamina VIIILamina VIII
• Consists of columns of neurons embedded in either lamina VII or VIII
• Cells include alphaalpha and gammagamma motor neurons, which axons exit via the ventral roots and innervate striatedstriated musclemuscle. SmallerSmaller neurons contribute axons to the ventral fasciculus propriusventral fasciculus proprius
• Four columns of motor neurons can be identified within this lamina; ventromedialventromedial, ventrolateralventrolateral, dorsolateraldorsolateral & central central each has characteristic dendritic features
• Consists of columns of neurons embedded in either lamina VII or VIII
• Cells include alphaalpha and gammagamma motor neurons, which axons exit via the ventral roots and innervate striatedstriated musclemuscle. SmallerSmaller neurons contribute axons to the ventral fasciculus propriusventral fasciculus proprius
• Four columns of motor neurons can be identified within this lamina; ventromedialventromedial, ventrolateralventrolateral, dorsolateraldorsolateral & central central each has characteristic dendritic features
Lamina IXLamina IXLamina IXLamina IX
Ventral gray columnsVentral gray columns in lamina IX have somatotopic arrangement: - Medial areasMedial areas innervate the axial musculatureaxial musculature - Lateral areasLateral areas innervate the limbs muscleslimbs muscles
Ventral gray columnsVentral gray columns in lamina IX have somatotopic arrangement: - Medial areasMedial areas innervate the axial musculatureaxial musculature - Lateral areasLateral areas innervate the limbs muscleslimbs muscles
Lamina IXLamina IXLamina IXLamina IX
PHRENIC NUCLEUSPHRENIC NUCLEUS
The The phrenic nucleusphrenic nucleus is located in the is located in the ventromedial areaventromedial area of the of theventral horn in C2-C5 segments. It receives bilateral innervation ventral horn in C2-C5 segments. It receives bilateral innervation from the from the solitary nucleussolitary nucleus of the medullary region, via of the medullary region, via solitary tractsolitary tract. . This nucleus is responsible for the innervation of the This nucleus is responsible for the innervation of the diaphragmdiaphragm
SPINAL ACCESSORY NUCLEUSSPINAL ACCESSORY NUCLEUS
The The spinal accessory nucleusspinal accessory nucleus (cranial nerve XI) is located in the (cranial nerve XI) is located in thelateral arealateral area of vental horn in C1-C5 segments. of vental horn in C1-C5 segments. Corticospinal tractCorticospinal tract innervates this nucleus bilaterally. This nucleus is also innervates this nucleus bilaterally. This nucleus is also responsible for the innervation of the responsible for the innervation of the trapeziustrapezius & & sternocleidomastoidsternocleidomastoid muscles (ipsilaterally) muscles (ipsilaterally)
Lamina IXLamina IXLamina IXLamina IX
• Located ventrolaterally in S1-S2 spinal segments
• Supplies muscles of the pelvic floor, including striated muscle sphincters for urinary and fecal continence
• Located ventrolaterally in S1-S2 spinal segments
• Supplies muscles of the pelvic floor, including striated muscle sphincters for urinary and fecal continence
Nucleus of OnufNucleus of Onuf S2
• Surrounds the central canalcentral canal, and includes the ventral gray commissureventral gray commissure
• Contains relatively small neuronsneurons, radial neuroglia cellsradial neuroglia cells & decussating axons
• Some dorsal root afferents terminate here
• Surrounds the central canalcentral canal, and includes the ventral gray commissureventral gray commissure
• Contains relatively small neuronsneurons, radial neuroglia cellsradial neuroglia cells & decussating axons
• Some dorsal root afferents terminate here
Lamina XLamina XLamina XLamina X
• Ascending and descending association fiber systems of theAscending and descending association fiber systems of the spinal cord which lie deep in the anterior, lateral & posteriorspinal cord which lie deep in the anterior, lateral & posterior funiculi adjacent to the gray matter.funiculi adjacent to the gray matter.
• Fasciculi propriiFasciculi proprii aka aka Flechsig's fasciculi Flechsig's fasciculi or or Ground bundlesGround bundles consist of: consist of: anterioranterior, , lateralislateralis & & intersegmentalintersegmental fasciculi fasciculi
• Ascending and descending association fiber systems of theAscending and descending association fiber systems of the spinal cord which lie deep in the anterior, lateral & posteriorspinal cord which lie deep in the anterior, lateral & posterior funiculi adjacent to the gray matter.funiculi adjacent to the gray matter.
• Fasciculi propriiFasciculi proprii aka aka Flechsig's fasciculi Flechsig's fasciculi or or Ground bundlesGround bundles consist of: consist of: anterioranterior, , lateralislateralis & & intersegmentalintersegmental fasciculi fasciculi
Fasiculus PropriusFasiculus PropriusFasiculus PropriusFasiculus Proprius
Dorsal RootsDorsal RootsDorsal RootsDorsal Roots
• Each dorsal rootdorsal root divides into 6 - 8 rootlets
• Each rootlet can be divided into lateral lateral & medial divisionmedial division
• Lateral divisionLateral division carries information related to painpain & temperaturetemperature
• Medial divisionMedial division carries information related to tactile tactile discriminationdiscrimination & vibrationvibration
• Each dorsal rootdorsal root divides into 6 - 8 rootlets
• Each rootlet can be divided into lateral lateral & medial divisionmedial division
• Lateral divisionLateral division carries information related to painpain & temperaturetemperature
• Medial divisionMedial division carries information related to tactile tactile discriminationdiscrimination & vibrationvibration
Dorsal RootsDorsal RootsDorsal RootsDorsal Roots
• Lateral divisionLateral division axons enter dorsolateral tract of Lissauerdorsolateral tract of Lissauer, and then divide into ascendingascending & descendingdescending branches, each terminate in the dorsal horndorsal horn
• Most terminate at same level & some fibers may travel up or down the cord up to four levels
• Lateral divisionLateral division axons enter dorsolateral tract of Lissauerdorsolateral tract of Lissauer, and then divide into ascendingascending & descendingdescending branches, each terminate in the dorsal horndorsal horn
• Most terminate at same level & some fibers may travel up or down the cord up to four levels
Dorsal RootsDorsal RootsDorsal RootsDorsal Roots
• Medial divisionMedial division axons enter the white matter & then divide into ascendingascending & descendingdescending branches
• Descending branchesDescending branches are organized into two bundles, the Septomarginalis FasiculusSeptomarginalis Fasiculus and the Interfascicular FasiculusInterfascicular Fasiculus
• All descending branchesdescending branches terminateterminate in thein the dorsal horn dorsal horn
• Medial divisionMedial division axons enter the white matter & then divide into ascendingascending & descendingdescending branches
• Descending branchesDescending branches are organized into two bundles, the Septomarginalis FasiculusSeptomarginalis Fasiculus and the Interfascicular FasiculusInterfascicular Fasiculus
• All descending branchesdescending branches terminateterminate in thein the dorsal horn dorsal horn
Dorsal RootsDorsal RootsDorsal RootsDorsal Roots
• Ascending branchesAscending branches of the medial division enter theenter the dorsal funiculusdorsal funiculus & terminate in gracilegracile & cuneatecuneate nuclei in the medulla
• Ascending branchesAscending branches of the medial division enter theenter the dorsal funiculusdorsal funiculus & terminate in gracilegracile & cuneatecuneate nuclei in the medulla
Ventral HornVentral HornVentral HornVentral Horn
• Lamina IXLamina IX contains two types contains two types of motor neurons, of motor neurons, alphaalpha and and gammagamma
• AlphaAlpha motor neurons motor neurons innervate innervate extrafusal fibersextrafusal fibers of striated of striated skeletal musclesskeletal muscles
• GammaGamma motor neurons motor neurons innervate innervate intrafusal fibersintrafusal fibers of neuromuscular of neuromuscular spindlesspindles
• Both types receive inputs from Both types receive inputs from interneurons, including theinterneurons, including the inhibitory inhibitory RenshawRenshaw cell cell
• Lamina IXLamina IX contains two types contains two types of motor neurons, of motor neurons, alphaalpha and and gammagamma
• AlphaAlpha motor neurons motor neurons innervate innervate extrafusal fibersextrafusal fibers of striated of striated skeletal musclesskeletal muscles
• GammaGamma motor neurons motor neurons innervate innervate intrafusal fibersintrafusal fibers of neuromuscular of neuromuscular spindlesspindles
• Both types receive inputs from Both types receive inputs from interneurons, including theinterneurons, including the inhibitory inhibitory RenshawRenshaw cell cell
Spinal Cord TractsSpinal Cord Tracts Spinal Cord TractsSpinal Cord Tracts
Tracts of the Spinal CordTracts of the Spinal CordTracts of the Spinal CordTracts of the Spinal Cord
1.1. Fasciculus GracilisFasciculus Gracilis2.2. Fasciculus CuneatusFasciculus Cuneatus3.3. Tractus spinocerebellaris dorsalisTractus spinocerebellaris dorsalis4.4. Tractus corticospinalis lateralisTractus corticospinalis lateralis5.5. Tractus spinothalamicus lateralisTractus spinothalamicus lateralis6.6. Tractus spinocerebellaris ventralisTractus spinocerebellaris ventralis7.7. Tractus rubrospinalisTractus rubrospinalis8.8. Tractus spinotectalisTractus spinotectalis9.9. Tractus corticospinalis anteriorTractus corticospinalis anterior10.10. Tractus olivospinalisTractus olivospinalis11.11. Tractus spinoolivarisTractus spinoolivaris12.12. Tractus tectospinalisTractus tectospinalis13.13. Tractus reticulospinalisTractus reticulospinalis14.14. Tractus vestibulospinalisTractus vestibulospinalis15.15. Tractus spinothalamicus anteriorTractus spinothalamicus anterior16.16. Raphe-spinal & Hypothalamospinal fibersRaphe-spinal & Hypothalamospinal fibers
1.1. Fasciculus GracilisFasciculus Gracilis2.2. Fasciculus CuneatusFasciculus Cuneatus3.3. Tractus spinocerebellaris dorsalisTractus spinocerebellaris dorsalis4.4. Tractus corticospinalis lateralisTractus corticospinalis lateralis5.5. Tractus spinothalamicus lateralisTractus spinothalamicus lateralis6.6. Tractus spinocerebellaris ventralisTractus spinocerebellaris ventralis7.7. Tractus rubrospinalisTractus rubrospinalis8.8. Tractus spinotectalisTractus spinotectalis9.9. Tractus corticospinalis anteriorTractus corticospinalis anterior10.10. Tractus olivospinalisTractus olivospinalis11.11. Tractus spinoolivarisTractus spinoolivaris12.12. Tractus tectospinalisTractus tectospinalis13.13. Tractus reticulospinalisTractus reticulospinalis14.14. Tractus vestibulospinalisTractus vestibulospinalis15.15. Tractus spinothalamicus anteriorTractus spinothalamicus anterior16.16. Raphe-spinal & Hypothalamospinal fibersRaphe-spinal & Hypothalamospinal fibers
1616
Ascending TractsAscending Tracts
Modality: Modality: Touch, Pain, Temperature, KinesthesiaTouch, Pain, Temperature, Kinesthesia
Receptor: Receptor: Exteroceptor, Interoceptor, ProprioceptorExteroceptor, Interoceptor, Proprioceptor
Primary Neuron: Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Secondary Neuron: Secondary Neuron: Spinal Cord or Brain StemSpinal Cord or Brain Stem
Tertiary Neuron: Tertiary Neuron: Thalamus (Ventrobasal Nuclear Complex) Thalamus (Ventrobasal Nuclear Complex)
Termination: Termination: Cerebral Cortex, Cerebellar Cortex, orCerebral Cortex, Cerebellar Cortex, or
Brain StemBrain Stem
Ascending TractsAscending Tracts
Modality: Modality: Touch, Pain, Temperature, KinesthesiaTouch, Pain, Temperature, Kinesthesia
Receptor: Receptor: Exteroceptor, Interoceptor, ProprioceptorExteroceptor, Interoceptor, Proprioceptor
Primary Neuron: Primary Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Secondary Neuron: Secondary Neuron: Spinal Cord or Brain StemSpinal Cord or Brain Stem
Tertiary Neuron: Tertiary Neuron: Thalamus (Ventrobasal Nuclear Complex) Thalamus (Ventrobasal Nuclear Complex)
Termination: Termination: Cerebral Cortex, Cerebellar Cortex, orCerebral Cortex, Cerebellar Cortex, or
Brain StemBrain Stem
Spinal Cord TractsSpinal Cord Tracts Spinal Cord TractsSpinal Cord Tracts
Ascending TractsAscending Tracts
Posterior White Column-Medial Lemniscal PathwayPosterior White Column-Medial Lemniscal Pathway
Spinothalamic TractSpinothalamic Tract
Spinoreticular or Spinoreticulothalamic TractSpinoreticular or Spinoreticulothalamic Tract
Spinocerebellar TractSpinocerebellar TractSpinomedullothalamic TractSpinomedullothalamic Tract
Cervicothalamic or Spinocervicothalamic Tract Cervicothalamic or Spinocervicothalamic Tract
Spino-olivary TractSpino-olivary Tract
Spinotectal TractSpinotectal Tract
Ascending TractsAscending Tracts
Posterior White Column-Medial Lemniscal PathwayPosterior White Column-Medial Lemniscal Pathway
Spinothalamic TractSpinothalamic Tract
Spinoreticular or Spinoreticulothalamic TractSpinoreticular or Spinoreticulothalamic Tract
Spinocerebellar TractSpinocerebellar TractSpinomedullothalamic TractSpinomedullothalamic Tract
Cervicothalamic or Spinocervicothalamic Tract Cervicothalamic or Spinocervicothalamic Tract
Spino-olivary TractSpino-olivary Tract
Spinotectal TractSpinotectal Tract
Spinal Cord TractsSpinal Cord Tracts Spinal Cord TractsSpinal Cord Tracts
Posterior White Column-Medial Lemniscal PathwayPosterior White Column-Medial Lemniscal Pathway Modality: Modality: Discriminative Touch Sensation (include Vibration) and Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia)Conscious Proprioception (Position Sensation, Kinesthesia)
Receptor: Receptor: Most receptors except free nerve endingsMost receptors except free nerve endings
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root - Posterior White ColumnPosterior Root - Posterior White Column
2nd Neuron: 2nd Neuron: Dorsal Column NucleiDorsal Column Nuclei (Nucleus Gracilis et Cuneatus)(Nucleus Gracilis et Cuneatus)
Internal Arcuate Fiber - Lemniscal Decussation Internal Arcuate Fiber - Lemniscal Decussation
- Medial Lemniscus- Medial Lemniscus
3rd Neuron: 3rd Neuron: Thalamus (VPLc)Thalamus (VPLc) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I)Primary Somesthetic Area (S I)
Posterior White Column-Medial Lemniscal PathwayPosterior White Column-Medial Lemniscal Pathway Modality: Modality: Discriminative Touch Sensation (include Vibration) and Discriminative Touch Sensation (include Vibration) and Conscious Proprioception (Position Sensation, Kinesthesia)Conscious Proprioception (Position Sensation, Kinesthesia)
Receptor: Receptor: Most receptors except free nerve endingsMost receptors except free nerve endings
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion)
Posterior Root - Posterior White ColumnPosterior Root - Posterior White Column
2nd Neuron: 2nd Neuron: Dorsal Column NucleiDorsal Column Nuclei (Nucleus Gracilis et Cuneatus)(Nucleus Gracilis et Cuneatus)
Internal Arcuate Fiber - Lemniscal Decussation Internal Arcuate Fiber - Lemniscal Decussation
- Medial Lemniscus- Medial Lemniscus
3rd Neuron: 3rd Neuron: Thalamus (VPLc)Thalamus (VPLc) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I)Primary Somesthetic Area (S I)
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
Posterior White Column -Posterior White Column -Medial Lemniscal PathwayMedial Lemniscal PathwayPosterior White Column -Posterior White Column -
Medial Lemniscal PathwayMedial Lemniscal Pathway
medial lemniscusmedial lemniscus
lemniscal decussationlemniscal decussation
internal arcuate fiberinternal arcuate fiber
posterior white columnposterior white column
posterior rootposterior root
- - ipsilateralipsilateral loss of discriminative touchloss of discriminative touch sensation and conscious proprioceptionsensation and conscious proprioception belowbelow the level of lesionthe level of lesion
Spinothalamic TractSpinothalamic Tract Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn ((Lamina IV, V, VILamina IV, V, VI))
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPLc, CL & POm)Thalamus (VPLc, CL & POm) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinothalamic TractSpinothalamic Tract Modality: Modality: Pain & Temperature Sensation, Light Touch Pain & Temperature Sensation, Light Touch
Receptor: Receptor: Free Nerve Ending Free Nerve Ending
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root Posterior Root
2nd Neuron: 2nd Neuron: Dorsal Horn Dorsal Horn ((Lamina IV, V, VILamina IV, V, VI))
Spinothalamic Tract - (Spinal Lemniscus)Spinothalamic Tract - (Spinal Lemniscus)
3rd Neuron: 3rd Neuron: Thalamus (VPLc, CL & POm)Thalamus (VPLc, CL & POm) Internal Capsule ----- Corona Radiata Internal Capsule ----- Corona Radiata
Termination: Termination: Primary Somesthetic Area (S I) &Primary Somesthetic Area (S I) &
Diffuse Widespread Cortical RegionDiffuse Widespread Cortical Region
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
Spinothalamic TractSpinothalamic TractSpinothalamic TractSpinothalamic Tract
spinothalamicspinothalamictracttract
anterior whiteanterior whitecommissurecommissure
posterior rootposterior root
decussationdecussation
- - contralateralcontralateral loss of pain and temperature loss of pain and temperature sensation sensation below below the level of lesionthe level of lesion
Spinothalamic TractSpinothalamic Tract& Spinoreticular Tract& Spinoreticular Tract
Widespread Widespread cortical regioncortical region
CL (intralaminarCL (intralaminar thalamic nuclei)thalamic nuclei)
reticulothalamicreticulothalamic pathwayspathways
spinoreticularspinoreticular tracttract
Primary MotorPrimary Motor Area (M I)Area (M I)
VPLc (ventrobasalVPLc (ventrobasal nuclear complex)nuclear complex)
(spinal lemniscus)(spinal lemniscus)
spinothalamicspinothalamic tracttract
thalamus
reticularformation
NeoSTTNeoSTT PaleoSTTPaleoSTT
Fast PainFast Pain Slow PainSlow Pain
Sharp, prickingSharp, pricking Dull, burningDull, burning
Group III (AGroup III (A) fiber) fiber Group IV (C) fiberGroup IV (C) fiber
Short latencyShort latency Slower onsetSlower onset
Well localizedWell localized DiffuseDiffuse
Short durationShort duration Long durationLong duration
Less emotional Less emotional Emotional, autonomic responseEmotional, autonomic response
Not blocked by morphineNot blocked by morphine Blocked by morphineBlocked by morphine
Neospinothalamic TractNeospinothalamic Tract Paleospinothalamic TractPaleospinothalamic Tract
Comparison of Fast and Slow PainComparison of Fast and Slow Pain ------ Spinothalamic Tract------ Spinothalamic Tract Comparison of Fast and Slow PainComparison of Fast and Slow Pain ------ Spinothalamic Tract------ Spinothalamic Tract
Spinocerebellar TractSpinocerebellar Tract
Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Muscle spindle, Golgi tendon organMuscle spindle, Golgi tendon organ
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root , [Posterior Column]Posterior Root , [Posterior Column]
2nd Neuron: 2nd Neuron: 1. Clarke’s column (1. Clarke’s column (Lamina VIILamina VII)) Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn Anterior Spinocerebellar TractAnterior Spinocerebellar Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinocerebellar TractSpinocerebellar Tract
Modality: Modality: Unconscious Proprioception Unconscious Proprioception
Receptor: Receptor: Muscle spindle, Golgi tendon organMuscle spindle, Golgi tendon organ
Ist Neuron: Ist Neuron: Dorsal Root Ganglion (Spinal Ganglion)Dorsal Root Ganglion (Spinal Ganglion) Posterior Root , [Posterior Column]Posterior Root , [Posterior Column]
2nd Neuron: 2nd Neuron: 1. Clarke’s column (1. Clarke’s column (Lamina VIILamina VII)) Posterior Spinocerebellar TractPosterior Spinocerebellar Tract
2. Accessory Cuneate Nucleus2. Accessory Cuneate Nucleus Cuneocerebellar Tract Cuneocerebellar Tract
3. Posterior Horn3. Posterior Horn Anterior Spinocerebellar TractAnterior Spinocerebellar Tract
Termination: Termination: Cerebellar CortexCerebellar Cortex
Spinal Cord Ascending TractsSpinal Cord Ascending Tracts Spinal Cord Ascending TractsSpinal Cord Ascending Tracts
Spinocerebellar TractSpinocerebellar TractSpinocerebellar TractSpinocerebellar Tract
Inferior cerebellarInferior cerebellar pedunclepeduncle
posteriorposterior spinocerebellarspinocerebellar tracttract
Clarke’sClarke’s columncolumn
posteriorposterior white columnwhite column
posterior rootposterior root
Posterior SCbllTPosterior SCbllT
Inferior Inferior cerebellarcerebellar pedunclepeduncle
cuneocerebellarcuneocerebellar tracttract (upper body)(upper body)
posteriorposterior white columnwhite column
posterior rootposterior root
Anterior SCbllTAnterior SCbllT
(superior(superior cerebellarcerebellar peduncle)peduncle)
anterioranterior spinocerebellarspinocerebellar tracttract
anterior whiteanterior white commissurecommissure
posterior rootposterior root
Spinocerebellar TractSpinocerebellar TractSpinocerebellar TractSpinocerebellar Tract
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionCrus Cerebri, Middle Portion
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tracts: Corticospinal Tracts:
- Lateral (crossed) - 85%- Lateral (crossed) - 85%
- Anterior (Not crossed) - 15%- Anterior (Not crossed) - 15%
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Corticospinal TractCorticospinal Tract
Origin: Origin: Cerebral CortexCerebral Cortex Brodmann Area 4 (Primary Motor Area, M I)Brodmann Area 4 (Primary Motor Area, M I)
Brodmann Area 6 (Premotor Area, PM )Brodmann Area 6 (Premotor Area, PM )
Brodmann Area 3,1,2 (Primary Somesthetic Area, S I) Brodmann Area 3,1,2 (Primary Somesthetic Area, S I)
Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule) Brodmann Area 5 (Anterior Portion of Sup. Parietal Lobule)
Corona RadiataCorona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionCrus Cerebri, Middle Portion
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid - pyramidal decussationPyramid - pyramidal decussation
Corticospinal Tracts: Corticospinal Tracts:
- Lateral (crossed) - 85%- Lateral (crossed) - 85%
- Anterior (Not crossed) - 15%- Anterior (Not crossed) - 15%
Termination: Termination: Spinal Gray (Rexed IV-IX)Spinal Gray (Rexed IV-IX)
Spinal Cord Descending TractsSpinal Cord Descending Tracts Spinal Cord Descending TractsSpinal Cord Descending Tracts
- - ipsilateralipsilateral UMN syndrome UMN syndrome
atat the level of lesion the level of lesion
Corticospinal TractCorticospinal TractCorticospinal TractCorticospinal Tract
Corona Radiata Corona Radiata
lnternal Capsule, Posterior Limblnternal Capsule, Posterior Limb
Crus Cerebri, Middle PortionCrus Cerebri, Middle Portion
Longitudinal Pontine FiberLongitudinal Pontine Fiber
Pyramid Pyramid
Pyramidal DecussationPyramidal Decussation
Corticospinal Tract Corticospinal Tract
- Lateral and Anterior- Lateral and Anterior
CR
IC
LPF
Pyr
PD LCST
ACST
Descending Tracts from Brain StemDescending Tracts from Brain Stem
Dorsolateral (Motor) PathwayDorsolateral (Motor) Pathway
Rubrospinal TractRubrospinal Tract
Ventromedial (Motor) Pathway Ventromedial (Motor) Pathway
Tectospinal TractTectospinal Tract
Vestibulospinal TractVestibulospinal Tract
MLF (Medial Longitudinal Fasciculus)MLF (Medial Longitudinal Fasciculus)
- interstitiospinal tract- interstitiospinal tract
Sensory Modulation pathwaysSensory Modulation pathways
Raphespinal & Cerulospinal PathwaysRaphespinal & Cerulospinal Pathways
Descending Autonomic PathwaysDescending Autonomic Pathways
Descending Tracts from Brain StemDescending Tracts from Brain Stem
Dorsolateral (Motor) PathwayDorsolateral (Motor) Pathway
Rubrospinal TractRubrospinal Tract
Ventromedial (Motor) Pathway Ventromedial (Motor) Pathway
Tectospinal TractTectospinal Tract
Vestibulospinal TractVestibulospinal Tract
MLF (Medial Longitudinal Fasciculus)MLF (Medial Longitudinal Fasciculus)
- interstitiospinal tract- interstitiospinal tract
Sensory Modulation pathwaysSensory Modulation pathways
Raphespinal & Cerulospinal PathwaysRaphespinal & Cerulospinal Pathways
Descending Autonomic PathwaysDescending Autonomic Pathways
Spinal Cord Descending TractsSpinal Cord Descending Tracts Spinal Cord Descending TractsSpinal Cord Descending Tracts
ventromedial pathway
dorsolateral pathway
DescendingDescendingTractsTractsfromfromBrain StemBrain Stem
Spinal Cord Spinal Cord TractsTracts
Spinal Cord Spinal Cord TractsTracts
upper motor neuronupper motor neuronUMNUMN
upper motor neuronupper motor neuronUMNUMN
SOMATIC MOTOR SYSTEMSOMATIC MOTOR SYSTEMSOMATIC MOTOR SYSTEMSOMATIC MOTOR SYSTEM
lower motor neuron
LMNLMN
Brain Stem Brain Stem DescendingDescending PathwayPathway
Final Common PathwayFinal Common Pathway
EFFECTORSskeletal muscle
Pyramidal Tract
VOLUNTARY CONTROL
AUTOMATIC CONTROL
Rubrospinal TractRubrospinal TractTectospinal TractTectospinal TractVestibulospinal TractVestibulospinal TractMLFMLFReticulospinal TractReticulospinal Tract
REFLEX
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Location of Location of Symptoms inSymptoms inSpinal DiseaseSpinal Disease
ipsilateral to lesion contralateral to lesion
Upper Motor Neuron (UMN) vs. Lower Motor Neuron (LMN) SyndromeUpper Motor Neuron (UMN) vs. Lower Motor Neuron (LMN) Syndrome
UMN syndromeUMN syndrome LMN SyndromeLMN Syndrome
Type of Paralysis Type of Paralysis Spastic ParesisSpastic Paresis Flaccid ParalysisFlaccid Paralysis
Atrophy Atrophy No (Disuse) Atrophy No (Disuse) Atrophy Severe Severe AtrophyAtrophy
Deep Tendon Reflex Deep Tendon Reflex Increase Increase Absent DTRAbsent DTR
Pathological Reflex Pathological Reflex Positive Positive Babinski Babinski Sign Sign AbsentAbsent
Superficial Reflex Superficial Reflex AbsentAbsent PresentPresent
Fasciculation and Fasciculation and Absent Absent Could be Could be Fibrillation Fibrillation PresentPresent
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Predominantly Motor SyndromesPredominantly Motor Syndromes
• Poliomyelitis (Infantile Paralysis)Poliomyelitis (Infantile Paralysis) - viral infection of lower motor neuron- viral infection of lower motor neuron
- LMN syndrome at the level of lesion- LMN syndrome at the level of lesion
• Amyotrophic Lateral Sclerosis (ALS)Amyotrophic Lateral Sclerosis (ALS) - combined LMN and UMN lesion- combined LMN and UMN lesion
- LMN syndrome at the level of lesion- LMN syndrome at the level of lesion
- UMN syndrome below the level of lesion- UMN syndrome below the level of lesion
- Lou Gehrig’s disease- Lou Gehrig’s disease
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis Amyotrophic Lateral SclerosisAmyotrophic Lateral Sclerosis
1. corticospinal tract
2. lower motor neuron (LMN)
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease
Lou "The Iron Horse" Gehrig (1903-41)Lou "The Iron Horse" Gehrig (1903-41)3.40, 2131(1925-39), 23 GSH, 147 RBI avg.
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease
Spinal CordSpinal CordSyndromeSyndrome
AmyotrophicAmyotrophicLateral SclerosisLateral Sclerosis
(ALS)(ALS)
Lou Gherig’sLou Gherig’sDiseaseDisease Stephen Haking (1946- )Stephen Haking (1946- )
British Physicist, A Brief History of Time
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Predominantly Sensory SyndromesPredominantly Sensory Syndromes
• Herpes ZosterHerpes Zoster - inflammatory reactions of spinal ganglion- inflammatory reactions of spinal ganglion - severe pain on the dermatomes of affected ganglion- severe pain on the dermatomes of affected ganglion
• Tabes DorsalisTabes Dorsalis - common variety of neurosyphilis- common variety of neurosyphilis - posterior column and spinal posterior root lesion- posterior column and spinal posterior root lesion - loss of discriminative touch sensation and conscious- loss of discriminative touch sensation and conscious proprioception below the level of lesionproprioception below the level of lesion - posterior column ataxia- posterior column ataxia - lancinating pain (- lancinating pain (a stabbing or piercing sensationa stabbing or piercing sensation)) - loss of deep tendon reflex (DTR)- loss of deep tendon reflex (DTR)
Herpes Zoster (Shingles)Herpes Zoster (Shingles)
• varicella-zoster virusvaricella-zoster virus reactivation from reactivation from the dorsal root gangliathe dorsal root ganglia
• unilateral vesicular unilateral vesicular eruption within eruption within a dermatomea dermatome
• T3 to L3 dermatome T3 to L3 dermatome lesions are frequentlesions are frequent
• zoster ophtahalmicus zoster ophtahalmicus (ophthalmic division(ophthalmic division of trigeminal n., Vof trigeminal n., V11))
• Ramsey-Hunt syndromeRamsey-Hunt syndrome (sensory br. of VII)(sensory br. of VII)
• acyclovir, antiviral agentacyclovir, antiviral agent
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Sub-Acute Combined DegenerationSub-Acute Combined Degeneration (Combined System Disease)(Combined System Disease) LesionLesion - posterior white column- posterior white column - corticospinal tract (UMN)- corticospinal tract (UMN)
SymptomSymptom - loss of discriminative touch sensation and conscious- loss of discriminative touch sensation and conscious proprioception below the level of lesionproprioception below the level of lesion - ipsilateral UMN syndrome below the level of lesion- ipsilateral UMN syndrome below the level of lesion
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Sub-Acute Combined DegenerationSub-Acute Combined Degeneration Sub-Acute Combined DegenerationSub-Acute Combined Degeneration
1. corticospinal tract
2. posterior white column
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Syringomyelia, HematomyeliaSyringomyelia, Hematomyelia LesionLesion
- central canal of spinal cord- central canal of spinal cord - gradually extended to peripheral part of the cord- gradually extended to peripheral part of the cord
SymptomSymptom
- initial symptom is bilateral loss of pain- initial symptom is bilateral loss of pain (compression of anterior white commissure)(compression of anterior white commissure)
- variety of symptoms appear- variety of symptoms appear according to the lesion extended from central canalaccording to the lesion extended from central canal
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Syringomyelia - Initial SymptomsSyringomyelia - Initial Symptoms Syringomyelia - Initial SymptomsSyringomyelia - Initial Symptoms
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Brown-Sequard syndromeBrown-Sequard syndrome (spinal cord hemisection)(spinal cord hemisection) Major SymptomsMajor Symptoms
1. ipsilateral 1. ipsilateral UMN syndromeUMN syndrome below below the level of lesionthe level of lesion
2. ipsilateral 2. ipsilateral LMN syndromeLMN syndrome at at the level of lesionthe level of lesion
3. ipsilateral loss of 3. ipsilateral loss of discriminative touch sensationdiscriminative touch sensation and and
conscious proprioceptionconscious proprioception belowbelow the level of lesion the level of lesion
(posterior white column lesion)(posterior white column lesion)
4. 4. contralateralcontralateral loss of loss of pain and temperaturepain and temperature sensation sensation belowbelow the level of lesion the level of lesion (spinothalamic tract lesion)(spinothalamic tract lesion)
Spinal Cord SyndromeSpinal Cord Syndrome Spinal Cord SyndromeSpinal Cord Syndrome
Brown-Sequard Syndrome (Spinal Cord Hemisection)Brown-Sequard Syndrome (Spinal Cord Hemisection) Brown-Sequard Syndrome (Spinal Cord Hemisection)Brown-Sequard Syndrome (Spinal Cord Hemisection)
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Good Luck !Good Luck !