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Somatosensory Pathways
Somatosensory Pathways
Somatosensory Pathways
Hello and welcome to neuroanatomy and physical therapy. I'm Dr. Annie Burke-Doe, a practicing
physical therapist and an associate professor at the University of St. Augustine for Health Sciences in
San Diego, California. This lecture series has been developed for physical therapists embarking on
the study of neurology. Neuroanatomy is the study of the anatomical organization of the brain, and
it is also considered a branch of neuroscience, which deals with the study of the gross structures of
the brain and the nervous system. The term somatosensory generally refers to body sensations of
touch, pain, temperature, vibration, and proprioception. In this series of slides, we will look at two
main pathways. We will also use anatomy of the three major long tracts to localize lesions in the
nervous system. We will discuss common disorders of the spinal cord and other locations that affect
these pathways.
Now, let's look at the anterolateral pathways, which have smaller diameter and unmyelinated axons
carrying information about pain and temperature sense. This pathway, as you can see, also enters
the spinal cord via the dorsal root; however, these axons make their first synapse immediately in the
gray matter of the spinal cord, mainly in the dorsal horn. Some axon collaterals will ascend or
descend for a few segments in Lissauer's tract before entering the central gray matter. Axons from
the second-order sensory neurons in the central gray matter cross over the spinal cord into the
anterior commissure to ascend in the anterolateral white matter. It should be noted that it takes
two or three spinal segments for the decussating fibers to reach the opposite side, so a lateral cord
lesion will affect contralateral pain and temperature sensation beginning a few segments below the
level of a lesion. The anterolateral pathways of the spinal cords have a somatotopic organization, in
which the feet are mostly laterally represented. To help us remember this organization, picture the
fibers from the anterior commissure adding medially, as the anterolateral pathway ascends in the
spinal cord. When the anterolateral pathways reach the medulla, they are located laterally, running
in the groove between the olives and into the inferior cerebellar peduncles. They enter the pontine
tegmentum to lie just lateral to the medial lemniscus in the pons and midbrain. The next major
synaptic relay is again in the thalamus, which projects via the thalamic somatosensory radiation to
the primary somatosensory cortex. The anterolateral pathway consists of three tracts: the spinal
thalamic tract, best known for and mediates discriminative aspects of pain and temperature, such as
location and intensity; the spinoreticular tract, which is thought to participate in the emotional and
arousal aspects of pain; and the spinomesencephalic tract in the periaqueductal gray participates in
the central modulation of pain. The spinothalamic and spinomesencephalic tracts arise mainly from
the spinal cord laminae 1 through 5, while the spinoreticular arises diffusely from the intermediate
zone to the ventral horn laminae 6 through 8. In addition to pain and temperature, some crude
touch sensations can be conveyed by the anterolateral pathways when the posterior column is
damaged. To summarize, if you step on a thumbtack with your left foot, your spinothalamic tract
enables you to realize "something sharp is puncturing the sole of my foot." Your spinothalamic
intralaminar projections and spinoreticular tract cause you to feel "ouch, that hurts," and your
spinomesencephalic tract leads to pain modulation allowing you to eventually think "aah, that feels
better."
Here, on slide 7, we have demonstrated a cord-level look at the somatotopic organization of the
dorsal column medial lemniscal (DCML) and anterolateral pathway. Remember that the somatotopic
organization preserves the spatial orientation of the central nervous system. Here you can visualize,
attempt to draw, or trace the pathway of the DCML, which will transmit sensations of fine touch,
proprioception, and vibration entering the spinal cord via the dorsal root on the same side of the
sensation into the posterior columns. It is helpful if you picture fibers, again adding on the lateral
aspects as you ascend higher into the posterior column. So if we begin in the lower extremity and
ascend in the cord, we see upper trunk to arm to neck is added as we rise. The anterolateral
pathways, which carry pain, temperature, and crude touch, also have somatotopic organization in
which the feet are mostly laterally represented. If we use the left side of the body as the location for
the sensory stimulation, you can picture fibers coming into the DRG and decussating at the cord
level in the anterior commissure and adding on medially, as the anterolateral pathway ascends in
the spinal cord. Slide 8: Spinal Cord Sensory and Motor Pathways
Here on slide 8, we can see both ascending pathways in blue and descending pathways in red. Let's
use this slide to review some of the concepts in the lecture series. Stop and take time to answer the
following questions: - At what level does the decussation occur for the dorsal column medial
lemniscal pathway? - At what level does the decussation occur for the anterolateral spinothalamic
pathway? - If your patient had a lesion on the left half of the spinal cord, which side of the body
would have loss of pain and temperature? - Which side of the body would have loss of
proprioception and vibration? - Which side of the body would have loss of motor function? - What
side will these deficits be on if the lesion was in the left cerebral cortex? Answers to these questions
will be related in the case at the end of the lecture series.