BCA-Human Structural Biology- The Spinal Cord by: Dr.

Virginia Braga
Basic Course Audit Anatomy-FEUNRMF
The Spinal Cord: A Review
by: Dr. Virginia Braga
OBJECTIVES
• Describe the External and Internal features of the
Spinal cord
• Differentiate the segments of the Spinal cord
• Discuss Spinal nerves
 Discuss the different Ascending and
 Descending tracts of the Spinal cords
• Discuss common clinical presentations of
 Spinal cord lesions
• Differentiate Spinal cord syndromes

• Lies within the

vertebral canal
and protected
by three
surrounding
fibrous
membranes –
MENINGES
• Held in position
by the
DENTICULATE
LIGAMENTS on
each side and
FILUM
TERMINALE
inferiorly
• SEGMENTED
and paired
POSTERIOR / SENSORY and ANTERIOR / MOTOR
ROOTS corresponding to each segment of the cord
leave the vertebral canal through the
INTERVERTEBRAL FORAMINA
• SHORTER than the vertebral column and
terminates in the adult at the level of lower border
of first Lumbar vertebra; in newborns and
children – at level L3

Reference: PPT from HSB Department Page 1 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga

SPINAL NERVE

INTERVERTEBRAL FORAMEN

2 ENLARGEMENTS:
• Cervical segment-upper extremity
• Lumbosacral segments- lower extremity
CERVICAL- 7 vertebrae, 8 nerves

Reference: PPT from HSB Department Page 2 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
SPINAL CORD
| Gray and White matter
| Central canal

PARTS OF GRAY MATTER

TAKE NOTE:
 Posterior horn
• 7 cervical vertebrae and 8 cervical nerves
 Lateral horn
• C 1 nerve: Cervical 1 (Atlas)
 Anterior horn
• C 2 nerve: Cervical 2 (Axis)
o The cell bodies in the gray substance are
• C 3-C6 nerves: C3 to C6 Vertebrae
grouped into clusters of nuclei of
• C7 vertebra
laminae.
o above C 7 nerve
MUST KNOW!
o below C 8 nerve

Reference: PPT from HSB Department Page 3 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
LAMINAE OF REXED NUCLEUS PROPRIUS
GROUPINGS LOCATION
Laminae I-VI posterior horn
Laminae VII lateral horn
Laminae VIII and IX anterior horn
Lamina X gray substance surrounding
the central canal

 Rexed Lamina IV
 Located anterior to substantia gelatinosa
 Composed of LARGE NEURONS
 Extends throughout the length of the spinal cord
 AFFERENTS: dorsal root fibers concerned with
senses of position & movement
(proprioception)

NUCLEUS DORSALIS
SUBSTANCE GELATINOSA
(CLARK’S COLUMN, NUCLEUS THORACIS)

 Rexed Lamina VII

 Located at the base of the dorsal horn
• Rexed Laminae II
 composed mostly of large neurons
• Location: APEX of the horn
 Extends from C8 to L3-4 segments
• composed of LARGE NEURONS
 associated with proprioceptive endings
• Extends throughout the length of spinal cord
 afferents: dorsal root fibers concerned with
• AFFERENTS: dorsal root fibers concerned with
information from muscle spindles & tendon
pain, temperature and touch
organs

Reference: PPT from HSB Department Page 4 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
VISCERAL AFFERENT NUCLEUS COLUMNS OF THE WHITE MATTER
 Posterior funiculus
 Lateral funiculus
 Anterior funiculus

 Rexed Lamina VII

 Located lateral to nucleus dorsalis
 Composed mostly of MEDIUM size neurons
 Extends from T1 to L3 segments
 Afferents: Visceral afferents

THE REXED LAMINAE

Reference: PPT from HSB Department Page 5 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga

TRACTS

ASCENDING TRACTS
 DORSAL/POSTERIOR COLUMN
o Position sense
o 2 pt discrimination
o Fine, discriminative
o Vibration Sense
o Stereognosis
 SPINOTHALAMIC
o ASTT- Touch/P
o LSTT- Pain & Temperature

Reference: PPT from HSB Department Page 6 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
DESCENDING COLUMN  Signs and symptoms of spinal cord dysfunction
may correspond to the level of the lesion
 CLINICAL SIGNS & SYMPTOMS OF SPINAL CORD
DISORDERS:
o Motor findings
o Sensory level
o Deep Tendon reflexes
o Autonomics

MOTOR FINDINGS (PARALYSIS)

 Bilateral cervical spinal cord damage C4-C6
may result in paralysis of all 4 extremities
(QUADRIPLEGIA)
 Unilateral spinal cord lesions in thoracic levels
may result in paralysis of the ipsilateral lower
extremity (monoplegia )
 If the thoracic spinal cord damage is bilateral,
both lower extremities may be paralyzed (
paraplegia)

SPINAL CORD INJURIES

SPINAL CORD LESIONS

 Spinal injuries can occur at any level and can be
due to trauma, vascular dysfunction, infections,
neoplasms and other causes
 Spinal cord lesions can have a significant impact
on motor, sensory and autonomic pathways

Reference: PPT from HSB Department Page 7 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga

MOTOR & SENSORY DEFICITS

DESTRUCTIVE SPINAL CORD SYNDROMES
 Complete cord transection
 Anterior cord
 Central cord
 Posterior cord
 Brown Sequard’s - Hemisection

Reference: PPT from HSB Department Page 8 of 12

BCA-Human Structural Biology- The Spinal Cord
RULES
DESTRUCTIVE SPINAL CORD SYNDROMES:
General Rule number 1
 Ascending tract – sensory information
If injured – sensory loss
 Descending tract – motor information
If injured – motor loss / paralysis
General Rule number 2
 SENSORY and MOTOR LOSSES WILL BE SEEN ON
THE SAME SIDE OF THE LESION except
spinothalamic tract which will be seen on the
opposite side
Brown Sequard’s – Hemisection
Reference: PPT from HSB Department
by: Dr. Virginia Braga
SPINAL CORD HEMISECTION
Features:
 Contralateral loss of pain & temperature
 Ipsilateral loss of proprioception
 Ipsilateral manifestations of upper and lower
motor neuron lesions
CASE 1
A 41 y/0 man is brought to the ER after an accident at a
construction site. The examination reveals a weakness and
a loss of vibratory sensation and discriminative touch all
on the LEFT lower extremity, and a loss of pain and
thermal sensations on the RIGHT lower extremity.
Page 9 of 12
BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
ANTERIOR CORD POSTERIOR CORD

CASE 3:
A 60 y/o man consulted into a neurology clinic and the
physician paid particular attention to his gait. The patient
raised his feet unnecessarily high and brought them to the
ground in a stamping manner. On questioning, the patient
said that he was having difficulty to walk especially when
he went out for walks in the dark. On examination, there is
loss of muscle joint sense and inability to detect vibration
sense on both legs. (+) Romberg’s test was seen. No
other sensory or motor deficits seen.
BILATERAL LOSS OF MUSCLE JOINT
SENSE and VIBRATORY SENSE on LEGS:
(+) Romberg’s test Tract injured? Lesion? Where? RIGHT
or LEFT? Midline?

AMYOTROPHIC LATERAL SCLEROSIS

 Pure motor disease involving the degeneration of
anterior horn cells (LMNL) and corticospinal
tract (UMNL)
 NO SENSORY LOSS

 Tabes Dorsalis is a condition caused by tertiary

syphilis (neurosyphilis).
o Bilateral degeneration of the dorsal roots
resulting in a secondary degeneration of
the posterior column.
o This occurs 20-30 years after the initial
infection.

Reference: PPT from HSB Department Page 10 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
 C3 DERMATOME extending over the UPPER
EXTREMITY and DOWN to the level of the NIPPLE
– C4 to T4 DERMATOMES
 TRACT INJURED?
 LESION? WHERE? RIGHT or LEFT? MIDLINE?

ROMBERG’S SIGN
 A patient who can stand with feet together and the
eyes open, but who sways and falls when the eyes
are closed – (+) Romberg Sign
 Indicates an absence of position sense in the
lower limbs

SYRINGOMYELIA – CENTRAL CORD SYNDROME

 CAPE like distribution of SENSORY LOSS
 SPINOTHALAMIC TRACT INJURY

CENTRAL CORD

CASE: A 17 y/o girl presents with a bilateral loss of pain

and thermal sensations at the base of the neck and
extending over the upper extremity and down to the level
of the nipple.
BILATERAL LOSS OF PAIN and THERMAL SENSATIONS
at the BASE of the NECK

Reference: PPT from HSB Department Page 11 of 12

BCA-Human Structural Biology- The Spinal Cord by: Dr. Virginia Braga
DERMATOMES
 Area of the skin supplied by the somatosensory
fibers from a single spinal nerve
 Useful in
localizing the
levels of lesions
o C2 – back of
head
o C5 – tip of
shoulder
o C6 – thumb
o C7 – middle
finger
o C8 – small
finger
o T4 – T5 –
nipple
o T10 –
umbilicus
o L1 – inguinal Subacute combined degeneration
o L4 – L5 – big  caused by vitamin B12 deficiency
toe  Degeneration of posterior and lateral columns
o S1 – small toe (loss of position sense and vibration in legs
o S5 – perineum associated with UMNL)

ANTEROLATERAL SYSTEM: LOSS OF PAIN AND TRY THIS CASE:

THERMAL SENSATIONS on the CONTRALATERAL SIDE
about 1 – 2 segments BELOW the level of the lesion
Examples
 Damage at the T 6 level would result in loss
beginning at the T 8 level on the contralateral side
 T8 on the LEFT Loss of PAIN / TEMPERATURE at
T10 dermatome RIGHT SIDE
 T10 level damage = loss at beginning T12 level
A 25 y/o male fell to the ground hitting his lower back
against the gutter when his motorbike skidded on the wet
road. When he tried to get up, he was unable to move his
right leg. He was brought to the hospital and upon
examination, he could NOT FEEL PAIN on the left side up
to the level of the umbilicus. He could NOT FEEL the
VIBRATION of the tuning fork on his right foot.
END OF TRANS

Reference: PPT from HSB Department Page 12 of 12