4.

SPINAL CORD
CONDUIT BETWEEN BODY AND BRAIN
PATHWAYS FOR MOVING AND FEELING THE BODY TRAVERSE THE LENGTH OF THE NEURAXIS
WHAT ARE THE THREE LONGEST PATHWAYS THAT TRAVERSE THE • Lemniscal pathway: Information about light touch,
NERVOUS SYSTEM AND WHAT SENSES DO THEY CONVEY?
vibration, and proprioception (the position of the
body) is carried through the dorsal column medial
lemniscus pathway.
• Spinothalamic pathway: Information about pain and
temperature is carried through the spinothalamic
tract, also known as the anterolateral system.
• Corticospinal pathway: Information about voluntary
movements is carried from cortex through the
corticospinal tract to spinal motoneurons innervating
muscles of the body
A: The lemniscal pathway carries information about
touch, vibration, and proprioception from the body to
the contralateral cerebral cortex. Primary afferents
with somata located in dorsal root ganglia (DRG)
transmit tactile information from the periphery all the
way to the dorsal column nuclei (DCN) in the caudal
medulla.
Within the spinal cord, these primary afferents travel
in the ipsilateral dorsal column. Cells in the dorsal
column nuclei that receive input from primary
afferents in turn project to the contralateral thalamus.
To reach the thalamus, dorsal column nuclear cells
send their axons across the midline. The crossing of
dorsal column nuclear axons marks the sensory
decussation. When the dorsal column nuclear axons
reach the contralateral side, they take a turn to travel
rostrally through the brainstem as the medial
lemniscus (ml).
Thalamic cells project to primary somatosensory
cortex (S1).

Page 1 of 18

PATHWAYS FOR SENSATION AND VOLUNTARY
MOVEMENT CROSS FROM ONE SIDE TO THE OTHER
HOW MANY NEURONS AND SYNAPSES ARE INVOLVED IN THE
DORSAL COLUMN MEDIAL LEMNISCUS PATHWAY?
HOW MANY NEURONS AND SYNAPSES ARE INVOLVED IN THE
SPINOTHALAMIC PATHWAY?
WHAT ARE THE COMPONENTS OF PAIN PERCEPTION?
B: The spinothalamic pathway carries information
about pain and temperature from the body to the
contralateral cerebral cortex. Primary afferents that
innervate the periphery have cell bodies located in
the dorsal root ganglia and transmit information from
the periphery to the dorsal horn (DH) of the spinal
cord. Cells in the dorsal horn send an axon across the
midline to travel rostrally in the spinothalamic tract
(stt) all the way to the contralateral thalamus.
Thalamic cells receiving input from the
spinothalamic tract project to primary somatosensory
cortex.
NB FOR PAIN AND TEMPERATURE THE USE
OF NOCICEPTORS AND THERMORECEPTORS
OCCUR IN THE NEURONS THAT INNERVATE
THE PERIPHERY
SPINOTHALAMIC AXONS TRAVEL IN THE
VENTROLATERAL OR ANTEROLATERAL
QUADRANT OF THE SPINAL CORD.
C: The corticospinal pathway originates from cells in
the primary motor cortex (M1) that send an axon
through the corticospinal tract (cst) to contralateral
motoneurons (MN) in the spinal cord. At the
spinomedullary junction, corticospinal tract fibers
cross the midline, marking the motor decussation.
Motoneurons that receive input from the
corticospinal tract innervate skeletal muscle, required
for voluntary movement. Red asterisks mark where
each pathway crosses the midline.
The axons of the corticospinal tract travel through the
forebrain, midbrain, and pons and then form the
pyramids, two parallel columns that run down either
side of the ventral medullary midline. For this reason,
the corticospinal tract is also termed the pyramidal
tract.
4 NEURONS 3 SYNAPSES
4 NEURONS 3 SYNAPSES
Pain perception involves components of both
sensoryd iscrimination—the what, where, and when
of a stimulus—and affect—the emotional and
motivational reaction evoked by a stimulus
Page 2 of 18
WHAT IS THE IMPORTANCE OF CENTRAL LESIONS ON THE The affective component of pain is carried through
PERCEPTION OF PAIN? indirect channels into regions of the cerebral cortex
that include but extend beyond the somatosensory
cortex. The clinical import of this is that central
lesions may exert differential effects on
sensory discriminative and affective aspects of pain.
WHAT TRACT ALSO FOUND IN THE MIDBRAIN / HINDBRAIN IS The corticobulbar tract forms an analogous pathway
ANALOGOUS TO THE CORTICOSPINAL TRACT? to the corticospinal tract, controlling voluntary
movement of the face, jaw, tongue, and upper airway
along with selected shoulder and neck movements.
Because motor centers targeted by the corticobulbar
tract are located in the brainstem, the corticobulbar
tract traverses a much shorter distance and
correspondingly is affected by lesions in a far more
restricted area than the corticospinal tract.
HOW DOES THE CORTICOBULBAR TRACT DIFFER FROM As detailed further in Chapter 23, the corticobulbar
CORTICOSPINAL? tract differs from the corticospinal tract in another
respect: it does not uniformly cross, so that
motoneurons controlled by the tract may be located
ipsilateral, contralateral, or both, to the site of
corticobulbar tract origin
WHAT HAPPENS TO THE MOTOR NEURONS OF THE CORTICOSPINAL One final point is worthy of mention. About 90% of
TRACT THAT DO NOT DECUSSATE? all the axons that are present in the medullary
pyramids cross at the motor decussation and the
remainder do not. The axons that cross form the
lateral corticospinal tract, which is commonly called
simply the corticospinal tract as is done throughout
this chapter. The remaining corticospinal tract axons
do not cross the midline and instead travel down the
ipsilateral spinal cord in the ventral corticospinal
tract. The ventral corticospinal tract is important in
the bilateral control of axial and proximal limb
muscles for postural adjustments.
DESCRIBE THE LOCALISATION OF THE PROBLEM IN A CASE WHERE Bilateral impairment of sensory or motor function
THERE IS BILATERAL IMPAIRMENT OF SENSORY OR MOTOR usually results from a systemic disease rather than a
FUNCTION AND LIKELY CAUSE? focal anatomical lesion. In fact, patients with Hansen
disease, commonly known as leprosy, often present,
or first seek medical attention, with a loss of
temperature and touch sensation caused by a systemic
loss of sensory nerve function.
THE SPINAL CORD AND SPINAL NERVES SERVE THE BODY
DIFFERENCE BETWEEN SPINAL NERVES AND SPINAL ROOTS? Thus, spinal nerves are mixed, carrying both sensory
fibers that terminate in the spinal cord and motor
axons that arise from the spinal cord, whereas roots
are not.
Figure 42 The organization of the spinal cord is
stereotyped with sensory inputs arriving dorsally and
motor outputs exiting ventrally. A: A spinal cord
segment has a bilateral pair of dorsal and ventral
roots. Roots are contained within the dural sheath
(located at arrowheads).
A1: The dorsal rootlets from one side of one spinal
segment exit the dura as a single group and become a
peripheral nerve on the peripheral side of the dura
Page 3 of 18
 B: Primary afferent neurons whose cell bodies are in
the dorsal root ganglia (DRG) collect information
from the skin, muscles, joints, bone, tendons, and
viscera of the body and then carry this information
into the spinal cord through the dorsal root. Motor
output, both somatomotor and autonomic, exits the
spinal cord through the ventral root to reach targets in
the head and body. Because peripheral nerves contain
both sensory fibers en route to the dorsal roots and
motor fibers emanating from the ventral roots, they
serve a mixture of motor, sensory, and autonomic
functions

C: Dorsal root ganglion neurons send out a single

process that bifurcates into peripheral, dendritelike,
and central, axonlike, processes. Sensory information
flows from the periphery to the spinal cord (orange
arrowheads).

NERVES THAT EXIT FROM THE VERTEBRAL COLUMN ARE Motoneurons that innervate two neck muscles
CALLED SPINAL NERVES; NERVES THAT EXIT THROUGH (trapezius, sternocleidomastoid) are located in the
HOLES IN THE SKULL ARE TERMED CRANIAL NERVES. spinal cord and send their axons into the skull and
FOR THE MOST PART,THE CRANIAL NERVES CARRY then out of the skull as cranial nerve XI, which is also
SENSORY INFORMATION INTO AND MOTOR known as the spinal accessory nerve (see Chapter 5).
INFORMATION OUT OF
THE BRAINSTEM. HOWEVER, THERE IS ONE EXCEPTION
TO THIS RULE:
SPINAL NERVES CONTAIN A MIX OF AXONS WITH SENSORY, SKELETAL MOTOR, AND AUTONOMIC
MOTOR FUNCTIONS
THE THREE MAIN FUNCTION S OF SPINAL NERVES? As should be evident by now, spinal nerves contain
axons serving a very limited number of functions:
somatosensory, autonomic motor, and somatomotor.
DESCRIBE THE EMBRYONIC ORIGIN OF DORSAL ROOT GANGLIA? The dorsal root ganglia contain the somata of all
spinal afferents, are derived from neural crest, and
comprise part of the peripheral nervous system. Thus,
neurons in the dorsal root ganglia sit just outside the
dural envelope and are susceptible to external
damage from toxins, viruses, and the like.

Page 4 of 18

DISCUSS THE MANEFESTATIONS OF DAMAGE OF SOMATOSENSORY
PATHWAYS
WHAT SENSORY CHANGES TYPICALLY ACCOMPANY NERVE
DAMAGE VERSUS ROOTLET DAMAGE?
DISCUSS DAMAGE TO THE MOTOR COMPONENT OF ROOTS AND
NERVES
THE SPINAL CORD IS TOPOGRAPHICALLY ORGANIZED
WHY ARE THERE ENLARGEMENTS IN THE SPINAL CORD
Figure 43 Sensory axons from a single region of skin
travel through a single nerve and then enter the spinal
cord through multiple roots to reach several spinal
segments. Similarly, motor axons arising in multiple
segments exit through multiple roots before
eventually converging onto one nerve to reach the
target muscle. Because of these arrangements, the
consequences of nerve lesions are more severe than
those of root lesions. Nerve lesions may cause
anesthesia in a wide area of peripheral tissue along
with the complete
inability to use a skeletal muscle, termed paralysis. In
contrast, a root lesion results in motor weakness and
a very limited region, if any, of anesthesia. Damage
to sensory axons anywhere along the line typically
produces paresthesias, including dysesthesias.
Beyond anesthesia, which is a negative symptom,
damage to somatosensory pathways also typically
produces positive symptoms, perceptions that are
inappropriate for the stimulus (see Chapter 1).
Abnormal somatosensory perceptions are
paresthesias, or are dysesthesias when associated
with an unpleasant reaction. Bauby, introduced in
Chapter 1, experienced relatively innocuous
paresthesias (e.g., numbness) as well as distressing
dysesthesias (pins and needles, burning pain).
Nerve lesions may cause anesthesia in a wide area of
peripheral tissue along with the complete inability to
use a skeletal muscle, termed paralysis. In contrast, a
root lesion results in motor weakness and a very
limited region, if any, of anesthesia. Damage to
sensory axons anywhere along the line typically
produces paresthesias, including dysesthesias.
Nerve damage often produces paresthesias, including
dysesthesias,
whereas root damage tends to produce painful
dysesthesias (Fig. 43).
Thus, nerve lesions or neuropathies, particularly
distal ones, can cause a complete inability to use a
muscle, termed paralysis, whereas root lesions or
radiculopathies typically cause weakness or paresis.
The number and diversity of tissues, as well as the
number and diversity of fine movements possible, are
far greater with the arms and legs than with the trunk.
Correspondingly, cervical and lumbosacral segments
that support arm (C4–T1) and leg (L1–S3) sensation
Page 5 of 18

ROOTS FROM PROGRESSIVELY MORE CAUDAL SEGMENTS TRAVEL PROGRESSIVELY LONGER TO EXIT
THE VERTEBRAL COLUMN
EXPLAIN WHY AND GIVE AN EXAMPLE
AUTONOMIC NEURONS BELONG TO EITHER THE SYMPATHETIC OR PARASYMPATHETIC DIVISION
DESCRIBE AUTONOMIC MOTOR CONTROL
and movement are enlarged (Fig. 45).
Figure 45 In humans of average stature, the spinal
cord is less than a foot and a half long, just over 40
cm, from the foramen magnum to the conus
medullaris. Each spinal cord segment has a
stereotyped structure with dorsal roots, leading to
dorsal root ganglia, emanating from the dorsal side of
the cord (left side) and ventral roots emanating from
the ventral side of the cord (right side). Dorsal and
ventral roots travel through the dural sleeve (gray
region) containing the spinal cord to exit from the
vertebral column, often at a location far more caudal
than the segment’s location, where rootlets emerge
from the cord. The innervations provided by sensory,
somatomotor, and autonomic motor neurons in
cervical (light blue), thoracic (red), lumbar (dark
blue), and sacral (green) segments are listed. The
cervical enlargement that serves the arms is located
from C4 to T1, and the lumbosacral enlargement that
serves the legs includes segments from L1 to S3. The
locations of preganglionic sympathetic and
parasympathetic (ps) neurons are marked on the left.
Since the vertebral column lengthens far more than
the spinal cord during development, all roots save the
most rostral ones must travel caudally to reach the
appropriate exit point from the vertebral column. As
a consequence, the most caudal portion of the
vertebral column contains a large number of spinal
roots but no cord, an area termed the cauda equina
(see Fig. 46). Attaching the spinal cord at the caudal
end is accomplished by the filum terminale, a
condensation of pia that is invested with dura to form
the coccygeal ligament as it leaves the dural sleeve.
The coccygeal ligament attaches to the coccyx. In
this way, the conus medullaris is anchored to the
coccyx by the filum terminale/coccygeal ligament.
Modified with permission from deArmond S et al.
Structure of the human brain:
For example, the L5 segment of the cord sits at
roughly the level of the final thoracic vertebral
segment (T12). Yet, the roots from the L5 segment
exit five vertebral segments away, from just below
the L5 vertebral bone.
The spine and body grows much faster than the spinal
neuronal matter.
Spinal autonomic motor neurons, termed
preganglionic, form the first neuron in the chain. The
second neuron in the chain
is a motor neuron in an autonomic ganglion, which
we call the postganglionic
Page 6 of 18

WHAT IS THE EXCEPTION TO THE DESCRITPION OF AUTONOMIC
MOTOR CONTROL ABOVE?
NAME THREE AUTONOMIC TARGET TISSUES:
WHERE DO YOU FIND PREGANGLIONIC SYMPATHETIC NEURONS IN
THE SPINAL CORD?
neuron. The soma of the preganglionic neuron is
within the CNS, in either the
spinal cord or brainstem. Preganglionic neurons send
their axons through the
ventral roots, just as motoneurons do. However,
preganglionic autonomic
neurons synapse on neurons in autonomic ganglia
rather than on the final target
muscle, as is the case for motoneurons. A neuron in
an autonomic ganglion is the
second neuron in the autonomic control chain, and it
sends its postganglionic
axon to an autonomic target of the body or head.
There is one exception to the two neuron chain rule
of autonomic motor control. The adrenal medulla,
which releases epinephrine and norepinephrine
during periods of stress or arousal, receives direct
innervation from preganglionic neurons. Notably,
adrenal chromaffin cells are similar to sympathetic
ganglion cells in developmental origin (neural crest)
and neurotransmitter class (catecholamine, see
Chapter 12).
1. SMOOTH MUSCLE
2. CARDIAC MUSCLE
3. GLANDS
Preganglionic sympathetic neurons are only present
in the thoracic and upper lumbar cord. They send
their preganglionic axons out through spinal ventral
roots to terminate in either paravertebral ganglia that
hug the spinal cord or prevertebral ganglia found
closer to abdominal target tissues. The ganglia lie in a
line called the sympathetic chain or trunk, situated
just ventrolateral to the
vertebral column.
Page 7 of 18
DESCRIBE THE PREGANGLIONIC PARASYMPATHETIC NEURONS AND
WHERE THEY ARE FOUND
DESCRIBE THE OCULOSYMPATHETIC PAHTWAY
DESCRIBE MANEFESTATIONS OF INTERRUPTION OF THE
SYMPATHETIC PATHWAYS THAT INNERVATES THE FACE AND EYE/
Preganglionic parasympathetic neurons are found
both in the brainstem and in the sacral spinal cord,
giving rise to the term craniosacral as a synonym for
parasympathetic. Preganglionic parasympathetic
neurons send out long axons that travel to
parasympathetic ganglia, which are located in or near
the final target tissue. Targets of the sacral
parasympathetic system include the hindgut and
organs of the pelvic floor, such as the bladder, colon,
rectum, and sexual organs. The cranial contribution
to the parasympathetic system reaches the lens,
pupillary constrictor, and lacrimal and salivary glands
within the head and the viscera of the body above the
hindgut.
The oculosympathetic pathway starts with
hypothalamic neurons that send axons to descend
through the brainstem and spinal cord and synapse on
preganglionic sympathetic neurons in T1 and T2
(Fig. 47). Preganglionic axons exit through the T1
root, travel close to the apex of the lung, through the
sympathetic chain, and ultimately synapse in the
superior cervical ganglion. Ganglionic neurons that
innervate the superior tarsal muscle, which lifts the
eyelid, and the pupillary dilator muscle that dilates
the pupil send postganglionic axons along the internal
carotid artery, through the cavernous sinus, and
ultimately to the eye.
Interruption of the sympathetic pathway to the eye at
any point causes Horner syndrome, which consists
principally of miosis, or pupillary constriction, and
may be accompanied by ptosis, or drooping eyelid.
Miosis and ptosis result from disruption of the tonic
sympathetic excitation of the pupillary dilator and
superior tarsal muscles. Facial anhidrosis, or lack of
sweating, along
with facial flushing indicative of vasodilation, occur
when the sympathetic
innervation to facial sweat glands and blood vessels
is interrupted.
Page 8 of 18
Figure 47 The oculosympathetic pathway involves three neurons. A hypothalamic neuron projects through the ventrolateral
medulla (vlm) to preganglionic sympathetic neurons in the intermediolateral cell column (iml) of the upper thoracic cord
(T1, T2). Preganglionic sympathetic neurons send axons through the sympathetic chain to the superior cervical ganglion
(scg), passing by the apex of the lung along the way. Distinct populations of ganglionic sympathetic neurons project along
the external and internal carotids (ec, ic) to the facial skin and eye, respectively. Central (1, 2), preganglionic (3), and
postganglionic (4, 5) lesions produce different combinations of symptoms as shown in the table inset.
DESCRIBE HOW MICTURITION IS A DANGEROUS CONDITION Micturition, the medical term for urination, depends
ASSOCIATED WITH SPINAL CORD INJURY on parasympathetically mediated contraction of the
bladder (detrusor muscle) along with relaxation of the
external urethral sphincter, a voluntary muscle. The
message that initiates sphincter relaxation arises in
the brain and is sent down to the sacral cord (S2–S4)
where sphincter motoneurons and preganglionic
neurons that target the detrusor are located.
Therefore, spinal cord damage above sacral levels
may interrupt the command for sphincter relaxation.
Since most spinal cord injury is above S2, micturition
is often affected in spinal cordinjured patients. The
urinary retention that results from interrupting this
message is potentially lethal and must be treated,
typically with catheterization, with some urgency
Table 42 KEY SPINAL CORD SEGMENTS, ROOTS, AND NERVES

Page 9 of 18
PERIPHERAL NERVES CONTAIN LARGE AND SMALL CALIBER FIBERS
WHICH FIBRE TYPES ARE MOST COMMONLY AFFECTED BY In sum, the predominant fiber types affected in most
NEUROPATHIES neuropathies are (1) large diameter motorserving
axons, (2) large diameter sensory fibers involved in
WHICH ACCOMPNYING SYSTEM IS USUALLY AFFECTED? touch, (3) small diameter sensory fibers involved in
SYMPATHETIC OR PARASYMPATHETIC? signaling pain and temperature, and (4) small
diameter sympathetic fibers innervating cutaneous
blood vessels and sweat gland

SYMPATHETIC
EACH SPINAL SEGMENT IS ASSOCIATED WITH A DERMATOME AND MYOTOME

Figure 48 A: Spinal dermatomes are the cutaneous regions innervated by the sensory fibers of each spinal segment. Note that
these territories appear primarily as horizontal slices through the trunk but as longitudinal slices in the limbs. Limb
dermatomes actually share the same orientation as trunk dermatomes in a quadruped. Thus, in a person on all fours, the
orientations of the dermatomes in trunk and limbs are roughly parallel. Note that there is no sensory root in the first cervical
segment. The top of the head, face, and oral cavity are innervated by the fifth cranial nerve (see Chapter 5). The innervation
Page 10 of 18
of the ear (not\ shown) is shared by the C2 spinal nerve and several cranial nerves. B: Nerve territories differ substantially
from dermatomes in shape and orientation. The few examples illustrated here show that nerve territories can cut across
dermatomes. For example, the territory supplied by the median nerve includes parts of dermatomes from segments C6 to C8.
The territory of the lateral cutaneous nerve includes parts of several lumbar dermatomes. In other cases, particularly in the
trunk, nerve territories are substantially smaller than dermatomes. For example, the ventral rami from the thoracic nerves
innervate no more than a quarter of the corresponding thoracic dermatome.
EXPLAIN IMPORTANCE OF C SPINE MYOTOMES RELATED TO Of critical importance to life is the innervation of the
BREATHING diaphragm, which stems from phrenic motoneurons
in C3–C5 (Table 42). Phrenic motoneurons, required
for breathing, need instructions. The instructions
come from medullary neurons that communicate a
respiratory rhythm to phrenic motoneurons and
thereby support breathing. Any damage to the
connection from the medulla to phrenic motoneurons
will impair breathing to one degree or another. An
individual with a complete spinal transection above
C3 only survives if placed on a ventilator
THE SPINAL CORD CONTAINS AN INNER BUTTERFLY OF GRAY MATTER SURROUNDED BY WHITE
MATTER
Figure 410 A: The spinal cord is divided into a
central region of gray matter and a surrounding
region of
white matter. The gray matter contains the dorsal
horn (DH), ventral horn (VH), and intermediate gray
(IG)
on each side and a midline region around the central
canal (X marked in B).

B: The dorsal horn contains a superficial region

(SDH) that processes pain and temperature
information, and a deeper area called nucleus
proprius (NP), where tactile information is processed.
The superficial dorsal horn is further subdivided into
the marginal zone (MZ), which contains neurons that
project to the brain and the substantia gelatinosa
(SG), where interneurons are concentrated. In the
ventral horn, motoneurons are topographically
arranged. Motoneurons innervating appendicular, or
limb, muscles are present in a lateral extension to the
ventral horn, whereas the medial portion of the
ventral horn contains motoneurons that innervate
axial muscles.

Page 11 of 18

WHAT DOES THE INTERMEDIATE GREY AREA IN FIGURE B
CONTAIN?
THE ORGANIZATION OF THE SPINAL GRAY
SUPERFICIAL DORSAL HORN:
THE MARGINAL ZONE OF THE DORSAL HORN:
THE SUBSTANTIA GELATINOSA:
C: The white matter of the spinal cord is divided into
sections called funiculi (funiculus is the singular
form). The dorsal root (dr) carries afferent axons into
the spinal cord. Those afferent axons enter either the
dorsal horn or the dorsal columns (dc), which make
up the dorsal funiculus. The dorsal columns contain
axons carrying information about touch, vibration,
and proprioception. Tactile information arising from
the legs travels medially in the fasciculus gracilis (fg)
and that from the arms travels more laterally in the
fasciculus cuneatus (fc). The lateral funiculus
contains the lateral corticospinal tract (lcst) dorsally
and the spinothalamic tract (stt) ventrally. The ventral
funiculus contains tracts primarily related to axial
motor function, such as the ventral corticospinal tract
(vcst).
Beyond the dorsal and ventral horns, there is an
intermediate gray and a central canal region (Fig. 4-
10B). The intermediate gray contains preganglionic
autonomic neurons but only in two regions:
• T1–L2 segments contain sympathetic preganglionic
neurons;
• S2–S4 segments contain parasympathetic
preganglionic neurons.
Sympathetic preganglionic neurons occupy the
intermediate gray in a column of cells known of as
the intermediolateral cell column, which is often
abbreviated
as IML. The IML juts out laterally into the lateral
funiculus and is so pronounced
that it is also termed the intermediate horn (Fig. 411).
The intermediate horn provides an easily
recognizable marker for thoracic segments.
Additional preganglionic sympathetic neurons are
found more medially, near the central canal, in an
area known of as the intermediomedial cell column.
In segments S2– S4, the intermediate gray contains
preganglionic parasympathetic neurons in a region
that is sometimes called the sacral autonomic nucleus
(Fig. 411). Preganglionic parasympathetic neurons
send their axons out the ventral roots to
parasympathetic ganglia typically located in or very
near the ultimate target
organ.
The superficial dorsal horn, consisting of a thin
marginal zone overlying the thicker substantia
gelatinosa, is critical to processing pain and
temperature information (Fig. 410B).
The marginal zone contains most of the neurons
critical to the perception of pain and temperature, and
these project from the spinal cord to the brain.
The substantia gelatinosa is home to interneurons
Page 12 of 18

THE NUCLEUS PROPRIUS
WHAT DOES THE INTERMEDIATE GREY CONTAIN?
THE THREE LONG PATHWAYS TAKE THREE DIFFERENT COURSES THROUGH THE SPINAL CORD
involved in the processing of somatosensory
information, especially that resulting from noxious
and thermal stimulation.
Deep to the superficial dorsal horn, the nucleus
proprius processes light touch information. Finally,
the deep dorsal horn serves heterogeneous purposes
including
processing pain, temperature, and viscerosensory
input.
In addition to the intermediomedial and
intermediolateral cell columns that contain autonomic
preganglionic neurons, the intermediate gray contains
a number of interneurons with important roles in
transforming sensory input into skeletal motor output
Figure 412 A: Dorsal root ganglion cells that code for
light touch, proprioception, and vibration send their
central process into the dorsal columns. Since
afferent input always joins the dorsal columns from
the lateral side, legs are represented most medially
and arms most laterally.
Page 13 of 18

WHERE DOE THE AXONS OF THE SPINOTHALAMIC CELLS TRAVEL
AND CROSS?
WHAT INFORMATIION IS CARRIED IN THE DORSAL COLUMN
SYSTEM
DESCRIBE THE TRAVEL OF AXONS OF SPINOTHALAMIC CELLS
B: Dorsal root ganglion cells that code for pain and
temperature send their central process into the dorsal
horn to the marginal zone. Cells in the marginal zone
send an axon across the midline in the ventral spinal
commissure to the contralateral spinothalamic tract,
located in the ventrolateral funiculus.
C: Corticospinal tract axons that control fine
voluntary movements travel in the dorsolateral
funiculus as the lateral corticospinal tract. Lateral
corticospinal axons leave the dorsolateral funiculus
and contact motoneurons in the ventral horn of the
cervical and lumbosacral enlargements.
The axons of spinothalamic cells cross in the same
segment in which they are located and enter the
contralateral ventrolateral funiculus. Spinothalamic
axons travel rostrally within the spinothalamic tract
of the ventrolateral funiculus to reach the thalamus.
In
sum, each ventrolateral funiculus contains
information about pain and
temperature from the contralateral side of the body.
In sum, each dorsal column carries information about
light touch,
vibration, and proprioception from the ipsilateral
body.
The axons of spinothalamic cells cross in the same
segment in which they are located and enter the
contralateral ventrolateral funiculus. Spinothalamic
axons travel rostrally within the spinothalamic tract
of the ventrolateral funiculus to reach the thalamus.
In sum, each ventrolateral funiculus contains
Page 14 of 18

DESCRIBE THE FORMATION OF THE CORTICOSPINAL TRACT
WHAT IS THE ROLE OF THE VENTRAL CORTICOSPINAL TRACT?
DESCRIBE THE TRAVEL OF AXONS IN THE CORTICOSPINAL TRACT IN
THE DORSAL FUNICULUS
TEST YOUR UNDERSTANDING OF SPINAL CORD FUNCTION
BY DEDUCING THE CLINICAL EFFECTS OF THREE LESIONS
information about pain and temperature from the
contralateral side of the body.
Recall that the motor decussation is located at the
spinomedullary junction, which means that, within
the spinal cord, the corticospinal pathway travels
contralateral to its point of origin in the cerebral
cortex and ipsilateral to the muscles that it ultimately
influences. When the corticospinal tract divides into
two unequal parts at the motor decussation, the
smaller portion does not cross the midline and forms
the ventral corticospinal tract (vcst in Fig. 410C).
The ventral corticospinal tract supports bilateral
postural adjustments of the trunk and proximal limbs
but is not involved in controlling fine movements of
the hands or feet
At the level of the targeted motoneurons,
corticospinal axons leave the dorsolateral funiculus to
enter the ipsilateral ventral horn, where they contact
motoneurons and motor interneurons (Fig. 412C).
The lateral corticospinal tract is primarily involved in
signaling voluntary movements of the limbs. In sum,
each dorsolateral funiculus contains axons critical to
the voluntary movement of ipsilateral limb muscles.
Figure 413 Three lesions that produce different
constellations of symptoms are illustrated here. Note
that sections are oriented according to radiological
convention with the right side on the left and the left
side on the right. A: A hemisection causes Brown-
Séquard syndrome, which includes ipsilateral (to the
lesion) loss of tactile, vibratory, and proprioceptive
sensation, contralateral loss of pain and temperature
sensations, and ipsilateral loss of voluntary
movements. In addition, pain and temperature
sensations are lost bilaterally at the level of the
hemisection. Illustrated here is the pattern of deficits
after a left L2 hemisection.
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DESCRIBE THE MANEFESTATIONS OF A SPINAL HEMISECTION
B: In its early stages, syringomyelia causes a lesion
localized to the central canal region. This lesion
affects only one of the three long pathways: the
spinothalamic tract pathway. Axons crossing through
the ventral spinal commissure are interrupted,
causing a bilateral loss of pain and temperature
sensations. Syringomyelia most commonly affects
lower cervical segments; shown here are the deficits
expected from a lesion affecting segments C6–C8.
C: After a right pyramidal stroke, the axons in the left
lateral corticospinal tract are no longer connected to
the motor cortex. Therefore, voluntary movement of
the left side will be severely impaired. The motor
impairment due to unilateral, or onesided,
corticospinal tract damage is most severely apparent
in limb movement. Voluntary movements of the
trunk are far less impaired in part because the ventral
corticospinal tract on the unaffected side can largely
compensate. No sensory deficits are associated with
damage to the corticospinal tract.
In a left hemisection of the spinal cord, the spinal
cord is cut completely from the midline to the left
edge of the cord. There are three major
consequences:
• Perception of all light touch, vibration, and
proprioceptive stimuli arising from the same or
ipsilateral side as the lesion—the left side—would be
impaired for dermatomes at the level of and caudal to
the lesion.
• Pain and temperature sensation would be impaired
on the opposite or contralateral side—the right side—
for dermatomes at the level of and caudal to the
lesion. At the level of the lesion, pain and
temperature would be impaired bilaterally due to
damage of the crossing spinothalamic tract axons (see
more later).
• Voluntary movements would be impaired on the
side ipsilateral to the lesion— the left side—for
myotomes at the level of and caudal to the lesion.
In addition to the obvious topographical effects of
lesions at different spinal levels, there are three key
syndromes to consider:
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WHY DOES A LEASION OF THE CENTRAL CANAL REGION NOT
AFFECT VOLUNTARY MOVEMENTS?
WHAT PATHWAY IS AFFECTED BY A CENTRAL CANAL LESION?
WHAT IS THE MOST COMMON CONDITION THAT QUALIFIES AS A
CENTRAL CANAL LESION?
DESCRIBE THE EFFECTS OF A PYRAMIDAL STROKE
• Damage above the sacral cord may adversely affect
micturition, sexual function, and defecation.
• Damage above thoracic levels may result in an
ipsilateral Horner syndrome.
• Damage above midcervical levels may produce
breathing insufficiency either all the time or at night.
Next, we consider a lesion affecting the central canal
region (Fig. 413B). A lesion of the central canal
region has no effect on voluntary movements because
it does not reach the dorsolateral funiculus. econd,
the dorsal columns are not affected. Consequently, a
lesion in the central canal region produces no change
in voluntary movement or in the sensations of touch,
vibration, and proprioception.
However, the spinothalamic pathway is affected by a
lesion around the central canal because the axons of
spinothalamic tract cells cross the midline just ventral
to the central canal. These axons, which cross at the
level of the primary afferent input, are interrupted by
a lesion of the central canal. Therefore, pain and
temperature sensations in the dermatome or
dermatomes at the level of the lesion are impaired
bilaterally
A lesion of the central canal is more than theoretical.
The most common cause is syringomyelia, which
occurs when either a cyst, or a cavity termed a syrinx
(Greek for “pipe” or “channel”), forms around the
central canal. The earliest symptom is usually a
bilateral loss of pain and temperature sensation
without any diminution in tactile or proprioceptive
sensations. This selective loss of pain and
temperature sensation bilaterally results from the
interruption of crossing spinothalamic tract axons.
The distribution of sensory loss is dermatomal, from
the dermatome of the segment where the damage is
located. Syringomyelia most frequently affects
cervical segments, giving rise to a bilateral loss of
pain and temperature in a glove distribution
bilaterally.
Finally, we consider a stroke affecting the right
pyramidal tract (Fig. 413C). Remember that the
corticospinal tract travels in the medullary pyramids
above the motor decussation. Therefore, a lesion of
the right medullary pyramid would affect the left
lateral corticospinal tract, which would impair
voluntary movements of the left arm and right leg.
The ventral corticospinal tract is also lesioned by a
pyramidal stroke. However, since the ventral
corticospinal tract influences motoneurons
innervating axial muscles bilaterally, voluntary
movements of the trunk are far less impaired than are
voluntary limb movements. Pyramidal lesions do not
affect either the lemniscal or spinothalamic pathways,
and, consequently, no sensory symptoms are present.
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