The Spinal Cord

Functions
• The spinal cord with its 31 pairs of spinal
nerves serves two important functions.
• It is the connecting link between the brain
and most of the body.
• It is involved in spinal reflex actions, both
somatic and visceral.
 Basic Anatomy of the Spinal
Cord
• The spinal cord extends caudally from the brain for about 45 cm and
has a width of ~14 mm. Its upper end is continuous with the brain
(medulla oblongata). The cord is slightly thicker than a pencil.
• There are 31 pairs of spinal nerves:8 cervical, 12 thoracic, 5
lumbar, 5 sacral, and coccygeal. The roots of the lumbar and
sacral are called cauda equina.
• Surrounding and protecting the spinal cord is the vertebral
column.
• The spinal cord is slightly flattened dorsally and ventrally,
with two enlargements-cervical and lumbosacral from
which the spinal nerves emerge that innervate the upper
and lower limbs.
 Basic Anatomy of the Spinal
Cord
• The cervical enlargement supplies nerves to
the pectoral girdle and upper limbs.
• The lumbar enlargement supplies nerves to
the pelvis and lower limbs.
• Inferior to the lumbar enlargement, the spinal
cord becomes tapered and conical-conus
medullaris.
• Filum terminale-slender strand of fibrous
tissue that extends from conus medullaris.
 Spinal Nerves
• There are 8 cervical nerves(C), 12 thoracic(T), 5 lumbar (L),
5 sacral (S), and 1 coccygeal (Co).
• Each pair of spinal nerves passes through a pair of
intervertebral foramina located between two successive
vertebrae. Each spinal nerve caudal to the first thoracic
vertebra takes its name from the vertebra immediately
preceding it.
• The nerves are then distributed to a specific pair of segments
of the body.
• The spinal cord and the roots of its nerves are protected by
the vertebral column, its ligaments, spinal meninges and
cerebrospinal fluid.
 Spinal Meninges
• The outer layer is called dura mater. This is a
tough, fibrous memebrane that merges with the
filum terminale.
• The middle layer, the arachnoid, runs caudally to
the S2 vertebral level. This is delicate and
transparent.
• The innermost is called, pia mater. It is highly
vascular and tightly attached to the spinal cord and
its roots.
• Meningitis-bacterial or viral infection.
 Spinal Meninges
• Between the dura mater and periosteum of the vertebrae
is the epidural space that contains many blood vessels
and fat.
• Anesthetics can be injected here below the L3 vertebral
level, from which it ascends to act upon sensory neurons
to help dull pain. This procedure is called caudal block.
(epidural block)
• Space between dura mater and archnoid-subdural
space-no CSF.
• Space between arachnoid and pia mater-subarchnoid
space-CSF, blood vessels, spinal roots.
 Cerebrospinal Fluid
• This is a clear watery ultra filtrate solution
primarily derived from blood.
• The basic mechanism involves an active transport
system and passive diffusion into the four
ventricles.
• The CSF provides a cushion that protects the
delicate tissues of the spinal cord.
• It is also involved in the exchange of nutrients
between the blood and neurons of the brain and
spinal cord.
 Internal Structure
• If the spinal cord is cut in X.S., a tiny central canal is
observed, which contains CSF.
• There is a dark portion of H-shaped or butterfly shaped
“gray matter”, surrounded by a larger area of “white
matter”.
• The spinal cord is divided into more or less symmetrical
halves by a deep groove called the anterior(ventral)
median fissure and a median septum called posterior
(dorsal) median sulcus.
• Extending from the spinal cord are the ventral and dorsal
roots of the spinal nerves.
 Gray Matter
• The gray matter of the spinal cord consists of nerve cell bodies,
dendrites and axon terminals(unmyelinated) and neuroglia. It is
pinkish-gray color because of a rich network of blood vessels.
• The gray matter forms an H shape and is composed of three
columns of neurons-posterior, anterior and lateral horns. The
projections of gray matter toward the outer surface of spinal cord
are called horns.
• The two that run dorsally-posterior horns which function in
afferent input. The two that run ventrally-anterior horns which
function in efferent somatic output. The two that extend laterally-
lateral horns.
• The nerve fibers that form the cross of the H are known as gray
commisure-functions in cross reflexes.
 White Matter
• The white matter gets its name because it is mainly composed
of myelinated nerve fibers, and myelin has a whitish color.
• The white matter is divided into three pairs of columns or
funiculi of myelinated fibers-anterior, posterior, lateral and a
commisure area.
• The bundles of fibers within each funiculus are divided into
tracts called fasciculi.
• Ascending tracts-sensory fibers carry impulse up the spinal
cord to the brain.
• Descending tracts-motor neurons transmit impulse from the
brain down the spinal cord.
 Spinal Nerves
• A series of connective tissue layer surrounds
each spinal nerve.
• Epineurium-outermost layer, consists of a
dense network of collagen fibers.
• Perineurium-extend inward from th
epineurium, dividing the nerve into a series of
compartments.
• Endoneurium-delicate connective tissue
fibers.
 Ventral and Dorsal Roots
• In the vicinity of the cord, each spinal nerve divides into a ventral
(anterior, motor) root and a dorsal (posterior, sensory) root.
• Ventral roots contain mostly efferent nerve fibers and convey
motor information.
• Dorsal roots contain afferent nerve fibers and convey sensory
information.
• The axons of motor neurons whose cell bodies are located within
the CNS in the ant. Horn emerge from the spinal cord to form
ventral roots (motor).
• Groups of sensory neurons , whose axons make up the dorsal roots
lie outside the cord in the dorsal root ganglia or spinal ganglia of
the PNS.
 Peripheral distribution of Spinal
Nerves
• A typical spinal nerve has a white ramus(this contains
myelinated axons), and a gray ramus (unmyelinated fibers
that innervate glands and smooth muscles in the body wall
or limbs)
• A dorsal ramus(providing sensory and motor innervation
to the skin and muscles of the back), and a ventral ramus
(supplying the ventrolateral body surface, structures in the
body wall and the limbs).
• Each pair of nerves monitors a region of the body surface
called a dermatome.
 Nerve Plexuses
• A complex, interwoven network of nerves
is a nerve plexus.
• The three large plexuses are the cervical
plexus, the brachial plexus and the
lumbosacral plexus. The latter can be
further divided into the lumbar plexus and
the sacral plexus.
Functional Roles of Pathways of
CNS
• Each pathway is composed of organized
sequences of neurons.
• Upper motor neurons in the brain influence the
activity of lower motor neurons in the cranial and
spinal nerves.
• Some neurons have long axons that terminate in
processing centers-called nucleus, ganglion, gray
matter of spinal cord or cortex of the brain.
 General Somatic Efferent
(Motor) System
• The brain exerts active influences on the activity
of skeletal muscles through descending motor
pathways that make up the upper motor neurons.
• These originate from the cell bodies in the cerebral
cortex and brainstem.
• These act by regulating and modulating the
activity of the lower motor neurons of the cranial
and spinal nerves.
 Lower Motor Neurons
• These include alpha and gamma motor neurons.
• Alpha motor neurons have their cell bodied in their
CNS. Their axons course through cranial and spinal
nerves and terminate on the motor end plates of skeletal
muscle fibers (extrafusal muscle fibers). Involved in
stretch reflex.
• Gamma neurons also have cell bodied within the CNS.
Their axons pass through cranial and spinal nerves to
innervate the intrafusal muscle fibers inside the
neuromuscular spindles. Involved in the gamma motor
neuron reflex.
 Lower Motor Neurons
• These are the only neurons that innervate the skeletal
muscle fibers, they function as the final common pathway,
the final link between the CNS and skeletal muscles.
• Axons are located both in the cranial and spinal nerves.
• Those in cranial nerves innervate the skeletal muscles
associated with the movements of the eyes, tongue,
chewing, swallowing, vocalizing.
• These are influenced by two sources: sensory receptors
that are integrated into reflexes and upper motor neurons
from the brain that form the “voluntary descending
pathways”.
 Upper Motor Neurons
• This is entirely located in the CNS.
 Sensory Pathways
• Some of these have sequences that are made of three
neurons.
• They may be called first, second and third order
neurons.
• A first-order neuron extends from sensory receptor
to CNS.
• A second-order neuron extends from the spinal cord
or brainstem to nucleus in the thalamus.
• A third-order neuron extends from the thalamus to a
sensory area of the cerebral cortex.
• A critical feature of many pathways is that they
cross over or decussate. By knowing where a
pathway crosses over, a physician can use this
information to help locate the site of an injury in
the CNS.
• Example is touch-pressure pathway that
decussates in the medulla oblongata.
 Tracts
• Many tracts are named after their nuclei of origin,
their termination as well as their location in the
spinal cord (eg. Lateral spinothalamic tract).
• Anterolateral System: this consists of the lateral
spinothalamic tract, spinoreticulothalamic tract
and anterior spinothalamic tract. This involves the
general sensatins of pain, temperature and light
touch.
• Posterior-column medial lemniscus pathway.
 Reflexes
• A reflex is a predictable involuntary
response to a stimulus.
• A reflex involving the skeletal muscles is
called a somatic reflex.
• A reflex involving responses of smooth
muscle, cardiac muscle, or a gland is a
visceral reflex.
 Classification of Reflexes
• Reflexes are classified according to :
• 1) their development : innate and acquired
• 2) site of information processing: cranial and
spinal reflexes.
• 3)nature of resulting motor response : somatic and
visceral reflexes.
• 4) the complexity of the neural circuit :
monosynaptic and polysynaptic reflexes.
 Spinal Reflexes
• A reflex always starts with a sensory neuron and
ends with a motor neuron.
• In a monosynaptic (one synapse, two neuron) reflex
arc, the sensory and motor neurons synapse directly.
• More often, however, one or more interneurons
synapse with the sensory and motor neurons in a
polysynaptc reflex arc.
• Most reflex actions never travel any higher than
spinal cord. Some maybe to brain stem.
 Types of Reflexes
• Stretch (Myotatic Reflex)-monosynaptic
reflex arc. Maintains erect posture. Eg.
Knee-jerk or patellar reflex. Ipsilateral-
response and stimulus on same side.
• Gamma Motor Neuron Reflex Arc-this
acts to smooth out the movements of
muscle contractions or to sustain the
contraction of a muscle.
 Types of Reflexes
• Plantar Reflex: this clinically tests the integrity
of the spinal cord from L4 to S2. It is tested by
drawing a blunt instrument down the lateral
aspect of the sole(plantar surface) of the foot. A
normal response is a curling or downward flexion
of the foot.
• Withdrawal reflex arc: involves sensory
receptors, afferent neurons, interneurons, alpha
motor neurons, skeletal muscles.
 Some Diagnostic Reflexes
• Abdominal reflex
• Achilles Reflex
• Biceps Reflex
• Babinski’s reflex
• Hoffmann’s reflex
• Patellar Reflex
• Plantar reflex
• Triceps reflex