The Spinal

Cord
Wilson O. Hamman
Department of Human Anatomy
Faculty of Basic Medical Sciences
Ahmadu Bello University
Zaria - Nigeria

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 GENERAL FEATURES
• The spinal cord is housed in the vertebral canal.
• It is continuous with the medulla below the
pyramidal decussation and terminates as the conus
medullaris between the first and second lumbar
vertebra of the adult.
• The roots of 31 pairs of spinal nerves (mixed) arise
segmentally from the spinal cord.
• The anterior median sulcus and the posterior median
sulcus divide the cord into equal right and left halves
• Inside the spinal cord, gray matter is centrally
located and shaped like a butterfly.
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 GENERAL FEATURES
• It contains neuronal cell
bodies, their dendrites, and
the proximal parts of axons.
• White matter surrounds
the gray matter on all sides.
• White matter contains
bundles of functionally
similar axons called tracts
or fasciculi, which ascend
or descend in the spinal
cord.

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 Spinal Cord Anatomy
• Conus medullaris – terminal portion of the spinal cord
• Filum terminale – fibrous extension of the pia mater;
anchors the spinal cord to the coccyx
• Denticulate ligaments – delicate shelves of pia mater; attach
the spinal cord to the vertebrae
• Spinal nerves – 31 pairs attach to the cord by paired roots
• Cervical nerves are named for inferior vertebra
• All other nerves are named for superior vertebra
• Cervical and lumbar enlargements – sites where nerves
serving the upper and lower limbs emerge
• Cauda equina {horse tail} – collection of nerve roots at the
inferior end of the vertebral canal
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 The spinal cord
• Gross anatomy
• 3 layers of meninges
• Epidural space (fat & vessels)
• CSF – subarachnoid space
• Connects via filum terminale
& denticulate ligaments (pia)
• The cauda equina consists of
the dorsal and ventral roots of
the lumbar, sacral, and
coccygeal spinal nerves
• In humans there are 8
cervical, l2 thoracic, 5 lumbar,
5 sacral, and 1 coccygeal
segments 5
 The spinal cord
• The spinal cord had two
enlargements: Cervical (C5
through TI) Lumbar (L1–S2).
• The Cervical innervates the
upper limb, whereas the
lumbar innervates the
lower limb.

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The Significance of SC
Enlargements
• The innervation of the many muscles
that constitute either the upper or
lower extremity requires an increase in
the number of neurons in the dorsal
and ventral horn. Consequently, the
cord is enlarged at C6–T1 and T12–S1.

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 The spinal cord
• During development and growth, particularly
intrauterine growth, the vertebral column
grows faster than the spinal cord so that, in
the adult, the spinal cord does not extend the
length of the vertebral column.
• The nerve roots run through the subarachnoid
space, which is filled with cerebrospinal fluid.
• When a needle is inserted through the space
between the 4th and 5th lumbar vertebra the
point penetrates the dura and pushes aside the
spinal roots. 8
Lumbar Tap

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Laminar Organization of Central Gray
• The gray matter is divided into 10 layers:
9 layers within the spinal gray and a thin
region surrounding the central canal
• The dorsal horn includes laminae 1–6,
the intermediate zone lamina 7, and the
ventral horn is laminae 8 and 9.

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Laminar Organization of Central
Gray

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Cross-Sectional Anatomy of the Spinal Cord
• Anterior median fissure – separates anterior funiculi
• Posterior median sulcus – divides posterior funiculi

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 Cross-sectional anatomy

• Gray matter (cell bodies,

neuroglia, &
unmyelinated
processes)
• Posterior horns (sensory,
all interneurons)
• Lateral horns
(autonomic, T1-L2)
• Anterior horns (motor,
cell bodies of somatic
motor neurons)
• Spinal roots
• Ventral (somatic &
autonomic motor)
• Dorsal (DRG)

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 Cross-sectional anatomy
• White matter
• 3 funiculi (posterior, lateral,
anterior)
• Ascending,
• descending,
• Consist of “tracts” containing
similarly functional axons
• All tracts are paired
• Most cross over
(decussate) at some
point
• Most exhibit somatotopy
(superior part of the
tracts are more lateral
than inferior body
regions)
• Most consist of a chain
of 2 or 3 successive
neurons

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 Gray Matter: Organization
• Dorsal half – sensory roots and ganglia
• Ventral half – motor roots
• Dorsal and ventral roots fuse laterally to form spinal nerves
• Four zones are evident within the gray matter – somatic sensory
(SS), visceral sensory (VS), visceral motor (VM), and somatic
motor (SM)

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White Matter: Pathway
Generalizations

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 Tracts :
1) Posterior column:
• Fine touch
• Light pressure
• Proprioception
2) Lateral corticospinal tract :
• Skilled voluntary movement
3) Lateral spinothalamic tract :
• Pain & temperature sensation
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 Tracts :
• Posterior column and lateral corticospinal
tract crosses over at medulla oblongata

• Spinothalamic tract crosses in the spinal

cord and ascends on the opposite side

NB to understand this as it helps to

understand the clinical features of injury
patterns and the neurological deficit
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Voluntary innervation of skeletal
muscle
• Two motor neurons, an upper and a lower
motor neuron, together form the basic neural
circuit involved in the voluntary contraction of
skeletal muscles everywhere in the body.
• The lower motoneurons are found in the
ventral horn of the spinal cord and in cranial
nerve nuclei in the brain stem.
• Axons of lower motoneurons of spinal nerves
exit in a ventral root, while axons of lower
motoneurons in the brainstem exit in a cranial
nerve. 19
Voluntary innervation of skeletal
muscle
• To initiate a voluntary
contraction of skeletal
muscle, a lower
motoneuron must be
innervated by an upper
motoneuron
• The upper motoneuron
innervates the lower
motoneuron, and the
lower motoneuron
innervates the skeletal
muscle. 20
Lesions of the Corticospinal Tract
• If lesion of the corticospinal tract occur above the
pyramidal decussation, weakness is seen in muscles
on the contralateral side of the body;
• Lesions below pyramidal decussation, produce an
ipsilateral muscle weakness.
• In contrast to upper motoneuron the cell bodies of
lower motoneuron are ipsilateral to the skeletal
muscles that their axons innervate
• A lesion to any part of a lower motoneuron will
result in an ipsilateral muscle weakness at the level
of the lesion.
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Lesions of spinal tracts

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Signs of Upper Motor Neuron
Lesions (UMNL)
1. Paralysis or weakness of movements of the
affected side but gross movements may be
produced. No muscle atrophy is seen initially but
later on some disuse atrophy may occur.
2. Babinski sign is present: The great toe becomes
dorsiflexed and the other toes fan outward in
response to sensory stimulation along the lateral
aspect of the sole of the foot.
The normal response is plantar flexion of all the toes.

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Signs of Upper Motor Neuron
Lesions (UMNL)
3. Loss of performance of fine-skilled voluntary
movements especially at the distal end of the limbs.
4. Superficial abdominal reflexes and cremasteric
reflex are absent.
5. Spasticity or hypertonicity of the muscles.
6. Clasp-knife reaction: initial higher resistance to
movement is followed by a lesser resistance
7. Exaggerated deep tendon reflexes and clonus may
be present.

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Signs of Lower Motor Neuron
Lesions (LMNL)
1. Flaccid paralysis of muscles supplied
2. Atrophy of muscles supplied.
3. Loss of reflexes of muscles supplied.
4. Muscles fasciculation (contraction of a group of fibers) due to
irritation of the motor neurons – seen with naked eye.
5. Muscle fibrillation (contraction of individual fibers) – detected
only by EMG
6. Muscle contracture (shortening of paralyzed muscles)
7. Presence of muscle wasting

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Peripheral Distribution of Spinal Nerves
• Each spinal nerve connects
to the spinal cord via two
medial roots
• Each root forms a series of
rootlets that attach to the
spinal cord
• Ventral roots arise from the
anterior horn and contain
motor (efferent) fibers
• Dorsal roots arise from
sensory neurons in the
dorsal root ganglion and
contain sensory (afferent)
fibers
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Figure 13–7a
Peripheral Distribution of Spinal
Nerves

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Blood supply to spinal cord

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Lesions of the spinal
cord

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Spinal Cord Trauma:
Transection
• Cross sectioning of the spinal cord at any
level results in total motor and sensory loss
in regions inferior to the cut
• Paraplegia – transection between T1 and L1
• Quadriplegia – transection in the cervical
region

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Spinal Cord Injury Classification
• Quadriplegia :
all 4 extremities affected

• Paraplegia :
injury in thoracic, lumbar or sacral segments
2 extremities affected

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Types
Complete:
i) Loss of voluntary movement of parts innervated by
segment, this is irreversible
ii) Loss of sensation
iii) Spinal shock
Incomplete:
i) Some function is present below site of injury
ii) More favorable prognosis overall
iii) Are recognisable patterns of injury, although they
are rarely pure and variations occur

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Brown-Sequard syndrome
• Hemi section of the cord results in a lesion of each
of the three main neural systems: the principal
upper motoneuron pathway of the corticospinal
tract, one or both dorsal columns, and the
spinothalamic tract.
• The hallmark of a lesion to these three long tracts is
that the patient presents with two ipsilateral signs
and one contralateral sign.

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Brown-Sequard syndrome
• Lesion of the corticospinal tract results in an
ipsilateral spastic paresis below the level of the
injury.
• Lesion to the fasciculus gracilis or cuneatus results in
an ipsilateral loss of joint position sense, tactile
discrimination, and vibratory sensations below the
lesion.
• Lesion of the spinothalamic tract results in a
contralateral loss of pain and temperature sensation
starting one or two segments below the level of the
lesion.
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Brown-Sequard syndrome
• Segmental LMN signs
and sensory changes at
the level of lesion due
to damage of the roots
and anterior horn cells
at the level of lesion

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Central Cord Syndrome :
• Typically in older
patients
• Hyperextension injury
• Compression of the
cord anteriorly by
osteophytes and
posteriorly by
ligamentum flavum

36
Central Cord Syndrome :
• Also associated with fracture dislocation and
compression fractures
• More centrally situated cervical tracts tend to be
more involved hence
• Perianal sensation & some lower extremity
movement and sensation may be preserved

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Anterior cord Syndrome:
• Due to flexion / rotation
• Anterior dislocation / compression fracture of a
vertebral body encroaching the ventral canal
• Corticospinal and spinothalamic tracts are
damaged either by direct trauma or ischemia of
blood supply (anterior spinal arteries)

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Anterior cord Syndrome:
Clinically:
• Loss of power
• Decrease in pain and sensation below lesion
• Dorsal columns remain intact

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Posterior Cord Syndrome:
• Hyperextension injuries with fractures of the
posterior elements of the vertebrae
Clinically:
• Proprioception affected – ataxia and faltering gait
• Usually good power and sensation

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43
What is the difference between
spinal shock and neurogenic
shock?
• Spinal shock is mainly a loss of reflexes
(flaccid paralysis)
• Neurogenic shock is mainly hypotension and
bradycardia due to loss of sympathetic tone

44
Spinal Shock vs Neurogenic
Shock
Spinal Shock :
• Transient reflex depression of cord function below level of
injury
• Initially hypertension due to release of catecholamines
• Followed by hypotension
• Flaccid paralysis
• Bowel and bladder involved
• Sometimes priaprism develops
• Symptoms last several hours to days

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Neurogenic shock
• Commonly seen in cervical injuries
• Due to interruption of the sympathetic input from
hypothalamus to the cardiovascular centers
• Hallmark: hypotension (due to vasodilation, due to
loss of sympathetic tonic input) is associated with
bradycardia (not tachycardia, the usual response),
due to inability to convey the information to the
vasomotor centers in the spinal cord and
hypothermia

46
High cervical injuries (C3 and
above)
• Motor and sensory deficits involve the entire arms
and legs
• Dependent on mechanical ventilation for breathing
(diaphragm is innervated by C3-C5 levels)

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Midcervical injuries (C3-C5)
• Varying degrees of diaphragm dysfunction
• Usually need ventilatory assistance in the acute
phase
• Shock

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Low cervical injuries (C6-T1)
• Usually able to breathe, although occasionally cord
swelling can lead to temporary C3-C5 involvement
(need mechanical ventilation)
• The level can be determined by physical exam

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Blood Supply of the Brain

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INTRODUCTION
• About 18% of the total blood volume in the body
circulates in the brain, which accounts for about 2%
of the body weight.

• Loss of consciousness occurs in less than 15 seconds

after blood flow to the brain has stopped, and
irreparable damage to the brain tissue occurs within 5
minutes.
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INTRODUCTION
• Cerebrovascular disease or stroke, occurs as a result
of vascular compromise or haemorrhage and is one of
the most frequent sources of neurologic disability.
• Nearly half of the admissions to many busy neurologic
services are because of strokes.
• Cerebrovascular disease is the third most common
cause of death in industrialized societies.
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 Arteries of brain
Two sources
• Internal carotid artery:
supplies anterior 2/3 of
cerebral hemisphere and
parts of diencephalon
• Vertebral artery:
supplies posterior 1/3 of
cerebral hemisphere and
parts of diencephalon,
brain stem and
cerebellum

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INTRODUCTION

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• The greater part of the of the
brain is supplied by Circle of
Willis
• Formed by four large arteries :
1.Two internal carotid arteries
2. two vertebral arteries
Int. carotid arteries give off :
• Two anterior cerebral arteries
• Two middle cerebral arteries
• Vertebral unites to form Basilar
artery ends by dividing into
• Two posterior cerebral
arteries

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56
Circle of Willis (circulos
arteriosus)
• The circle of Willis is a
confluence of vessels that
gives rise to all of the major
cerebral arteries.
• It is fed by the paired
internal carotid arteries and
the basilar artery.
• When the circle is complete,
it contains a posterior
communicating artery on
each side and an anterior
communicating artery.
• The circle of Willis shows
many variations among
individuals.
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• The two anterior cerebral
arteries are connected to each
other by
anterior communicating artery
• The posterior cerebral arteries
are connected to the internal
carotids by posterior
communicating arteries
• Basilar artery is formed by the
union of vertebral arteries
• Vertebral arteries arise from the
first parts of the subclavian
arteries and go to the cranium
through the foramina of the
transverse processes of the
cervical vertebrae; enter the
cranium through the foramen
magnum
• They join to form the basilar
artery 59
60
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 SUMMARY
• The CIRCLE OF WILLIS is
therefore formed by
• 2 internal carotid
arteries
• 2 anterior cerebral
arteries
• 2 posterior cerebral
arteries
• 1 anterior
communicating artery
• 2 posterior
communicating arteries
• `1 Basilar artery
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Cerebral arterial circle ( circle of Willis
)
• Formation: formed by anterior
communicating artery, both
anterior cerebral arteries,
internal carotid arteries,
posterior communicating
arteries, and posterior cerebral
arteries
• Position: lies on sella turcica
around optic chiasma, tuber
cinereum and mamillary bodies

63
CIRCLE OF WILLIS
1 – Vertebral artery
2 – Ant. Inf. Cerebellar Art.
3 – Basilar artery
4 – Superior cerebellar artery
5 – Posterior cerebral artery (PCA)
6 – Posterior communicating artery
7 – Middle cerebral artery (MCA)
8 – Int. carotid art. (ICA)
9 – Opthalmic artery
10 – Anterior cerebral artery (ACA)
11 – Anterior communicating artery
12 – Hypothalamic artery
13 – Anterior choroidal artery

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INTERNAL CAROTID
ARTERY
• Arises from the COMMON CAROTID ARTERY
• Enters skull through carotid canal in the temporal
bones (petrous)
• Passes anteromedially through the cavernous sinus
• divides at medial end of the lateral sulcus
• anterior and middle cerebral arteries
• anterior circulation of the brain

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 Branches of Int. Carotid Artery
• Anterior cerebral arteries
– smaller terminal branch of the ICA
– enters longitudinal fissure
– connected to the opposite anterior cerebral artery by anterior
communicating artery (part of the CoW)
– central branch supply deep masses of gray matter w/in the
cerebral hemisphere
– Supply:
• cortical branches supply all medial surface of cerebral
cortex up to parieto-occipital sulcus
• corpus callosum
• approximately 1 inch of the frontal and parietal cortex on
the superior aspect of their lateral surface (this include the
leg area of the precentral gyrus)
• anterior portions of the basal ganglia and internal capsule
66
Anterior cerebral artery

• Joined the fellow of the

opposite side by the
anterior communicating
artery
• Cortical branches:
supply all medial surface
of the cerebral cortex as
far back as the
parietooccipital sulcus
and superior border of
the suprolateral surface
of the cerebral
hemisphere

67
Branches of Int. Carotid Artery
• Middle Cerebral Arteries: largest branch.
• runs laterally in the lateral sulcus .
• cortical branches supply entire lateral surface of the hemisphere
EXCEPT
• area supplied by anterior cerebral artery
• inferolateral surface supplied by posterior cerebral artery
• occipital pole
– central branch supply deep masses of gray matter within the
cerebral hemisphere
– Supply:
• cortical branches supply all medial surface of cerebral cortex up
to parieto-occipital sulcus
• corpus callosum
• approximately 1 inch of the frontal and parietal cortex on the
superior aspect of their lateral surface (this include the leg area
of the precentral gyrus)
• anterior portions of the basal ganglia and internal capsule
68
Middle cerebral artery
• runs laterally in the lateral
sulcus .
• Cortical branches: supply
most of superolateral
surface of cerebral
hemisphere and insular
lobe
• Central branches: supply
lentiform and caudate
nuclei, genu and posterior
limb of internal capsule
(lenticulostriate artery)

69
Middle Cerebral Arteries:
branches
• Ophthalmic artery
– enters orbit through optic canal, below and lateral to
optic nerve
– supplies the eye, including retina and optic nerve
• Posterior communicating artery
– runs backward to join posterior cerebral artery at
interpeduncular fossa
• deep depression on inferior of midbrain between
cerebral peduncles
• part of the circle of Willis
• Choroidal artery
– enter inferior horn of lateral ventricle to supply
choroid plexus
– branches may help supply the optic tract, LGB,
internal capsule and crus cerebri
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VERTEBRAL ARTERY
• Branch of the 1st part of the subclavian artery
• Ascends the neck through the transverse foramina of
upper 6 cervical vertebrae
• Enters skull through foramen magnum
• Cranial branches
– Meningeal arteries
– Anterior and posterior spinal arteries
– Posteroinferior cerebellar artery
• Largest branch of the vertebral artery and supplies
parts of the cerebellum and the dorsolateral
portion of the rostral medulla
• Occlusion: lateral medullary syndrome
– Medullary arteries
• Along with posteroinferior cerebellar artery,
supply most of the medulla
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 Branches contd.
• At lower border of pons, vertebral arteries unite to
form the BASILAR ARTERY
• Ascends along the ventral midline of the pons
and terminates near the rostral border of pons by
dividing into 2 posterior cerebral arteries
• Branches: branches to pons, cerebellum, internal
ear
• Labyrinthine artery: follows the course o the CN
VIII and supplies inner ear
• Anterior inferior cerebellar artery: supplies part of
the pons and the anterior and inferior regions of
the cerebellum
• Superior cerebellar artery: supplies part of the
rostral pons and superior region of the cerebellum
• Pontine branches : supply most of pons
72
Branches contd.
• Posterior cerebral arteries
• Formed by the terminal bifurcation of the
basilar artery
• Anastomoses with the posterior
communicating artery in the circle of Willis
• Supply: lateral surface of the hemisphere –
occipital pole and inferior temporal lobe
• Medial surface of the hemisphere –
occipital lobe and posterior 2/3 of
temporal lobe
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Posterior cerebral artery
• Cortical branches: supply
medial and inferior
surfaces of temporal lobe
and occipital lobe
• Central branches: supply
dorsal thalamus, medial
and lateral geniculate
bodies, hypothalamus
and subthalamus

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