Spinal cord

The Anatomy,
Physiology And
Pathology
 The anatomy
• Structure - extends from
the medulla oblongata
inside brain and continues
through the conus
medullaris near the lumbar
level at L1-2, terminating in
a fibrous extension known
as the filum terminale.
• It is about 45 cm long in
men and 42 cm long in
women, ovoid-shaped, and
is enlarged in the cervical
 Cont.
• The peripheral
region of the cord
contains neuronal
white matter tracts
containing sensory
and motor neurons.
Internal to this
peripheral region is
the gray, butterfly
shaped central
region made up of
 Posterior
Horn

Anterior
Horn
 Cont.
• The three meninges that cover the spinal cord -- the
outer dura mater, the arachnoid membrane, and the
innermost pia mater -- are continuous with that in the
brainstem and cerebral hemispheres, with
cerebrospinal fluid found in the subarachnoid space.
• The cord within the pia mater is stabilized within the
dura mater by the connecting denticulate ligaments
which extends from the pia mater laterally between
the dorsal and ventral roots. The dural sac ends at the
 Physiology
• The tracts
– Descending tracts
– Ascending tracts
 Cont.
• Descending tracts
– Corticospinal tract (x at pyramids)
• Lateral – fine motor fx
• Anterior – gross & postural motor fx
– Vestibulospinal tract – postural reflexes (no
x)
– Rubrospinal tract – motor fx (x at midbrain)
– Reticulospinal tract – modulation of sensory
transmission, modulation of spinal reflexes
– Descending autonomic – mod. Of
autonomic fx
– Tectospinal tract – reflex head turning (x at
midbrain)
– Medial longitudinal fasciculus –
 Cont.
• Ascending tract
– Dorsal column system – fine touch,
propioception (x at Medulla)
– Spinothalamic tracts – sharp pain,
temp., crude touch (x at level)
– Dorsal spinocerebellar tract –
movements, position mech
– Ventral spinocerebellar tract tract –
movements, position mech
– Spinoreticular pathway – deep, chronic
pain
 The pathology
Types of
Spinal
Cord
lesions
 Cont.
1. Small central lesion; affect decussating
spinothalamic tract – lost of pain,
temp.; preserve vibration and position
senses. E.g. syringomyelia.
2. Large central lesion; lost of pain,
temp., can be LMN at level with below
level UMN, sometime lost of vibration
and weakness.
3. Dorsal column lesion; affect Dorsal
column system – lost propioception
and vibration (same side) only. E.g.
 Cont.
4. Irregular peripheral lesion; involved
long pathways and gray matter. E.g.
stab wound, gun shot wound,
compression.
5. Complete hemisection; Brown-Sequard
syndrome – ipsilateral LMN/UMN
paralysis (depend on level), ipsilateral
cutaneous anesthesia (at level),
ipsilateral lost of propioceptive,
vibratory and 2 point discrimination
below the level. Contralateral lost of
 Cont.
6. Tumor of dorsal root;
e.g. neurofibroma or
schwannoma – pain
and sensory loss.
Reflex at the level
also diminished.
7. Cord compression
due to extramedullay
tumor; e.g. tumor of
meninges or bone
*both 6 & 7 pathologies are occurred
extramedullary.
 Conus medullaris and Cauda
Equina
• In understanding the pathological basis
of any disease involving the conus
medullaris, keep in mind that this
structure constitutes part of the spinal
cord (the distal part of the cord) and is
in proximity to the nerve roots. Thus,
injuries to this area often yield a
combination of upper motor neuron
(UMN) and lower motor neuron (LMN)
symptoms and signs in the dermatomes
and myotomes of the affected
segments. On the other hand, a cauda
equina lesion is a LMN lesion because
Cont.
Cont.