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Gross Anatomy Lecture 1: Spinal Cord and Nerves Basic Terminology A. Neuron 1. Cell body processes called neuritis a. Dendrites receive information b. Axon carries away information from cell body 2. Nucleus collection of nerve cell bodies that perform a common function within brain or spinal cord 3. Ganglion a collection of nerve cell bodies outside brain and spinal cord 4. Afferents nerve fibers that carry information or signals to a ganglion or nucleus 5. Efferents nerve fibers that carry info away from cell body 6. Types of Neurons: a. Sensory neuron (Dorsal root ganglia) b. Motor neuron (spinal cord) B. Central Nervous System (CNS) 1. Neurons whose cell bodies and neuritis are contained within brain and SC C. Peripheral Nervous System (PNS) carry motor, sensory and/or autonomic signals between CNS and body (composed of cranial, spinal, splanchnic nerves) 1. Somatic Nervous System innervates skeletal muscles of the body wall or limbs and maintain voluntary control over body movement -Somatic nerves that innervate skeletal muscles at SC levels are SPINAL nerves; at brain or brainstem level are CRANIAL nerves a. Motor Somatomotor: voluntary and reflex contraction of skeletal muscle b. Sensory somatosensory: sensory innervation of skin, muscles, and joints 2. Visceral Nervous System innervates internal organs, smooth/cardiac muscle, and sweat glands. Controls most of unconscious homeostatic mechanisms of the body and innervate smooth muscle of BV, cardiac muscle of heart, glands in skin and various organs or viscera in body cavity -Splanchnic nerves innervate visceral nervous system a. Motor - Visceromotor (Autonomic Nervous System): involuntary contraction of smooth muscle, cardiac muscle and glands i. Divided into sympathetic and parasympathetic divisions b. Sensory Viscerosensory: modulates blood pressure and chemistry, respiration, etc. Spinal Cord A. General morphology 1. Extends from foramen magnum and ends in cone shaped structured (conus medularis between L1 and L2 of vertebral column a. Filum terminale ligament attaches SC to vertebral column caudally 2. Cauda equine collection of dorsal and ventral roots exiting and entering SC below L1 or L2 (continue below level of conus medularis) 3. Lumbar cistern: space between conus medularis and end of vertebral canal a. Lumbar punctures are performed in patients to assess the content of the CSF and are done at the level of the cauda equina in order to prevent damage to the spinal cord b. Needle inserted in midline between spinous processes of L3 and L4 (or L4 and L5) vertebrate 4. 2 enlargements towards cranial and caudal ends a. Cervical enlargement area of cord where additional motor neurons are located that innervate upper limb b. Lumbar enlargement contains neurons that innervate lower limb

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5. Spinal nerves exit vertebral canal between individual vertebrae through intervertebral foramen to innervate muscles from neck to feet a. 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal) 6. Relationship between spinal cord level and vertebral level in adult a. Vertebral level position of an individual vertebrate along vertebral column b. Spinal cord level location of an individual spinal cord segment along the SC i. Spinal cord segment region of spinal cord that contains all the neurons and nerve roots that make up individual spinal nerve c. In adults SC and vertebral elves not equivalent because vertebral column elongates at faster rate than the SC i. SC shorter than vertebral column ends at L1 (cauda equina extend to end of vertebral column) ii. 31 pairs of spinal nerves and only 30 vertebrate d. Position of spinal nerve as it exist vertebral column changes in relation to the vertebrate it exists adjacent to i. Between C1-C7, spinal nerve exists above the vertebrate with same anatomical name ii. SN C8 exits between C7 and T1 vertebrate iii. Caudal to T1 all spinal nerves exit column below vertebrae with the same name e. In cervical region, SC segment and vertebral level closely linked f. In lumbar region, they are far apart B. Gray and white matter 1. Gray matter: Central parts of cord contain the cell bodies a. Shape of gray matter has H or butterfly appearance 3 parts i. Dorsal (posterior) horn: specialized for receipt of sensory information from peripheral nerve ii. Ventral (anterior) horn: contains motor neurons whose axons exit the spinal cord and innervate skeletal muscle iii. Intermediate (lateral) horn at levels T1-L2: contains neurons that are part of the ANS and exit spinal cord to modulate autonomic activity in the periphery 2. White matter area surrounding gray matter that contains myelinated axons that travel up and down the cord 3. Grey/White Matter Characteristics of spinal cord grey/white matter ratio differs in different parts of SC a. Cervical SC i. Large ventral horns for innervation of upper limb ii. Large amount of dorsal white matter for transmission of sensory information from all parts of body b. Thoracic spinal cord i. Special area of gray matter (lateral horn) that houses cell bodies for sympathetic (preganglionic) neurons) Spinal Nerves A. Nerve roots 1. Dorsal root carries sensory information from periphery into dorsal horn of spinal cord a. Composed of sensory axons whose cell bodies are located in dorsal root ganglion (somatosensory and viscerosensory axons)

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b. Dorsal root ganglion contains somatosensory and viscerosensory cell bodies 2. Ventral root carries motor information form spinal cord to periphery a. Somatomotor axons in ventral root derived from motor neurons in ventral horn b. Ventral roots of thoracic and lumbar spinal nerves carry visceromotor (autonomic sympathetic preganglionic) axons from cell bodies in intermediate horn of spinal cord 3. Spinal nerve anatomical definition small part of nerve where roots and rami come together and sensory and motor fibers cross a. At intervertebral foramen, two nerve roots join to form spinal nerve which divides into two primary rami B. Rami 1. Dorsal primary ramus- first branch of spinal nerve that courses dorsally (somatosensory, Somatomotor, post-ganglionic sympathetics) a. Supplies fibers (sensory and motor) to synovial joints of vertebral column, deep muscles of the back and the skin that overlays the deep back musculature b. Posterior cutaneous nerve: begin at surface of erector spinae muscle and continue to the skin, passing though superficial back muscles without innervating them 2. Ventral primary ramus carries both sensory and motor fibers to and from rest of the body including anterior and lateral muscles of trunk and limbs a. Lateral or anterior cutaneous nerve: part of ventral ramus that innervates skin on the lateral and anterior surface of the trunk 3. Cutaneous nerve: nerve that innervates the skin and contains somatosensory and visceromotor (ANS) axons C. Components of spinal nerve have two targets (skeletal muscles and skin) 1. Innervates muscles all three components a. Somatomotor, somatosensory, visceromotor 2. Innervates skin a. Contains somatosensory and visceromotor ANS axons D. Dermatome - area of skin innervated by sensory fibers of single spinal nerve or spinal cord segment 1. Sensory or cutaneous fibers of primary rami that innervate skin remained segregated and have segmented distribution on skin surface 2. Sensory fibers from dorsal and ventral rami of each SC segment come together to form a continuous band of sensory input from a localized area of body wall Processing of sensory information A. Sensory motor circuit 1. Sensory info conveyed to CNS by sensory fibers located in spinal and cranial nerves 2. Sensory limb (afferent) gives info to brain/SC which gives info to motor limb (efferent) 3. Sensory motor circuit integrates information between peripheral and central NS B. Two pathways to respond of sensory stimulus 1. Voluntary sensory info can be evaluated at higher centers such as cortex to formulate conscious (voluntary) motor plan to guide desired response a. Ex picking up glass of water b. Sensory limb spinal cord cortex spinal cord motor limb 2. Reflex - rapid involuntary movement in response to sensory stimulus that does not require conscious thought

a. Somatic reflex contraction of skeletal muscle and occur naturally to prevent injury from harmful stimulus (stepping on tack or touching hot pot) i. Integrity of somatic reflex tested clinically using stretch reflex Knee jerk reflex tests L2, l3, L4 Ankle jerk reflex tests S1, S2 ii. Decreased reflex response indicates peripheral nerve injury iii. Exaggerated reflex indicates injury to the CNS b. Cranial nerve reflex -involve components of either or both visceral and somatic nervous system as well s our special senses i. Pupillary light reflex regulates size of pupil based on intensity of light ii. Accommodation reflex adjusts thickness of lens to maintain focus of objects both near and far iii. Corneal reflex eyes blink to lubricate eye to remove foreign object iv. Gag reflex prevent something from entering throat except as part of normal swallowing, also evoked by strong negative taste