NEURO

LO 1 WEEK 5

EXTERNAL ANATOMY OF VERTEBRAL COLUMN

Vertebral column  33 bones (7 cervical, 12 thoracal, 5 lumbar, 5 sacral, 4 coccyx), separated by intervertebral disc
Functions:
- Protection: encloses and protects spinal cord
within spinal canal
- Support: carries weight of the body above
pelvis
- Axis: forms central axis of the body
- Movement: roles in both posture and
movement

Vertebral arch
Forms lateral and posterior aspect of each vertebrae, bersama vertebral body ngebentuk hole yang tertutup
bernama vertebral foramen. Kalo all foramen di line up ngebentuk vertebral canal (pembungkus spinal cord)
Ada beberapa penonjolan tulang, yang berfungsi buat attachment dari muscle and ligament:
- Spinous process: setiap vertebrae ada 1, di tengah bagian
posterior
- Transverse process: ada 2, di lateral dan posterior dari
vertebral body (di thoracic vertebrae, transverse process
articulate sama ribs)
- Pedicles: connect vertebral body ke transverse process
- Lamina: connect transverse and spinous process
- Articular process: form joints between one vertebrae to
superior and inferior counterparts. Ada di pertemuan
lamina dan pedicles.
Classifications of vertebrae
1. Cervical vertebrae
- ada 7
- ciri khas:
o spinous process terbelah 2 di distal ends  kecuai C1 (gada spinous
process), dan C7 (spinous process longer than C2-C6)
o transverse foramina: ada opening di each transverse process
(tempat vertebral arteries travel ke otak)
o cervical vertebrae yang khas:
 atlas and axis  specialized buat movement of the head
2. Thoracic vertebrae
- Ada 12
- Increase in size dari superior ke inferior
- Function to articulate ribs = bony thorax
- Each T vertebrae ada “demi facets” di bagian superior dan inferior samping T body  tempat articulate
dengan heads of 2 different ribs
- Di bagian transverse process nya ada costal facet buat artivulate with shaft (batang) dari a single rib.
- Bentuk dari spinous processnya tajem ke bawah. Beda dari cervical vertebrae, T vertebrae punya vertebral
foramen bentuknya circular.

3. Lumbar vertebrae
- Ada 5
- Carry greatest amount of body weight jadi characterized by the
large size and thickness.
- Short transverse process, and short, blunt spinous process
- size dia allow clinical acess to spinal canal and spinal cord
between lumbar vertebrae. E.g epidural anaesthesia
administration and lumbar puncture.

4. Sacrum and coccyx

- Superior base: weight-bearing. Inferior base: non weight-bearing
- Fusion of 5 sacral vertebrae
- Anterior surface: lines of vertebral fusion nya bisa dilihat as 4 transverse ridges
- Posterior surface: running down the midline ada median sacral crest (tonjolan dari fusion of spinous
processes). Di lateralnya, ada fused transverse process namanya lateral sacral crest
- Sacral promontory: ada di anterior lip of superior base of sacrum. Sisi lateralnya ada roughened auricular
surface (gabung sama ilium dari hipbone to form immobile sacroiliac joints of pelvis)
- Passing inferiorly thru the sacrum ada bony tunnel = sacral canal, dan terminates di sacral hiatus
 - Anterior dan posterior surfaces ada series of paired openings = sacral foramina yang connect to sacral canal.
Each of the openings namanya posterior (dorsal) sacral foramen or anterior (vetral) sacral foramen. 
untuk tempat keluarnya spinal nerves dari sacrum
- Coccyx or tailbone merupakan fusion dari 4 very small coccygeal vertebrae. Dia ga weight bearing kalo lg
berdiri tapi dia receive some body weight when sitting.

Intervertebral disc
- Fibrocartilaginous pad yang isi gap between vertebral bodies.
- Bantu dalam weight-bearing. Makanya dia thin di cerival vertebrae, tapi thickest di lumbar vertebrae.
- Menyumbang sekitar 25% dari body height
- Consist of 2 parts:
o Annulus fibrosus: tough, fibrous outer layer of the disc.
o Nucleus pulposus (bagian dalam): softer, gel-like material.
 High water content buat resist compression
 Increasing age, bikin water content nya gradually declines  disc jadi lebih tipis,
reduce flexibility dan membungkuk jadi makin susah
 Kalo posterior annulus fibrosus weakened karna injury atau increasing age,
pressure neken disc nya pas membungkuk ke
depan dan lifting heavy object bisa bikin
nucleus pulposus protrude posteriorly ke
annulus fibrosus = herniated disc  bulging ini
bisa neken spinal nerve bikin pain or muscle
weakness di body regions supplied by that
nerve.
o Most common site: L4/L5 or L5/S1
intervertebral disc  cause sciatica,
widespread pain yang radiates dari
lower back ke thigh dan legs
Ligaments of vertebral column
Adjacent vertebrae united by ligaments di anterior dan posterior. Berguna untuk prevent excess forward or
backward bending movements dari vertebral column.
- Anterior longitudinal ligament
o Runs down anterior side of vertebral column
o Serve to resist excess backward bending of vertebral column
o Penting banget di movement of the neck dimana extreme posterior bending of head and neck bisa
stretch or tear this ligament  painful whiplash injury
- Supraspinous ligament
o Runs down posterior side of vertebral column
o Supports vertebral column during forward bending motions
 o Di posterior neck, dimana spinous processnya pendek, supraspinous lig. Expands jadi nuchal
ligament.
o Nuchal ligament attach ke cervical spinous process dan
extends upward to attach ke midline base of skull ke external
occipital protubarence.  support and prevents skull from
falling forward
- Additional ligaments ada di dalam vertebral canal, next to spinal cord
o Posterior longitudinal ligament: anterior dari spinal cord,
attached ke posterior sides of vertebral bodies
o Ligamentum flavum (“yellow ligament”): posterior to spinal
cord. Consist of a series of short, paired ligaments,
menghubungkan antar lamina regions. Punya banyak elastic
fibers yang berwarna kuning

EXTERNAL ANATOMY OF SPINAL CORD

Long, thin, tubular bundle of nervous tissue and support cells yang dimulai dari occipital bone yang pass thru
foramen magnum sampe ke lumbar region. Around 45 cm in men and 43 cm in women.
Function: transmission of nerve signals from motor cortex to body, and from afferent fibers of sensory neurons to
sensory cortex.
Structure
- Originates di brain stem, pass thru foramen magnum, continues sampe ngebentuk conus
medullaris (deket 2nd lumbar vertebrae) dan terminates as filum terminale (perpanjangan
pia mater), spinal nerves inferior to conus medullaris are called cauda equine (horse’s tails)
- Cervical enlargement (C5-T1) adalah origin of brachial plexus, tempat sensory input comes
from and motor output goes to arms and trunks
- Lumbar enlargement (L1-S3) handles sensory input and motor output coming from and
going to legs
- Made of 31 segments from which branch one pair of sensory nerve roots and one pair of
motor nerve roots
- Dorsal roots are afferent fascicles, receiving sensory information dari skin, muscles, visceral
organs  terminates di dorsal root ganglia
- Ventral roots consist of efferent fibers that arise from motor neurons dimana cell bodiesnya
ada di ventral (anterior) gray horns of spinal cord.
Cross-section
- Peripheral region ada neuronal white matter tracts: contain sensory and motor axons
- Di dalam white matter ada grey matter: contain nerve cell bodies arranged in the 3 grey columns  butterfly
shaped
- di tengah ada garis atau sulci. Di dorsal side: posterior median sulcus, ventral side: anterior median fissure

Spinal meninges
- Spinal cord dilindungi sama 3 layes of tissue or membrane called meninges.
o Dura mater
 Lapisan paling luar
 Separated from walls of vertebral canal by epidural space (contain loose connective tissue,
adipose tissue, and internal vertebral venous plexus)
  Di saat spinal nerve menembus dura mater, spinal nerve diselubungi oleh namanya
epineurium
o Arachnoid matter
 Membrane halus yang terletak between dura mater and pia mater yang dipisahin sama
subarachnoid space (contains CSF)
 Distal to conus medullaris, subarachnoid space expands ngebentuk lumbar cistern. 
tempat akses dari lumbar puncture (obtain CSF fluid) dan spinal anesthesia
o Pia mater
 Lapisan paling dalam dari meninges. Thin membrane yang cover spinal cord, nerve roots,
dan blood vessels
 The cord is stabilized within the dura mater by the connecting denticulate ligaments, which
extend from the enveloping pia mater laterally between the dorsal and ventral roots.

VASCULARIZATION OF SPINAL CORD

Arterial supply to spinal cord via 3 longitudinal arteries  anterior spinal artery and paired posterior spinal arteries
- single anterior spinal artery: branches of vertebral arteries. They travel in the anterior median fissure.
Supplies anterior 2/3 of spinal cord
- paired posterior spinal artery: originates dari vertebral artery or the posteroinferior cerebellar artery.
Mereka bergabung di pia mater. Supply posterior 1/3 of spinal cord.
- Anterior and posterior spinal arteries are connected by anastomoses called arterial vasocorona (encircles
the cord)
- additional artery:
o anterior and posterior segmental medullary (radicular) arteries  small vessels yang masuk via
nerve roots
 largest anterior segmental medullary arteries = artery of damkiewicz / arteria redicularis
magna  arise between T9-L2. arise from inferior intercostal or upper lumbar arteries,
supplies inferior 2/3 dari spinal cord

Venous drainage via 3 anterior and 3 posterior spinal veins. Spinal veins drain into internal and external vertebral
plexuses  empty into systemic segmental veins. Internal vertebral plexus also empties into dural venous sinus
superiorly.
SPINAL NERVE AS COMPONENT OF PERIPHERAL NERVOUS SYSTEM
Terbentuk dari gabungan anterior nerve / ventral root (efferent motoric) and posterior nerve /
dorsal root (afferent sensoric)
Spinal nerves leave the vertebral canal via intervertebral foramina, terus divide jadi 2
o posterior rami  supplies nerve fibers to the synovial joints of vertebral column,
deep muscles of the back, and skin
o anterior rami  supplies nerve fibers to the remaining area of the body (motor
and sensory)

Spinal cord composed of 31 segments:

- 8 cervical (C) segments
- 12 thoracic (T) segments
- 5 lumbar (L) segments
- 5 sacral (S) segments
- 1 coccygeal (Co) segment – mainly vestigial

C1-C7 muncul superior to each cervical vertebrae, lalu C8 diantara

tulang C7 dan T1, dan sisa nerve muncul dibawah dari tulang yang
dinamainya.

Regional nerves
1. Cervical nerves
- All cervical nerves except C8 ada di above their corresponding
vertebra.
- Posterior distribution includes: suboccipital nerve (C1),
greater occipital nerve (C2), third occipital nerve (C3).
- Anterior distribution includes: cervical plexus (C1-C4), brachial
plexus (C5-T1)
- Cervical nerves innervate the sternohyoid, sternothyroid,
omohyoid muscles.
- Loop of nerves called ansa cervicalis adalah part of cervical
plexus
2. Thoracic nerves
- Each thoracic nerve T1-T12 originates below each
corresponding thoracic vertebra.
- Anterior divisions: intercostal nerves come from thoracic
nerves T1-T11 and run between ribs.
o T2 and T3 further branches jadi intercostobrachial
nerve
o T12 branches jadi subcostal nerve
- Posterior divisions: medial branches (ramus medialis) of posterior branches of upper 6 thoracic nerves run
between semispinalis dorsi and multifidus which they supply.
3. Lumbar nerves
- Posterior divisions: medial branches run close to articular processes of vertebrae and end in multifidus
muscle.
MAJOR TRACTS OF SPINAL CORD
Descending tracts
Pathways by which motor signals are sent from brain to lower motor neurons, then directly innervates muscles to
produce movements. 2 major groups:
- Pyramidal tracts: originates di cerebral cortex, carrying motor fibers to spinal cord and brain stem 
responsible for voluntary control of muscle of the body and face.
- Extrapyramidal tracts: originates di brainstem, carrying motor fibers to spinal cord.  responsible for
involuntary and autonomic control of all musculature.
All neurons within the descending motor system = upper motor neurons
1. Pyramidal tracts
- Responsible for voluntary control of the musculature of the body and face.
- 2 subdivisions:
o corticospinal tracts: supplies the musculature of the body
o corticobulbar tracts: supplies the musculature of the head and neck
- CORTICOSPINAL TRACTS
o Begin in cerebral cortex, which they receive inputs from: primary motor cortex, premotor cortex,
supplementary motor area. Dan juga menerima impulse dari somatosensory area (ascending tract)
o Impuls2 dari cortex tersebut diterima di daerah white matter yang disebut corona radiate
o Lalu neuron2 tersebut akan menyatu di daerah internal capsule (diantara thalamus dan basal
ganglia)
o Dari internal capsule, neurons akan melewati Crus Cerebri of the midbrain, turun ke pons sampai
medulla oblongata
o Di caudal dari medulla, tractnya akan dibagi 2 :
 Lateral corticospinal tract akan decussate (menyebrang ke contralateral)  turun melalui
spinal cord  dilanjutkan ke lower motor neurons menuju otot masing2
 Anterior corticospinal tract akan tetap pada ipsilateral  turun ke spinal cord dan akan
decussate (menyebrang) di daerah setinggi cervical sampai upper thoracal segmental levels.
o Damage:
 Unilateral lesion of left or right corticospinal tract = symptoms contralateral
 Cardinal signs:
 Hypertonia
 Hyperreflexia
 Clonus: involuntary, rhythmic muscle contractions
 Babinski sign
 Muscle weakness
 - CORTICOBULBAR TRACTS
o supplies musculature of the head and neck
o Corticobulbar tracts dimulai dari sisi lateral dari primary motor cortex
o Sinyal yang diberikan sama dengan corticospinal tract, namun pada corticobulbar, the fibers
akan melewati internal capsule menuju brainstem
o Neurons akan terminate di motor nuclei of the cranial nerves  dilanjutkan ke lower motor
neuron menuju otot2 daerah muka dan leher
o Pada umumnya neuron2 di corticobulbar akan mempengaruhi secara bilateral (contoh left
primary motor cortex akan act sebagai upper motor neuron di trochlear kiri dan kanan), tapi
ada beberapa exception :
 Facial nerve CN VII : have a contralateral innervation (hanya pada otot2 di lower
quadrant dibawah mata)
 Hypoglossal nerve CN XII : only provide contralateral innervation
o damage:
 hypoglossal nerve: lesion to upper motor neurons for CN XII result in spastic paralysis of
contralateral genioglossus.  deviation of tongue to contralateral side.
 Facial nerve: lesion of UMN for CN VI result in spastic paralysis of muscle in contralateral
lower quadrant of the face.

2. Extrapyramidal tracts
- VESTIBULOSPINAL TRACTS
o 2 pathways: medial and lateral. Arise from vestibular nuclei, which receives input from organs of
balance  remains ipsilateral
o Fibres in this pathway control balance and posture by innervating the ‘anti-gravity’ muscles (flexors
of the arm, and extensors of the leg), via lower motor neurones.
- RETICULOSPINAL TRACTS
o Differentiate into 2:
 Medial reticulospinal tracts: arise from pons. Facilitates voluntary movements and increases
muscle tone.
 Lateral reticulospinal tracts: arise from medulla. Facilitates voluntary movements and
reduces muscle tone.
- RUBROSPINAL TRACTS
o Originates from red nucleus (midbrain).
o Fibers nya decussate and descend into spinal cord  contralateral
o Plays a role in fine control of hand movements
 - TECTOSPINAL TRACTS:
o Begins at superior colliculus (receives input from optic nerve) of the midbrain. Neurons nya
decussate and enter sinal cord.
o Terminate at cervical levels
o Coordinates movements of head in relation to vision stimuli

ASCENDING TRACT
Neural pathways by which sensory information from peripheral nerves is transmitted to cerebral cortex.
Divided into type of information they transmit:
- Conscious tracts: terdiri dari dorsal column-medial lemniscal pathway and the anterolateral system
- Unconscious tracts: terdiri dari spinocerebellar tracts.

1. DORSAL COLUMN MEDIAL LEMNISCAL PATHWAY

- DCML bawa impulse sensory dari touch (tactile sensation), vibration, proprioceptive
- Terdiri dari 3 tahap :
o First Order Neurones :
 Membawa sensory information dari peripheral nerve ke medulla oblongata
 Terdapat 2 different pathways :
 Signals from upper limb (T6 and above)  travels di fasciculus cuneatus  sampai
ke nucleus cuneatus di medulla
 Signals from lower limb (below T6)  travels di fasciculus gracilis  sampai ke
nucleus gracilis di medulla
o Second Order Neurones :
 Membawa impuls dari nucleus gracilis dan cuneatus ke thalamus
 BERSILANGAN (decussation) dahulu  dibawa ke medial lemniscus  baru ke thalamus
o Third Order Neurones :
 Transmit sensory signals dari thalamus ke ipsilateral primary sensory cortex
 Naik melalui ventral posterolateral nucleus of thalamus  internal capsule  sensory cortex
- Lesion:
o Loss of proprioception and fine touch
o Lesion di spinal cord: sensory loss will be ipsilateral (decussation di medulla oblongata)

ANTEROLATERAL SYSTEM (SPINOTHALAMIC TRACT)

Terdiri dari 2 separate tracts
- Anterior spinothalamic tract : bawa sensory dari crude touch dan pressure
- Lateral spinothalamic tract : Bawa sensory pain dan temperature
Terdiri dari 3 tahap juga :
a. First order neurons :
o Berasal dari sensory receptor di peripher
o Masuk ke spinal cord  naik sebanyak 1-2 level dari spinal cord
 o Synapse dari dorsal horn (lebih tepatnya bagian substantia gelatinosa)
b. Second order neurons :
o Bawa impulse dari substantia gelatinosa ke thalamus
o Setelah dari first order neurons, fibres2 ini akan decussate di spinal cord, dan membentuk 2 tracts :
 Crude touch and pressure fibers  anterior spinothalamic tract
 Pain and temperature fibers  lateral spinothalamic tract
o Walaupun berbeda, namun kedua jalur ini beriringan dan dapat dikatakan sebagai 1 jalur dan
berakhir di thalamus
c. Third order neurons :
o Transmit sensory signals dari thalamus ke ipsilateral primary sensory cortex
o Naik melalui ventral posterolateral nucleus of thalamus  internal capsule  sensory cortex
- Lesions:
o Impairment of pain and temperature sensation
o Sensory loss will be contralateral (decussation within spinal cord)
o **Brown-Séquard syndrome: hemisection of spinal cord. Involves both anterolateral and DCML
pathway

2. SPINOCEREBELLAR TRACTS
- Carries unconscious proprioceptive information.
- Transmit info from muscles to cerebellum. 4 individual pathways:
o Posterior spinocerebellar tract  from lower limbs to ipsilateral cerebellum
o Cuneocerebllar tract  from upper limbs to ipsilateral cerebellum
o Anterior spinocerebellar tract  from lower limbs. The fibers decussate twice and terminate di
ipsilateral cerebellum
o Rostral spinocerebellar tract  frm upper limbs to ipsilateral cerebellum
- Lesions:
o Ipsilateral loss of muscle coordination