Copyright © 2016 McGraw-Hill Education. All rights reserved.

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without the prior written consent of McGraw-Hill Education.

Anatomy and Physiology An Integrative

Approach 2nd Edition McKinley OLoughlin Bidle
0078024285 9780078024283
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CHAPTER 14: Nervous System: Spinal Cord and Spinal Nerves

CHAPTER OVERVIEW
This chapter is the third chapter in the series of chapters involving the nervous system. Chapter twelve
presented concepts involving nerve cells and nerve tissue, while chapter thirteen presented concepts on
the organ-system level, discussing the brain and cranial nerves. This chapter similarly presents organ-
system concepts involving the spinal cord and spinal nerves. This chapter is designed to help students
understand the anatomical and physiological concepts involving the spinal cord and its 31 pairs of spinal
nerves. Though the spinal cord provides a vital link between the brain and the rest of the body, it
exhibits some functional independence from the brain. The spinal cord contains ascending sensory
tracts and descending motor tracts that serve as the vital link between the brain and the rest of the
body. The independence of the spinal cord is engendered in its reflex actions which serve as fast
reactions to certain stimuli.

This chapter introduces the student to the gross anatomy of the spinal cord along with the development
of the spinal cord and spinal nerves. The protection and support of the spinal cord will be discussed.
Sectional anatomy of the spinal cord in regards to gray matter and white matter is presented. Ascending
sensory and descending motor pathways are presented and discussed in detail. The gross anatomical
organization of the spinal nerves is shown and presented along with detailed descriptions of four nerve
plexuses: the cervical plexus, brachial plexus, lumbar plexus, and the sacral plexus. The anatomical and
physiological concepts involving spinal nerve reflexes are presented. After reading this chapter the
student will understand that though the brain is the ultimate controller of the entire nervous system,
the spinal cord is its main liaison with the rest of the body.

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KEY POINTS TO EMPHASIZE WHEN TEACHING

THE BIOLOGY OF THE SPINAL CORD AND SPINAL NERVES
An instructional understanding: As mentioned in the instructional understanding in chapters twelve and
thirteen, the nervous system is one of the most difficult systems for students to comprehend because of
the large amount of didactic information. Though the spinal cord does not have as many anatomical and
functional components as the brain, it still can pose some difficulty to students, particularly when they
try to understand the anatomical and physiological intricacies of the spinal tracts. The anatomical
construct of the nerve plexuses is generally very difficult to learn. A key to teaching spinal cord and
spinal nerve functioning is to relate the functions to everyday actions. Students oftentimes enjoy being
able to see and demonstrate some of the somatic motor reflexes, like the patella tendon reflex. Since
the majority of students taking a human anatomy and physiology course are seeking healthcare fields,
integration of pathological conditions is important.

1. Using PowerPoint slides of figure 14.1 (p. 538), show and explain the overall gross anatomical
construct of the spinal cord and how the spinal nerves originate from the cord; show and explain the
sections of the spinal cord: cervical, thoracic, lumbar, and sacral sections.
2. Explain that the spinal cord generally ends around L1 and tapers at its inferior end, forming a
structure known as the conus medullaris; the continuation of nerve roots that project inferiorly
after the cord ends is termed the cauda equina and the continuation of the pia mater inferiorly after
the cord ends is termed the filum terminale.
3. Using a PowerPoint slide of figure 14.1(a) (p. 538), show the cervical enlargement and lumbosacral
enlargement of the spinal cord; explain that the cord enlarges in these two regions as a result of
containing more neuron cell bodies in order to supply innervation to the upper and lower
extremities.
4. Using PowerPoint slides of figure 14.3 (p. 540), show and explain the anatomical arrangement of the
meningeal coverings around the spinal cord; using information from chapter 12, compare and
contrast the meningeal coverings around the spinal cord to those around the brain.
5. Discuss all the meningeal spaces and meningeal layers; show and explain the role of the denticulate
ligaments.
6. Explain and discuss the clinical procedure known as the lumbar puncture, also known as the spinal
tap.
7. Using PowerPoint slides of figure 14.4 (p. 542), show and explain the sectional anatomy of the spinal
cord in terms of the locations of gray matter and white matter.
8. Using PowerPoint slides of figure 14.5 (p. 542), show the butterfly (or H shape) of the gray matter,
which is deep to the white matter in the spinal cord; explain the construct of the anterior, lateral,
and posterior horns, along with their individual functions.
9. Explain that the anterior horns contain somatic motor nuclei and the lateral horns contain
autonomic motor nuclei; explain that the posterior horns contain the somatic and visceral sensory
nuclei which consist of interneuron cell bodies.
10. Explain and discuss the construct of the gray commissure and its function, also show the central
canal and explain its function in terms of the CSF.
11. Show and discuss the superficial layer of white matter surrounding the gray matter in the spinal
cord; show and explain the three funiculi and the white commissure.
12. Explain and discuss the conduction pathways in the spinal cord.
a. Explain that the white matter in the spinal cord contains the conduction pathways; a conduction
pathway contains a tract and a nucleus.

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b. A tract is an accumulation of neuron cell axons in the central nervous system, while a nucleus is
a cluster of neuron cell bodies in the central nervous system.
c. Explain that there are sensory pathways and motor pathways in the spinal cord.
d. Explain that sensory pathways ascend the spinal cord while motor pathways descend the spinal
cord.
e. Explain that most pathways cross over (decussate) from one side of the body to the other side.
f. Define the terms ipsilateral and contralateral.
g. Inform students that all pathways are paired in that there are matching pathways on both sides
of the spinal cord.
h. Explain the fact that most pathways are composed of a series of two or three neurons that work
together; sensory pathways may have up to three interconnected (synapsed) neurons
interposed from the pathway’s origin to its final destination, while motor pathways generally
only have two interconnected neurons in the pathway.
13. Explain and discuss the sensory pathways.
a. Explain that sensory pathways are ascending and conduct information about limb
proprioception and the sensations of touch, temperature, pressure, and pain.
b. Explain that somatosensory pathways process stimuli received from receptors within the skin,
muscles, and joints, while viscerosensory pathways process stimuli received from the viscera.
c. Explain the functions and locations of the three neurons found in most sensory pathways;
explain the primary receptor neuron, the secondary (second-order neuron), and the tertiary
neuron.
d. Explain and discuss the three major types of somatosensory pathways: the funiculus-medial
lemniscal pathway, the anterolateral pathway, and the spinocerebellar pathway.
e. Explain how the name of the funiculus-medial lemniscal pathway is derived along with where its
pathway travels in the brain and spinal cord.
f. Explain that the funiculus-medial lemniscal pathway conducts sensory stimuli concerned with
proprioceptive (posture and balance) information about limb position, discriminate touch,
precise pressure, and vibration sensations.
g. Show the funiculus-medial lemniscal pathway.
h. Show the anterolateral pathway.
i. Explain that the anterolateral pathway is composed of the anterior spinothalamic tract and the
lateral spinothalamic tract.
j. Explain that the anterolateral pathway conducts nerve signals related to crude touch and
pressure, as well as pain and temperature.
k. Explain that the funiculus-medial lemniscal pathway and the anterolateral pathway involve
three neurons in the pathway, with the final destination in the primary somatosensory cortex in
the postcentral gyrus.
l. Show the spinocerebellar pathway.
m. Explain that the spinocerebellar pathway is composed of the anterior spinocerebellar tracts and
the posterior spinocerebellar tracts.
n. Explain that the spinocerebellar pathway conducts proprioceptive information to the
cerebellum concerning movements; unlike the funiculus-medial lemniscal pathway and
anterolateral pathway, the spinocerebellar information is acted on at a subconscious level.
o. The spinocerebellar pathway is a two neuron pathway unlike the three neuron pathways of the
funiculus-medial lemniscal pathway and anterolateral pathway.
p. Use table 14.1 (p. 546) to show a summarization of the presented concepts concerning the
sensory pathways.
14. Explain and discuss the motor pathways.

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a. Explain that motor pathways are descending and control effectors.

b. Though effectors can be all types of muscle and glands, the effectors discussed in this chapter
are skeletal muscles; cardiac muscle, smooth muscle, and gland innervation will be discussed in
the chapter on the autonomic nervous system.
c. Explain that skeletal muscle motor pathways originate from the cerebral cortex, cerebral nuclei,
the cerebellum, descending projection tracts, and/or motor neurons.
d. Show the location of some of the motor tracts.
e. Explain and discuss that motor pathways consist of two neurons, an upper motor neuron and a
lower motor neuron; upper motor neurons are housed either within the cerebral cortex or
nucleus within the brainstem, whereas the cell bodies of lower motor neurons, involving
skeletal muscle innervation, are housed in the anterior horn of the spinal cord or within the
brainstem cranial nerve nucleus.
f. Explain that upper motor neurons innervate lower motor neurons; lower motor neurons always
excite the skeletal muscle effector.
g. Explain that motor neuron axons form two types of motor pathways: direct pathways and
indirect pathways.
h. Explain that the direct pathways are responsible for conscious control of skeletal muscle activity;
the indirect pathways are responsible for subconscious or unconscious control.
i. Explain the direct pathway, also called the pyramidal pathway or corticospinal pathway,
originates in the pyramidal cells of the primary motor cortex; the axons of the upper motor
neurons of this pathway synapse on secondary neurons in the brainstem (corticobulbar tract)
or spinal cord (corticospinal tract).
j. Explain that corticobulbar tracts are associated with cranial nerves whereas corticospinal tracts
are associated with spinal nerves.
k. Explain the role of the corticobulbar tracts.
l. Using a PowerPoint slide of figure 14.11 (p. 547), show the corticospinal tract, pointing out that
the corticospinal tracts have two components: the anterior corticospinal tract and the lateral
corticospinal tract.
m. Explain the role of the lateral corticospinal tract and the anterior corticospinal tract.
n. Explain that the indirect pathways initiate motor commands for activities that occur at a
subconscious or reflexive level; the pathway is termed indirect in that the upper motor neurons
originate in the brainstem nuclei and take a complex, circuitous route through the brain before
finally conducting the nerve signal to the spinal cord.
o. Explain that the indirect pathway modifies or helps control the pattern of somatic motor activity
by exciting or inhibiting the lower motor neurons that innervate the muscles.
p. Explain that there are two groups of indirect pathways based on where they are located in the
spinal cord: the lateral pathway and the medial pathway.
q. Explain that the lateral pathway consists of the rubrospinal tracts, which originate in the red
nucleus of the midbrain; the rubrospinal tract regulates and controls precise, discrete
movements and tone in the flexor muscles of the limbs, like the biceps muscle.
r. Explain that the medial pathway regulates muscle tone and gross movements of the muscles of
the head, neck, proximal limb, and trunk.
s. Explain that the medial pathway consists of three groups of tracts: reticulospinal tracts,
tectospinal tracts, and vestibulospinal tracts.
t. Explain that the reticulospinal tract originates from the reticular formation and controls
unskilled reflexive movements related to posture and maintaining balance.

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u. Explain that the tectospinal tracts conduct motor commands from the tectum, composed of the
superior and inferior colliculi, to help regulate positional changes of the arms, eyes, head, and
neck as a consequence of visual and auditory stimuli.
v. Explain that the vestibulospinal tracts originate within the vestibular nuclei in the brainstem and
conduct nerve signals to regulate muscular activity that helps maintain balance during sitting,
standing, and walking.
w. Use table 14.2 (p. 548) to show a summarization of the presented concepts concerning the
motor pathways.
15. Use figure 14.12 (p. 549) to compare and contrast the sensory pathways with the motor pathways.
16. Show, explain, and discuss the spinal nerves.
a. Remind students that a nerve was defined in chapter 12 of the text; a nerve is a union of
thousands of motor and sensory axons and is enveloped in the three successive layers of
connective tissue wrappings: epineurium, perineurium, and endoneurium.
b. Explain that there are 31 pairs of nerves originating from the spinal cord, termed the spinal
nerves: Remind students that there were 12 pairs of cranial nerves discussed in chapter 13.
c. Using a PowerPoint slide of figure 14.13 (p.550), show and explain the gross anatomy of the
spinal nerves; explain that the anterior root (or ventral root) only carries motor fibers and the
posterior root (or dorsal root) only carries sensory fibers.
d. Show and explain that the cell bodies of the sensory neurons in the posterior are clustered
together into a structure known as the posterior (dorsal) root ganglion; a ganglion is an
accumulation of neuron cell bodies in the peripheral nervous system.
e. Show and explain how the two roots (anterior and posterior) unite within the intervertebral
foramen to form a spinal nerve.
f. Explain that the spinal nerves are numbered according to the vertebrae numbering, but a spinal
nerve travels through the invertebral foramen superior to the vertebra of the same number;
thoracic spinal nerve 6 exits the intervertebral canal between T5 and T6, thus above vertebrae
T6.
g. Using a PowerPoint slide of figure 14.12 (p. 549), show that the spinal nerves, after leaving the
intervertebral foramen, immediately split into branches termed rami; there are two rami, an
anterior ramus and a posterior ramus.
h. Explain that the posterior ramus innervates deep muscle of the back, while the larger anterior
ramus splits into multiple other branches, which innervate the anterior and lateral portions of
the trunk, the upper limbs, and the lower limbs.
i. Explain that there is an additional ramus associated with some spinal nerves, termed the rami
communicantes, which will be discussed in the autonomic nervous system chapter.
17. Explain and discuss the dermatomes.
a. Define the term dermatome.
b. Using PowerPoint slides of figure 14.14 (p. 551), show and explain the dermatome map and how
each spinal nerve receives sensory input from one section of the skin.
c. Discuss dermatomes in terms of referred pain, using appendiceal pain as an example.
d. Discuss the condition shingles, relating its clinical presentation to the dermatome map.
18. Explain and discuss the intercostal nerves.
a. Inform students that the anterior rami of spinal nerves T1–T11 are called the intercostal nerves
because they travel in the intercostal spaces sandwiched between two adjacent ribs.
b. Explain that T12 is termed the subcostal nerve since it travels below the rib.
c. Explain that except for T1 all the intercostal nerves do not form nerve plexuses; T1 is involved in
the brachial plexus.

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d. Explain and discuss the innervation patterns of intercostal nerves T2–T12; these do not form
plexuses.
19. Explain and discuss the nerve plexuses.
a. Explain that a nerve plexus is a network of interweaving anterior rami of spinal nerves.
b. Explain that the anterior rami of most spinal nerves form nerve plexuses on both the right and
left sides of the body; the nerve plexuses then split into multiple ‘named’ nerves that innervate
various body structures.
c. Explain that nerve plexuses are organized such that axons from each anterior ramus extend to
body structures through several different branches; each terminal branch of the plexus houses
axons from several different spinal nerves.
d. Inform students that there are four main nerve plexuses: cervical plexus, brachial plexus,
lumbar plexus, and the sacral plexus.
20. Using PowerPoint slides of figure 14.16 (p. 553), show, explain, and discuss the gross anatomy of the
cervical plexus.
a. Explain that the left and right cervical plexuses are located deep on each side of the neck,
immediately lateral to cervical vertebrae C1–C4.
b. Use table 14.3 (p. 554) to explain the branches of the cervical plexus in terms of nerve names,
anterior rami of origin, and structures innervated.
c. One very important branch of the cervical plexus is the phrenic nerve, which innervates the
diaphragm, a muscle very important in breathing; the anterior rami of C3, C4, and C5 contribute
to the formation of the phrenic nerve.
21. Using PowerPoint slides of figure 14.17 (p. 555), show and explain the gross anatomy of the brachial
plexus.
a. Explain that the left and right brachial plexuses are networks of nerves that supply the upper
limbs.
b. Explain that the anterior rami of spinal nerves C5–T1 form the brachial plexus.
c. Explain that the brachial plexus is far more structurally complicated than the cervical plexus in
that it involves forming trunks, divisions, cords, and then nerves.
d. Using PowerPoint slides of figure 14.16 (p. 553), show that the anterior rami of five spinal
nerves (C5–T1) emerge from the intervertebral foramina and coalesce to form three trunks:
superior, middle, and inferior trunks.
e. Explain that each individual trunk then divides into a posterior division and an anterior division.
f. Explain that the anterior and posterior divisions converge to form three cords that are named in
accordance with their positioning in relation to the axillary artery: posterior cord, medial cord,
and lateral cord.
g. Explain that five terminal branches emerge from the cords: the axillary nerve (from the
posterior cord), median nerve (from the medial and lateral cords), musculocutaneous nerve
(from the lateral cord), radial nerve (from the posterior cord), and ulnar nerve (from the medial
cord).
h. Using table 14.4 (pp. 556–559), show and explain what each of the five terminal branches
innervate.
i. Explain the clinical manifestations of certain brachial plexus injuries: axillary nerve injury, radial
nerve injury, posterior cord injury, median nerve injury, ulnar nerve injury, superior trunk
injury, and inferior trunk injury.
22. Using PowerPoint slides of figure 14.18 (p. 560), show and explain the gross anatomy of the lumbar
plexus.
a. Explain that the left and right lumbar plexuses are networks of nerves that supply part of the
lower limbs.

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b. Explain that the anterior rami of spinal nerves L1–L4 form the lumbar plexus.
c. Explain that the lumbar plexus is less structurally complicated than the brachial plexus, but it
does have an anterior division and posterior division; the main nerve of the posterior division is
the femoral nerve and the main nerve of the anterior division is the obturator nerve.
d. Using table 14.5 (pp. 561–562), show and explain what each of the lumbar plexus nerves
innervate.
23. Using PowerPoint slides of figure 14.19 (p. 563), show and explain the gross anatomy of the sacral
plexus.
a. Explain that the left and right lumbar plexuses are networks of nerves that innervate the gluteal
region, pelvis, perineum, posterior thigh, and almost all of the leg and foot.
b. Explain that the anterior rami of spinal nerves L4–S1 form the sacral plexus; since the sacral
plexus includes a lumbar nerve, it is sometimes called the lumbosacral plexus.
c. Explain that the anterior rami of the sacral plexus organize themselves into an anterior division
and posterior division; the nerves of the anterior division tend to innervate muscles that flex
(plantar flex) parts of the lower limb, while the posterior division nerves tend to innervate
muscles that extend (or dorsiflex) part of the lower limb.
d. Explain that the main nerves of the sacral plexus are the sciatic nerve, tibial nerve, common
fibular nerve, deep fibular nerve, and superficial fibular nerve.
e. Using table 14.6 (pp. 564–565), show and explain what each of the sacral plexus nerves
innervate.

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24. Explain and discuss the reflexes in general.

a. Define a reflex as a rapid, pre-programmed, involuntary reaction of muscles or glands to a
stimulus; a reflex is a survival mechanism that allows an individual to quickly respond to some
stimulus that may be detrimental to the well-being of the individual without having to wait for
the brain to process the information.
b. Explain and discuss the four common properties of a reflex: stimulus, rapid response, pre-
programmed response, and an involuntary response.
c. Explain that reflexes operate through the use of a reflex arc, which has five steps.
d. Explain and discuss each of the five steps of the reflex arc and how they sequentially integrate.
e. Explain and discuss that a reflex may involve only one synapse (monosynaptic) in the reflex arc
or more than one (polysynaptic).
f. Explain and discuss that a reflex arc may only involve one side of the body (ipsilateral) or the
other side (contralateral); if the receptor and effector organs of the reflex are on the same side
of the spinal cord, the reflex is ipsilateral, however if the impulses from a receptor organ cross
over through the spinal cord to activate effector organs in the opposite limb, it is termed
contralateral.
g. Explain that there are four common spinal reflexes with individual variations in numbers of
synapses and variations in laterality (ipsilateral versus contralateral); the four common reflexes
are the stretch reflex, the Golgi tendon reflex, the withdrawal (flexor) reflex, and the crossed-
extensor reflex.
25. Using a PowerPoint slide of figure 14.22 (p. 568), explain and discuss the stretch reflex.
a. Explain that the stretch reflex is a simple reflex; it is an ipsilateral, monosynaptic reflex that
prevents muscles from overstretching.
b. Show and explain the construct of a muscle spindle, which is a neuromuscular structure, found
within a skeletal muscle, that monitors the tension on a muscle.
c. Explain and give examples of the reflex arc action of the stretch reflex.
d. Define and discuss reciprocal inhibition.
26. Using a PowerPoint slide of figure 14.23 (p. 569), explain and discuss the Golgi tendon reflex.
a. Explain that the Golgi tendon reflex is an ipsilateral, polysynaptic synapse that prevents muscles
from tensing or contracting excessively.
b. Show and explain the construct of the Golgi tendon organ, which is composed of sensory nerve
endings within a tendon or near a muscle-tendon junction.
c. Explain and give examples of the reflex arc action of the Golgi tendon reflex.
d. Define and discuss reciprocal activation, which is an opposite action to reciprocal inhibition,
discussed earlier in the stretch reflex action.
27. Using a PowerPoint slide of figure 14.24 (p. 570), explain and discuss the withdrawal reflex.
a. Explain that the withdrawal is a protective, ipsilateral, polysynaptic reflex that allows an
individual to withdraw after touching something very painful, like something excessively sharp,
hot, or cold.
b. Explain that the nerve signal is transmitted by a sensory neuron to the spinal cord.
c. Explain and give examples of the reflex arc action of the withdrawal reflex.
28. Using a PowerPoint slide of figure 14.24 (p. 570), explain and discuss the crossed-extensor reflex.
a. Explain that the crossed-extensor reflex is a contralateral, polysynaptic synapse that often
occurs in conjunction with the withdrawal reflex, usually in the lower (weight-bearing) limbs;
when the withdrawal reflex is occurring in one limb, the crossed-extensor reflex occurs in the
other limb.

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b. Explain that when sensory neurons transmit nerve signals to the spinal cord, some sensory
branches synapse with interneurons involved in the stretch reflex, while other sensory branches
synapse with interneurons involved in the crossed-extensor reflex.
c. Explain and give examples of the reflex arc action of the crossed-extensor reflex.
29. Use table 14.7 (p. 571) to list, explain, and discuss some of the clinically relevant reflexes; inform
students that clinicians evaluate these reflexes primarily in the neurological part of a physical
examination.
30. Using PowerPoint slides of figure 14.25 (p. 572), show, explain, and discuss development of the
spinal cord.
a. Using information from chapter 13, the brain chapter, explain that the spinal cord develops from
the caudal (inferior) portion of the neural tube; spinal cord development is far less complicated
than brain development, which occurred from the cephalic (superior) portion of the neural tube.
b. Show and explain that the lumen (hollow center) of the neural tube forms the central canal
where, eventually, some cerebrospinal fluid will be found.
c. Show and explain that the neural tube grows rapidly in both length and width; the width
enlargement is more of a thickening of the wall of the neural tube, rather than an enlargement
of the diameter of the central canal.
d. Explain that the outer (more superficial) rim of the thickened neural tube forms the white
matter, while other components form the gray matter.
e. Explain that the sulcus limitans develops in the lateral walls of the central canal; the sulcus
limitans’ lateral expansion acts to push apart and separate two developing regions lateral to the
central canal.
f. Explain that the two developing regions separate into an anteriorly positioned basal plate and
posteriorly positioned alar plate; the basal plate develops into the anterior and lateral horns and
the alar plate develops into the posterior horns and posterior part of the gray commissure.

ADDITIONAL TOPICS FOR DISCUSSION

1. Discuss with students the neurologic examination of spinal nerves; explain how reflexes are involved
in the examination.
2. Explain and discuss that the spinal tap can be used to evaluate CSF pressure in addition to obtaining
CSF for analysis.
3. Explain and discuss epidural anesthesia versus spinal anesthesia.
4. Discuss the importance of the muscle spindles in governing muscle tonus; explain the physiologic
importance of maintaining a certain degree of resting muscle tension.
5. Discuss why the Golgi tendon organ needs to protect the muscle tendons when a skeletal muscle is
contracting excessively.

SUGGESTED CHAPTER OUTLINE

14.1 Spinal Cord Gross Anatomy: The adult spinal cord extends from the medulla oblongata of
the brain to L1. (pp. 538−539)
1. A typical adult spinal cord ranges between 16 to 18 inches in length.
2. The superiormost part of the spinal cord, continuous with the medulla oblongata, is the
cervical part.
3. The part of the spinal cord that lies inferior to the cervical part, containing neurons for the
thoracic nerves, is the thoracic part.

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4. The shorter segment of the spinal cord, containing neurons for the lumbar nerves, is the
lumbar part.
5. The part of the spinal cord containing neurons for the sacral nerves is
the sacral part.
6. The most inferior tip of the spinal cord is the coccygeal part.
7. The conus medullaris marks the official ‘end’ of the spinal cord.
8. Nerve roots projecting inferiorly from the spinal cord are called cauda equina.
9. A thin strand of pia mater, located within the pia mater that anchors the conus medullaris to
the coccyx, is the filum terminale.
10. Spinal nerves are mixed, consisting of both sensory axons and motor axons.
11. The posterior median sulcus, a narrow groove, and posterior median sulcus, a wider groove,
both follow along the external surface of the spinal cord.
14.2 Protection and Support of the Spinal Cord: The spinal cord is protected and encapsulated
by spinal cord coverings known as the spinal cord meninges. (pp. 539−541)
1. The spinal cord meninges protect and envelop the spinal cord.
2. The epidural space contains areolar connective tissue, blood vessels, and adipose connective
tissue.
3. The dura mater extends between adjacent vertebrae while fusing with connective tissues
surrounding the spinal nerves, and serves to stabilize the spinal cord.
4. Potential space found in tissue preparations that separates the dura mater from the
arachnoid mater is called subdural space.
5. Space internal to the arachnoid mater filled with cerebrospinal fluid is called the
subarachnoid space.
6. The innermost meningeal layer, consisting of elastic and collagen fibers, is called the pia
mater.
7. Paired, lateral extensions of the pia mater that attach to the dura mater and anchor the
spinal cord laterally are called denticulate ligaments.
8. Clinical View: Lumbar Puncture (p. 541)
a. A lumbar puncture (spinal tap) is used to obtain cerebrospinal fluid (CSF) for clinical
analysis.
b. The needle is inserted at a spinal level below vertebrae L1, since the spinal cord
ends at L1, thus the spinal cord cannot be inadvertently injured if the needle is
inserted too far.
c. The needle is inserted into the intervertebral space to a depth sufficient to enter the
subarachnoid space, where the CSF circulates; fluid is then withdrawn for analysis.
14.3 Sectional Anatomy of the Spinal Cord: The spinal cord is partitioned into an inner gray
matter region and an outer white matter region. (pp. 541−543)
1. Gray matter mainly consists of; dendrites, cell bodies, glial cells and unmyelinated axons,
whereas white matter mainly consists of myelinated axons extending to and from the brain.
A. Distribution of Gray Matter (pp. 541−542)
1. Gray matter is centrally located within the spinal cord and resembles a butterfly in shape.
2. Anterior horns, masses of gray matter, house cell bodies of somatic motor neurons which
innervate skeletal muscle.
3. Lateral horns located in T1–L2 of the spinal cord house cell bodies of the autonomic nervous
system.
4. Posterior masses of gray matter containing axons of sensory neurons and cell bodies of
interneurons are called posterior horns.

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5. The horizontal seam of gray matter containing unmyelinated axons surrounding the central
canal, serving as a communication route between left and right gray matter, is called the
gray commissure.
6. Nuclei are functional groups of neuron cell bodies located within certain parts of gray
matter.
7. Posterior horn sensory nuclei contain interneuron cell bodies.
8. Somatic sensory nuclei receive nerve signals from skin receptors, detecting pain and
pressure.
9. Visceral sensory nuclei receive nerve signals from blood vessels and viscera, detecting
stretching.
10. Motor nuclei of the anterior and lateral horns transmit nerve signals to muscles and glands.
11. Somatic motor nuclei innervate skeletal muscle.
12. Autonomic motor nuclei innervate smooth muscle, cardiac muscle, and glands.
B. Distribution of White Matter (pp. 542–543)
1. White matter of the spinal cord is partitioned into three regions, called funiculi.
2. Between the posterior gray horns and posterior median sulcus lies the posterior funiculus.
3. Lateral regions of white matter are called the lateral funiculus.
4. The anterior funiculus is composed of white matter tracts located between anterior gray
horns and the anterior median fissure.
5. The white commissure interconnects the anterior funiculi.
6. Clincial View: Poliomyelitis (p. 543)
a. Poliomyelitis is an infection of the somatic motor neurons in the anterior horn of the
spinal cord.
b. The infection is caused by one of three strains of the polio virus, which enters the
body through the oral-fecal or oral-oral route; this most often is due to consuming
contaminated food or water.
c. The damage to the anterior horn generally leads to paralysis of the muscles
innervated by the segments of the cord affected.
7. Clinical View: Treating Spinal Cord Injuries (p. 543)
a. Spinal cord injuries can impair sensory and/or motor functioning.
b. Proper use of medications can sometimes alleviate or decrease the problems
associated with spinal cord injuries.
c. Stem cells are being studied as a treatment for spinal cord injuries.
14.4 Spinal Cord Conduction Pathways: The CNS communicates with the peripheral body
structures through pathways. (pp. 543−549)
1. Pathways travel through spinal cord white matter to serve as CNS communication routes,
conducting either sensory nerve signals from receptors or motor nerve signals to effectors.
A. Overview of Conduction Pathways (pp. 543–544)
1. Pathways consist of tracts, or bundles of axons, traveling together in the CNS and a nucleus,
or a group of neuron cell bodies, located within the CNS.
2. Sensory pathways of the nervous system, also called ascending pathways, transmit nerve
signals from sensory receptors to the brain.
3. Motor pathways of the nervous system, also called descending pathways, transmit nerve
signals from the brain to muscles and glands.
4. Most pathways decussate, meaning cross over, where information from the right side of the
body is processed by the left side of the brain and vice versa.
5. Contralateral indicates a relationship between opposite sides.
6. Ipsilateral means same side.

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7. All pathways consist of matching left and right tracts, or paired tracts.
8. Most pathways consist of series of two or three neurons working together.
B. Sensory Pathways (pp. 544−546)
1. Ascending pathways that conduct information regarding limb proprioception, touch,
temperature, pressure, and pain sensations are called sensory pathways.
2. Pathways that process stimuli received from the skin, muscles, and joints are somatosensory
pathways.
3. Pathways that process stimuli received from the viscera are viscerosensory pathways.
4. The primary neuron, first-order neuron, shares dendrites of a receptor that detects specific
stimuli.
5. The secondary neuron, an interneuron, projects either to the thalamus for conscious
sensation processing or to the cerebellum for unconscious proprioception.
6. The tertiary neuron, an interneuron and last neuron in the sensory pathway chain, resides in
the thalamus, the central processing center for sensory information, and projects to the
primary somatosensory cortex of the parietal lobe.
7. The posterior funiculus-medial pathway is composed of spinal cord tracts called the
posterior funiculus and brainstem tracts called the medial lemniscus.
8. The posterior funiculus-medial pathway uses a chain of three neurons to signal the brain of
stimuli and conduct sensory stimuli regarding limb position, discriminative touch, precise
pressure, and vibration.
9. Primary neuron axons ascend within either the fasciculus cuneatus or fasciculus gracilis of
the posterior funiculus, synapsing in secondary cell neurons which will further relay the
signal to the thalamus on the opposite side of the medial lemniscus.
10. Located within the anterior and lateral white funiculi of the spinal cord lies the anterolateral
pathway, composed of the anterior spinothalamic tract and lateral spinothalamic tract.
11. Axons of the anterolateral pathway decussate through the anterior white commissure,
conducting nerve signals concerning crude touch, pressure, pain, and temperature to the
opposite side of the spinal cord.
12. The spinocerebellar pathway coordinates body movements by conducting proprioceptive
information to the cerebellum by action of primary and secondary neurons.
13. Posterior spinocerebellar tracts conduct nerve signals from upper and lower limbs and trunk.
C. Motor Pathways (pp. 546−549)
1. Descending motor pathways consist of an upper motor neuron housed within the cerebral
cortex or nucleus within the brainstem, controlling effectors.
2. The upper motor neuron either excites or inhibits activity of the lower motor neuron.
3. The lower motor neuron only excites activity due to its axon connecting directly to skeletal
muscle fibers.
4. Direct motor pathways dictate conscious control of skeletal muscles, whereas indirect motor
pathways dictate subconscious or unconscious control.
5. Direct pathways, or pyramidal pathways, originate in the pyramidal cells of the primary
motor cortex, and consist of tetrahedral shaped upper motor neuron cell bodies and axons
that project either into the brainstem or spinal cord.
6. Corticobulbar tracts indicate the embryonic rhombencephalon of the brainstem and
originate from the facial region of the motor homunculus.
7. Corticospinal tracts descend from the cerebral cortex through the brainstem, forming the
pyramids of the medulla oblongata.
8. Lateral corticospinal tracts decussate within the pyramids of the medulla oblongata, making
up 85% of the axons on the motor neurons.

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9. Anterior corticospinal tracts decussate through the anterior gray commissure, synapsing
with either anterior interneurons or lower motor neurons, and innervating axial skeletal
muscle.
10. The indirect pathway, a circuitous route through the brain, helps control somatic motor
activity by exciting or inhibiting lower motor neurons that innervate muscles.
11. The lateral pathway consists of rubrospinal tracts, originating in the red nucleus of the
midbrain, and controls precise movements and tone in flexor muscles of the limbs.
12. The medial pathway consists of three tracts and regulates muscle tone and gross
movements.
13. The reticulospinal tracts of the medial pathway control unskilled reflexive movements
related to posture and balance.
14. The tectospinal tracts of the medial pathway control positional changes in the arms, eyes,
head, and neck.
15. The vestibulospinal tracts of the medial pathway control balance during sitting, standing,
and walking.
14.5 Spinal Nerves: There are 31 pairs of spinal nerves that connect the central nervous
system to the muscles, glands, and receptors. (pp. 550−565)
A. Overview of Spinal Nerves (pp. 550−552)
1. Multiple anterior rootlets exiting the spinal cord merge, forming a single anterior root, or
ventral root, containing motor axons alone.
2. A single posterior root, the dorsal root, enters the spinal cord, branching off into multiple
posterior rootlets containing sensory axons alone.
3. Within the posterior root lies the posterior root ganglion where sensory neuron cell bodies
reside.
4. Anterior and posterior roots unite within the intervertebral foramen, forming spinal nerves.
5. Spinal nerves contain both motor axons and sensory axons.
6. Cervical spinal nerves exit the vertebral canal, traveling through the intervertebral foramen
superior to the vertebra of corresponding number.
7. The smaller, posterior ramus innervates deep muscles of the back, whereas, the larger,
anterior ramus splits, innervating the anterior and lateral portions of the trunk, and upper
and lower limbs.
8. Rami communicantes extend between the spinal nerves and the sympathetic trunk ganglion
and contain ANS axons.
9. Specific segments of skin innervated by a single spinal nerve, with the exclusion of C1, are
called dermatomes.
10. Dermatome maps detail divisions of the skin by sensory segments.
11. Loss of sensation, or numbness, is called anesthesia.
12. Referred visceral pain occurs when pain or discomfort from a specific organ is mistakenly
attributed to a dermatome.
13. Clinical View: Shingles (p. 552)
a. Shingles is a condition that affects spinal nerves; it is a reactivation of the childhood
chicken pox virus.
b. Psychological stress, other infections, and even sunburn can trigger the
development of shingles.
c. During the initial infection of chicken pox, the virus migrated from the skin to the
posterior root ganglion, where it remained dormant until reactivation.
d. Upon being stimulated by a certain trigger, the virus proliferates and travels down
the sensory axons of a dermatome.

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e. Antiviral medication can be used to treat shingles.

B. Nerve Plexuses (p. 552)
1. Nerve plexuses are networks of interweaving anterior rami arranged such that axons from
each anterior ramus branch extend to various body structures.
2. The main nerve plexuses are the cervical plexus, brachial plexus, lumbar plexus, and sacral
plexus.
C. Intercostal Nerves (p. 552)
1. Intercostal nerves, also called anterior rami of spinal nerves T1–T11, travel through the
intercostal space between two adjacent ribs.
2. The brachial plexus is a portion of the anterior ramus of T1.
3. The anterior ramus of T2 branches, conducting sensory information from the skin of the
axilla and the medial surface of the arm.
4. The anterior rami of T3–T6 receive lateral and anterior chest wall sensations.
5. The anterior rami of T7–T12 innervate the inferior intercostal spaces and abdominal
muscles.
D. Cervical Plexuses (pp. 552−554)
1. The left and right cervical plexuses are formed by the anterior rami of spinal nerves C1–C4.
2. The phrenic nerve, formed from the C4 nerve, travels through the thoracic cavity innervating
the diaphragm.
E. Brachial Plexuses (pp. 554−559)
1. Brachial plexuses are formed by the anterior rami of spinal nerves C5–T1, extending laterally
from the neck, passing superior to the first rib, continuing into the axilla.
2. The superior trunk of the brachial plexus consists of nerves C5 and C6, the middle trunk of
C7, and the inferior trunk of C8 and T1.
3. Anterior and posterior divisions converge at the axilla, forming the posterior cord, medial
cord, and lateral cord.
4. The posterior cord runs posterior to the axillary artery and contains portions of C5–T1
nerves.
5. The medial cord runs medial to the axillary artery and contains portions of C8–T1 nerves.
6. The lateral cord runs laterally to the axillary artery and contains portions of C5–C7 nerves.
7. The axillary nerve traverses through the axilla, innervating both the deltoid and teres minor
muscles and receives sensory signals from the superolateral part of the arm.
8. The median nerve travels along the midline of the arm, forearm, and wrist, innervating the
anterior forearm muscles, thenar muscles, and two lateral lumbricals, and receives sensory
signals from the palmar side of the lateral three and a half fingers.
9. The musculocutaneous nerve innervates the anterior arm muscles, which perform arm
flexion and receive sensory signals from the lateral surface of the forearm.
10. The radial nerve travels along the posterior side of the arm and radial side of the forearm,
innervating the posterior arm and forearm muscles, and receives sensory signals from the
surface of the posterior arm and forearm, as well as the dorsolateral side of the hand.
11. The ulnar nerve descends along the medial side of the arm, innervating some of the anterior
forearm muscles, palmar and dorsal interossei, and medial two lumbricals, and receives
sensory signals from the skin of the pinky finger and medial half of the ring finger.
12. Clinical View: Brachial Plexus Injuries(p. 559)
a. Injuries to the brachial plexus are quite common, especially in individuals aged 15–
25.
b. The axillary nerve can be compressed within the axilla, or it can be damaged if the
surgical neck of the humerus is broken; an individual with axillary nerve damage

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has difficulty abducting the arm due to lack of proper innervation to the deltoid
muscle.
c. The radial nerve can be injured as a result of humeral shaft fractures or injuries to
the lateral elbow; radial nerve damage results in paralysis of the extensor muscles
of the forearm, wrist, and fingers.
d. A posterior cord injury of the brachial plexus can be caused by improper use of
crutches or by draping the upper arm over the back of a chair for an extended
period of time; the axillary and radial nerves are both affected in a posterior cord
injury.
e. The median nerve can be impinged or compressed as a result of carpal tunnel
syndrome or a deep laceration to the wrist; a classic sign of median nerve injury is
ape hand deformity, in which muscles in the thenar eminence become atrophied
along with the two lateral lumbricalis muscles.
f. Using the drawing shown of the median nerve distribution on table 14.4 (p. 557),
show the location of sensory loss as a result of median nerve injury.
g. Ulnar nerve injury can occur as a result of fractures or dislocations of the elbow
because of the nerve’s close proximity to the medial epicondyle of the humerus;
the hitting of the so called ‘funny bone’ is actually ulnar nerve injury.
h. In ulnar injury there is motor loss of the intrinsic hand muscles so the person is
unable to adduct or abduct the fingers.
i. Using the drawing shown of the ulnar nerve distribution on table 14.4 (p. 558),
show the location of sensory loss as a result of ulnar nerve injury.
j. The superior trunk of the brachial plexus can be injured by excessive separation of
the neck of the shoulder, as well as when a person riding a motorcycle is flipped
from the bike and lands on the side of the head; a superior trunk injury affects C5
and C6 anterior rami, so any brachial plexus branch that has these nerves is
affected.
k. Inferior trunk injury can occur if the arm is excessively abducted, as well as when a
neonate’s arm is pulled too hard during delivery; the inferior trunk injury involves
C8 and T1 anterior rami, so any brachial plexus branch that is formed from these
nerves is affected.
F. Lumbar Plexuses (pp. 560−562)
1. Anterior rami of nerves L1–L4 make up left and right lumbar plexuses.
2. The femoral nerve of the posterior division of the lumbar plexus innervates the quadriceps
femoris and iliopsoas, while receiving sensory signals from the anterior and inferomedial
thigh and medial aspect of the leg.
3. The obturator nerve of the anterior division of the lumbar plexus innervates the medial
thigh, while receiving sensory signals from the superomedial skin of the thigh.
G. Sacral Plexuses (pp. 562−565)
1. Anterior rami of nerves L4–S4 form the left and right sacral plexuses and innervate the
gluteal region, pelvis, perineum, posterior thigh, and almost all of the leg and foot.
2. Nerves of the anterior division innervate plantar flexion muscles, while nerves of the
posterior division innervate dorsiflexion muscles.
3. The largest and longest nerve in the body, the sciatic nerve, is formed from both divisions of
the sacral plexus and projects from the pelvis into the posterior region of the thigh.
4. The tibial nerve innervates the hamstrings, the hamstring part of the adductor magnus,
plantar flexors, and toe flexors, and receives sensory signals from the skin of the sole of the
foot.

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5. The common fibular nerve innervates the biceps femoris and splits into two branches.
6. The deep fibular nerve innervates the anterior leg muscles, controlling foot dorsiflexion and
toe extension, and receives sensory signals from the skin between the first and second toes.
7. The superficial fibular nerve innervates the lateral compartment muscles of the leg and
receives sensory signals from most of the dorsal surface of the foot and anteroinferior part
of the leg.
8. Clinical View: Sacral Plexus Injuries (p. 562)
a. The sacral plexus can be injured by an improper gluteal muscle injection or a
herniated disc.
b. If the sciatic nerve is injured, a condition known as sciatica may occur which
produces a shooting pain down the posterior of the thigh and leg on the affected
side of the body.
c. A fibular nerve injury can occur due to a fracture of the neck of the fibula or the
compression of a leg cast that is too tight; a fibular nerve injury may cause the
anterior and lateral leg muscles to become paralyzed, which results in an individual
not being able to dorsiflex and evert the foot.
d. The inability to dorsiflex the foot is sometimes referred to as ‘foot drop’.
14.6 Reflexes: Reflexes are automatic protective responses to certain harmful stimuli.
(pp. 566–571)
A. Characteristics of Reflexes (p. 566)
1. Rapid, pre-programmed, involuntary muscle reactions or gland reactions are called reflexes.
2. Reflexes have four similar properties: a stimulus which initiates a response, a rapid response
attributed to limited neuron involvement and minimal synaptic delay, a pre-programmed
response, and an involuntary response.
B. Components of a Reflex Arc (p. 566)
1. A reflex arc is the neural ‘wiring’ of a single reflex which begins at a PNS receptor,
communicates with the CNS, and ends at a peripheral muscle or gland cell.
2. The first step in a reflex involves sensory receptors responding to external and internal
stimuli.
3. The second step in a reflex involves the conduction of a signal from sensory receptor to
spinal cord.
4. The third step in a reflex involves the processing and transmission of sensory signals to
motor neurons.
5. The fourth step in a reflex involves the transmission of a signal from the motor neuron to the
peripheral effector organ.
6. The fifth step in a reflex involves the response of an effector to a nerve signal, resulting in
the removal of the original stimulus.
7. The simplest of all reflexes, where sensory axons synapse directly with motor neurons,
resulting in minor synaptic delay and very prompt reflex response, are called monosynaptic
reflexes.
8. A reflex that utilizes a number of synapses involving interneurons and results in a prolonged
synaptic delay between stimulus and response is called a polysynaptic reflex.
C. Classifying Spinal Reflexes (p. 567)
1. A monosynaptic reflex that detects muscle stretch and regulates skeletal muscle length is
called a stretch reflex.
2. Intrafusal muscle fibers, innervated by gamma motor neurons, reside within muscle spindles
or stretch receptors and detect muscle stretch.

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3. Extrafusal muscle fibers, innervated by alpha motor neurons, wrap around muscle spindles
and contain sensory neurons that detect muscle stretch.
4. The Golgi tendon reflex, a polysynaptic reflex, prevents muscles from tensing or contracting
excessively.
5. The Golgi tendon organ, composed of sensory nerve endings, transmits nerve signals to
interneurons which inhibit alpha motor neurons of the same muscle, thus allowing the
associated muscle to relax and avoid excessive tension damage.
6. Reciprocal activation occurs when sensory neurons communicate with other interneurons of
the spinal cord that stimulate alpha motor neurons of the antagonistic muscles.
7. A polysynaptic reflex arc that is initiated by a painful stimulus is called a withdrawal reflex.
8. The crossed-extensor reflex often occurs simultaneously with the withdrawal reflex and
involves the synapse of sensory branches with interneurons which cross to the other side of
the spinal cord and synapse with motor neurons of the antagonistic muscles of the opposite
limb, resulting in the contraction of antagonistic muscles.
D. Spinal Reflexes (pp. 568–571)
1. Some common spinal reflexes are the stretch reflex, the Golgi tendon reflex, the withdrawal
(flexor) reflex, and the crossed-extensor reflex.
2. The stretch reflex and Golgi tendon reflex are initiated by proprioceptors; the two principal
proprioceptors are the muscle spindle, located within skeletal muscles, and the Golgi tendon
organ, located in the muscle tendon.
3. Use figure 14.22 (p. 568) and figure 14.23 (p. 569) to view the anatomy of the muscle spindle
and Golgi tendon organ, respectively.
4. The stretch reflex is a muscle reflexively contracting in response to it stretching; this stretch
is monitored by the muscle spindle.
5. Use figure 14.22 (p. 568) to view the steps of the stretch reflex; note this is a somatic,
monosynaptic, ipsilateral reflex, generally involving one spinal nerve segment.
6. The stretch reflex is indirectly involved in reciprocal inhibition; this action inhibits
contraction of the opposing (antagonistic) muscle.
7. The Golgi tendon reflex prevents muscles from contracting excessively; it is monitored by
the Golgi tendon organ and has an opposite action compared to the stretch reflex.
8. Use figure 14.23 (p. 569) to view the steps of the Golgi tendon reflex; note this is a somatic,
polysynaptic, ipsilateral reflex, generally involving one spinal nerve segment.
9. The Golgi tendon reflex is involved in reciprocal activation, which has an opposite action to
reciprocal activation, as seen in the stretch reflex; this action stimulates the antagonistic
muscles to contract.
10. The withdrawal (flexor) reflex involves contracting to withdraw the body part from a painful
stimulus; the reflex involves pain receptors.
11. Use figure 14.24 (p. 570) to view the steps of the withdrawl reflex; note this is a somatic,
polysynaptic, ipsilateral reflex that involves more that one spinal nerve segment.
12. The crossed-extensor reflex often occurs in conjuction with the withdrawal reflex, usually in
the lower (weight-bearing) limbs.
13. When there is considerable withdrawal, as occurs with the withdrawal reflex, the individual
could be thrown off balance; the extension of the opposite leg will attempt to prevent the
person from falling.
14. The crossed-extensor reflex is somatic, contralateral, ipsilateral (generally involves
withdrawal), polysynaptic, and involves several spinal nerve segments.
15. Use figure 14.24 (p. 570) to view the steps of the crossed-extensor reflex.

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E. Reflex Testing in a Clinical Setting (p. 571)

1. Reflexes are a diagnostic tool which test specific muscle groups, spinal nerves, and spinal
cord segments.
2. Diminished or absent reflex responses are called hypoactive reflexes.
3. Abnormally strong reflex responses, called hyperactive reflexes, may indicate brain or spinal
cord damage.
4. Rhythmic oscillations between flexion and extension are referred to as clonus.
14.7 Development of the Spinal Cord: The spinal cord develops the caudal (inferior) portion of
the neural tube, whereas the brain developed from the cephalic (anterior) portion. (p. 572)
1. The hollow canal within the neural tube that develops into the central canal of the spinal
cord is called the neural canal.
2. The fourth and fifth weeks of embryonic development involve neural tube growth and white
and gray matter formation.
3. At the sixth week of development, a horizontal groove forms in the lateral walls of the
central canal, dividing the neural tube into two specific regions, and is called the sulcus
limitans.
4. Basal plates lie anterior to the sulcus limitans, later developing into the anterior and lateral
horns, the motor structures of gray matter; they also form the anterior part of the gray
commissure.
5. Alar plates lie posterior to the sulcus limitans, later developing into the posterior horns, the
sensory structures of the gray matter; they also form the posterior part of the gray
commissure.
6. Spinal cord and vertebral canal lengths match prior to reaching the fetal stage, where
vertebral column growth exceeds spinal cord growth, resulting in the lumbar, sacral, and
coccygeal parts of the spinal cord lying distally to their respective vertebrae instead of next
to them.

DISCUSSIONS, DEMONSTRATIONS, IN-CLASS VISUALS

1. Show and explain the anatomical construct of the spinal cord in the vertebral column using a flexible
spine model with the 31 pairs of spinal nerves.
2. Use a transparency, PowerPoint slide, or 35 mm slide to show the arrangement of the meninges
around the spinal cord; compare and contrast the anatomical construct of the meninges around the
spinal cord to those around the brain.
3. Show a spinal cord model to explain the various anatomical features of the spinal cord and how the
spinal nerves originate from the spinal cord.
4. Show PowerPoint slides or 35 mm slides of the cross sectional anatomy of the spinal cord at various
levels; explain and show the cauda equina and filum terminale.
5. Use a preserved specimen of the spinal cord to show how delicate the nerves are that arise from the
cord.
6. Using posters and slides of the spinal cord and spinal nerves, show the location of the tracts; explain
the function of the tracts and fasciculi.
7. Draw the locations of the crossover of fiber tracts in the spinal cord.
8. Discuss the deficits in motor function and/or sensory function with transections at various levels of
the spinal cord.
9. Discuss a cord hemisection and a rhizotomy; discuss a presacral neurotomy used to treat some
forms of pelvic pain in the female.

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10. Discuss how stem cell research could lead to amazing advancements in the amelioration of spinal
cord injuries.
11. Discuss the types of meningitis; discuss the cause, symptoms, signs, and treatments for this
condition.
12. Obtain and show an MRI and CT scan of the spinal cord.
13. Explain, show, and discuss myelography.

Media
Anatomy and Physiology: The Nervous System. Insight Media.
Brain and Nervous System: Your Information Superhighway; Films for the Humanities and Sciences.
The Complete “Human Body”. DVD Series, NIMCO.
Concussions and Spinal Cord Injuries; Films for the Humanities and Sciences.
The Nervous System. Insight Media.
Reflexes and Conscious Movement. NIMCO.
The Spine: The Body’s Central Highway; Films for the Humanities and Sciences.
Exploring the Spine. Denoyer-Geppert.
Interactive Functional Anatomy. Denoyer-Geppert.
Secondary Conditions of Spinal Cord Injury. Health Education Video Series, UAB-PM&R/Research
Services.
Changes [Living with Spinal Cord Injury Series]. Fanlight Productions.
Life with SCI: A Group Discussion. Fanlight Productions.
Spinal Cord Stimulator Placement: Lumbar Spine. Medical Animation. High Impact Graphics.
Moving Forward after Spinal Cord Injury. DVD, Research and Markets.
Anatomy & Physiology REVEALED 3.0. McGraw-Hill.
Human Body: The Nervous System. Ambrose Video.
Anatomy of the Spine. Primal Pictures.
Myelopathy. ViewMedica.
Interactive Spine. DVD-ROM, Primal Pictures.
Laminectomy Back Surgery for Spinal Stenosis. Video, ViewMedica.
Spinal Stenosis Symptoms and Diagnosis. Video, ViewMedica.

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