Last edited: 8/30/2021

21. ANATOMY OF SPINAL CORD AND SPINAL NERVES

Neurology | Gross Anatomy of the Spinal Cord and Spinal Nerves Medical Editor: Donya Moslemzadeh

Spinal Nerves Coming out of the Spinal Cord are part of

OUTLINE
Peripheral Nervous System
I) INTRODUCTION o There are 31 pairs of spinal nerves:
II) SPINAL CORD ANATOMY AND BASIC FUCNTION  Cervical →8 pairs
III) SPINAL NERVE ANATOMY AND BASIC FUCNTION  Thoracic →12 pairs
IV) REVIEW QUESTIONS  Lumbar →5 pairs
V) REFRENCES  Sacral →5 pairs
 Coccygeal →1 pair

o There are 7 Cervical Vertebrae, but 8 pairs of spinal

nerves come out of the cervical segment
 Nerves C1–C7 exit above the corresponding
I) INTRODUCTION vertebrae
 C8 spinal nerve exits below C7 and above T1
CNS → Brain and Spinal Cord o All other nerves exit below the corresponding
CNS intimately connected with the peripheral nervous vertebra.
system
PNS→ Sensory and motor components → Spinal Nerves

Figure 1. Central and Peripheral Nervous System.

II) SPINAL CORD ANATOMY AND BASIC FUCNTION

Extends from the Foramen Magna of the Skull, starts
from C1 to between L1 and L2

Structure Anatomy

Cervical Enlargement
C5-T1 of the spinal
Cervical Region Cord→ more Gray
Matter → Supply upper
limb skeletal muscles
Thoracic Region No Enlargement
Lumbar Enlargement
L2-S3 of the spinal
Lumbar Region Cord→ more Gray
Matter → Supply lower
limb skeletal Muscles
Sacral Region No Enlargement
Coccygeal Region No Enlargement
Figure 2. Spinal Cord and Spinal Nerves.
Tapered terminal end of
Conus Medullaris spinal cord, Between L1
and L2
Bundle of Nerve Roots
Cauda Equina from L2 to Co 1, looks
like horse tail

ANatomy of SPinal cord and Spinal Nerves NEURO PHYSIOLOGY: Note #21. 1 of 4
(A) SPINAL CORD CROSS-SECTIONAL ANATOMY Myelin
o Made of Lipid and Protein →Whitish color
o Formed by oligodendrocytes (central nervous system)
White matter
and Schwann cells (peripheral nervous system).
o Myelinated axons
o As we go down from cervical region to Coccygeal Nucleus= Group of cell bodies in the CNS
region → White matter Decrease ↓↓ Ganglia= Group of cell bodies in the PNS
 Ascending Tracts carrying Sensory Information → Tract = Bundle of Axons in the CNS
Thicker as we go up
 Descending Tracts carrying Motor Information→
Thicker at the top
Gray Matter
o Contains cell bodies (soma), dendrites, unmyelinated
axons
o As we go down from cervical region to Coccygeal
region → Gray matter Increase ↑↑
 Higher Muscle Mass in the lower extremities →
need more motor supply

Figure 4. Neuron Structure.

Structure Anatomy Overall Function

Anterior
(Ventral)
Funiculus
Lateral
Funiculus
Contains Bundle of
Posterior
Myelinated Axons called
White (Dorsal)
Tract
Matter Funiculus
Axons Transmit signals
between CNS and
Anterior
Periphery
median fissure

Posterior
median sulcus

Posterior
(Dorsal) Horn
Gray Lateral Horn Contains Cell bodies and
Matter Anterior Dendrites of neurons
(Ventral) Horn

Figure 3. White Matter and Gray Matter in Different regions of

spinal cord

Figure 5.Gray Matter and White Matter Structure

2 of 4 NEURO PHYSIOLOGY: Note #21. ANatomy of SPinal cord and Spinal Nerves
 Structure Function
Ascending tract, Sensory
Dorsal Funiculus
Information
Lateral Funiculus Ascending and Descending Tracts
Dorsal Horn Sensory Neurons
Ventral Horn Somatic Motor Neurons
T1-L2, Preganglionic Motor
Lateral Horn Neurons of the Sympathetic
Nervous System

III) SPINAL NERVE ANATOMY AND BASIC FUCNTION Figure 6. Spinal Nerve Structure.

Spinal Nerves Coming out of the Spinal Cord are part of

Peripheral Nervous System
o There are 31 pairs of spinal nerves:
 Cervical →8 pairs
 Thoracic →12 pairs
 Lumbar →5 pairs
 Sacral →5 pairs
 Coccygeal →1 pair
Spinal Nerve= Dorsal Root + Ventral Root

Structure Anatomy & Function

Contain Sensory (afferent)
Dorsal Root
fibers
Contain Motor (efferent)
Ventral Root fibers that control Skeletal
and Smooth Muscle Figure 7. Spinal Nerve Function
Posterior part of the spinal
nerve
Innervation of IV) REVIEW QUESTIONS
Dorsal Rami
o Back
o Neck
o Vertebrae Lateral Horn’s Location and Function:
a. T1-L1, Somatic Motor Neurons
Anterior part of the spinal
b. T1-T12, Parasympathetic Motor Neurons
nerve
Innervation of c. T2-L2, Sensory Neurons
Ventral Rami d. T1-L2, Preganglionic Sympathetic Motor Neurons
o Anterior trunk
o Lateral Trunk
o Limbs The Ventral Root of Spinal Nerve contains:
a. Sensory fibers
Contains Cell bodies of the
Dorsal Root Ganglia b. Motor fibers
sensory neurons
c. Cell bodies of PNS
White Rami Myelinated Preganglionic
d. Cell bodies of CNS
Communicans Sympathetic Nerve Fibers
Unmyelinated The Conus Medullaris is approximately located at
Gray Rami
Postganglionic Sympathetic a. L1-L2
Communicans
Nerve Fibers
b. S5-Co1
c. L4-L5
Group of cell bodies in the d. T12-L1
Ganglia
PNS
As we go down from Cervical region to Coccygeal
region of the Spinal Cord
a. Gray Matter ↑, White Matter ↑
b. Gray Matter ↓, White Matter ↓
c. Gray Matter ↑, White Matter ↓
d. Gray Matter ↓, White Matter ↑

Which statement is true?

a. All spinal nerves exit below the corresponding
vertebra.
b. There are 8 pairs of spinal nerves coming out of the
cervical segment.
c. There are 8 cervical vertebrae and 8 pairs of spinal
nerve coming out of them .
d. Thoracic enlargement is located between T1-T3

CHECK YOUR ANSWERS

ANatomy of SPinal cord and Spinal Nerves NEURO PHYSIOLOGY: Note #21. 3 of 4
 V) REFRENCES
● Marieb, E. N., & Hoehn, K. (2012). Human Anatomy &
Physiology (9th ed.). Pearson.
● AMBOSS: medical knowledge platform for doctors and students.
(n.d.). Amboss. Retrieved August 22, 2021, from
https://www.amboss.com/us/

4 of 4 NEURO PHYSIOLOGY: Note #21. ANatomy of SPinal cord and Spinal Nerves
 Last edited: 9/1/2021

22. SPINAL CORD-GRAY MATTER

Neurology | Spinal Cord: Gray Matter Structure & Function Medical Editor: Donya Moslemzadeh

OUTLINE Basic Function

I) GRAY MATTER STRUCTURE Posterior gray horn → Sensory function

II) GRAY MATTER FUNCTION
o Somatic Sensations
III) REVIEW QUESTIONS
o Visceral Sensations
IV) REFRENCES
Anterior gray horn → Motor function
o Somatic Motor Function
Intermediate Zone → Motor function
o Visceral Motor Function

I) GRAY MATTER STRUCTURE

Gray Matter = Contains cell bodies (soma), dendrites,
unmyelinated axons
Myelin
o Made of Lipid and Protein →Whitish appearance
o Formed by oligodendrocytes (central nervous system)
and Schwann cells (peripheral nervous system). Figure 3. Gary Matter Basic Function.
Node of Ranvier
o Unmyelinated regions between two adjacent Laminae of Rexed and Associated Nuclei
myelinated segments of axons in the CNS and PNS
o Contain a large amount of Na+ channels→ allow Laminae of Rexed → Organization of Gray Matter of the
saltatory conduction → increases the velocity of Spinal Cord into 10 Laminae
action potentials [Amboss, 2021]
Section Lamina
Nucleus= Group of cell bodies in the CNS Posterior Gray Horn Lamina I, II, III, IV, V, VI
Ganglia= Group of cell bodies in the PNS Intermediate Zone Lamina VII
Anterior Gray Horn Lamina VIII, IX
Gray Commissure Lamina X
Functionally, the gray matter can be subdivided into
nuclei
Lamina of
Associated Nuclei
Rexed
Lamina I Posterior Marginal Nucleus
Lamina II Substantia Gelatinosa of Rolando
Lamina III Nucleus Proprius
Lamina IV Nucleus Proprius
Figure 1. Neuron Structure.
Clark’s Column (Nucleus)
Basic Anatomy
Posterior gray horn Lamina VII Intermediomedial Nucleus
Anterior gray horn
Intermediolateral Nucleus
Intermediate zone
o Lateral gray horn T1-L2 Lateral Nuclear Group
Gray Commissure → connecting the two sides Lamina IX Central Nuclear Group

Medial Nuclear Group

Figure 2. Gray Matter Anatomy.

Figure 4. Rexed Laminae and Associated Nuclei.

Spinal Cord-Gray matter NEURO PHYSIOLOGY: Note #22. 1 of 6

 II) GRAY MATTER FUNCTION

Lamina IX

Nuclei Function

Only Present
o Cervical Enlargement
(C5-T1)
o Lumbar Enlargement
Lateral Nuclear Group
(L2-S3) sections
Supply Distal Limbs

Phrenic Nucleus (C3-C5)

o Diaphragm
Accessory Spinal Nucleus
(C1-C5)
o Sternocleidomastoid
Central Nuclear Group
muscle
o Phrenic Nucleus
o Trapezius Muscle
o Accessory Spinal
Nucleus Onuf’s Nucleus (S2-S4)
o Onuf’s Nucleus o External Sphincters
o Muscles involved in
Erection and
Ejaculation
Supply Proximal Limbs Figure 5. Lamina IX and X.
Lamina X
Medial Nuclear Group Supply Axial Musculature

Lamina X is where axons cross from one side of the gray

Cervical Enlargement → More Gray Matter → supply matter to the other
upper extremities Axons are nonmyelinated
Lumbar Enlargement → More Gray Matter → supply
Lower extremities
Lamina I

Somatotopic Arrangement Lamina Nuclei Function

o Imaginary Horizontal Line
 Nuclei on the Posterior aspect of the line supply Temperature
the Flexors Pain
 Nuclei on the Anterior aspect supply the o Fast Pain→
Extensors Aδ Fibers
Posterior Marginal
Lamina I
o Imaginary Vertical lines Nucleus Become part of
 Lateral Nuclear Group → Distal Limbs Anterolateral
 Central Nuclear Group → Proximal Limbs Spinothalamic
 Medial Nuclear Group → Axial Musculature (Trunk Tract
and Neck)

Cell bodies of the somatic motor neurons in

this section of Spinal Cord are the Relay
station for the Upper motor neurons of the
Corticospinal Tract

Figure 6. Lamina I.

2 of 6 NEURO PHYSIOLOGY: Note #22. Spinal Cord-Gray matter

 Lamina II Lamina III & IV

Lamina Nuclei Function Lamina Nuclei Function

Temperature Temperature/Pain
Pain o C Fibers
o Slow Pain→ C o Aδ Fibers
fibers
Touch/Vibration
Become part of o Aβ Fibers
Substantia Anterolateral
Proprioception
Gelatinosa of Spinothalamic
o Ia Fibers
Rolando Tract
Lamina II Lamina III & Nucleus
As ascend the IV Proprius Become part of
Spinal cord to the o Spinothalamic
medulla it become Tract
Spinal Trigeminal o Dorsal
Nucleus (CN V) Column–
Medial
Involved in Pain Lemniscus
Modulation Pathways

Figure 8. Lamina III and IV.

Lamina V

Lamina Function
Figure 7. Lamina II.
Pain and Temperature
sensations from
visceral organs
Lamina V
Becomes part of
Anterolateral
Spinothalamic Track

Figure 9. Lamina V.

Spinal Cord-Gray matter NEURO PHYSIOLOGY: Note #22. 3 of 6

Lamina VI

Lamina Function

Proprioception
Limb Reflexes
Lamina VI
Part of Ventral
Spinocerebellar Track
(L2 -Co 1)

Figure 10. Lamina VI.

Lamina VII

Lamina Nuclei Function

Intermediolateral T1-L2 (Lateral
Nucleus Gray Horn)

Cell bodies of the

Sympathetic
Preganglionic
Neurons

Supply glands,
smooth muscles
and cardiac
muscles
Interomediomedial S2-S4
Nucleus
No lateral Gray
Lamina VII Horn in this area

Cell bodies of the

Parasympathetic
Preganglionic
Neurons

Clark’s Nucleus C8-L2

Proprioception

Cell bodies that

making Dorsal
Spinocerebellar
Tract

Figure 11. Lamina VII.

4 of 6 NEURO PHYSIOLOGY: Note #22. Spinal Cord-Gray matter

 Lamina VIII III) REVIEW QUESTIONS
Which Column of Gray Matter of the Spinal Cord
receives the sensory input for the body?
Lamina Function a. Posterior Column
Cell bodies that are Relay Stations b. Anterior Column
for Subcortical Tract c. Lateral Column
o Rubrospinal pathway d. B and C
o Reticulospinal tract
Lamina VIII o Vestibulospinal tract Which of these Nucleus is in Lamina IX?
o Tectospinal tract a. Clark’s Nucleus
Supply Skeletal Muscles b. Intermediolateral Nucleus
c. Lateral Nuclear group
d. Substantia Gelatinosa of Rolando

Pathways Site Of Origin Function Lateral Gray horn of the spinal cord is located
between:
Red nucleus Limbs
Rubrospinal a. L2-L5
Movement
b. T12-L2
Pontine and Medullary c. T1-L2
Reticulospinal Medullary →Flexion d. T1-T11
reticular Pontine
formation →Extension
Anterior gray horn is primarily occupied by
Vestibular Eye Movement a. Lamina X
Vestibulospinal nucleus Posture b. Lamina VIII and IX
Balance c. Lamina VII
Tectospinal Head and eye d. Lamina VIII, IX and X
Superior
colliculus movement
Posterior gray horn is primarily occupied by
a. Lamina I, II and III
b. Lamina IV, V and VI
c. Lamina VII
d. A and B

Which type of information is not received by

Nucleus Proprius?
a. Temperature
b. Vision
c. Touch
d. Pain

Which statement is not true about the nuclear

groups located in Lamina IX?
a. Lateral Nuclear group is only present in L2-S3
segment of the spinal cord.
b. Accessory Spinal nucleus supplies the Trapezius
muscle.
c. Onuf’s nucleus supplies the muscles involved in
ejaculation.
d. Lateral Nuclear group supply distal limbs.

Nucleus Proprius primarily occupies

a. Lamina III and IV
b. Lamina II and III
c. Lamina I and II
d. Lamina VII
Figure 12. Lamina VIII.
Which statement is not true about Substantia
Gelatinosa of Rolando?
a. Receives Temperature sensations
b. Involved in pain modulation
c. Involved in balance
d. Become part of anterolateral spinothalamic tract

Which Nucleus contains cell bodies of the

parasympathetic preganglionic neurons?
a. Intermediolateral nucleus
b. Intermediomedial nucleus
c. Clark’s nucleus
d. A and B

Spinal Cord-Gray matter NEURO PHYSIOLOGY: Note #22. 5 of 6

 Which statement is true about Lamina VIII?
a. Only present between T1 to L2 segment of the spinal
cord.
b. Supply glands and smooth muscles
c. Contain nuclei that are relay station for Tectospinal
Tract.
d. Involved in pain modulation

CHECK YOUR ANSWERS

IV) REFRENCES

● AMBOSS: medical knowledge platform for doctors and students.

(n.d.). Amboss. Retrieved August 22, 2021, from
https://www.amboss.com/us/
● Blumenfeld, H. (2010). Neuroanatomy Through Clinical Cases
(2nd ed.). Sinauer Associates, Inc.
● Le T, Bhushan V, Sochat M, Chavda Y, Zureick A. First Aid for
the USMLE Step 1 2018. New York, NY: McGraw-Hill Medical; 2017
● Marieb EN, Hoehn K. Anatomy & Physiology. Hoboken, NJ:
Pearson; 2020.
● Boron WF, Boulpaep EL. Medical Physiology.; 2017.
● Urry LA, Cain ML, Wasserman SA, Minorsky PV, Orr RB,
Campbell NA. Campbell Biology. New York, NY: Pearson; 2020.
● Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL,
Loscalzo J. Harrison's Principles of Internal Medicine. New York
etc.: McGraw-Hill Education; 2018.
● Felten DL, O'Banion MK, Maida ME. Netter's Atlas of
Neuroscience. Amsterdam, The Netherlands: Elsevier Health
Sciences; 2015

6 of 6 NEURO PHYSIOLOGY: Note #22. Spinal Cord-Gray matter

 Last edited: 9/2/2021

23. SPINAL CORD-WHITE MATTER

Neurology | Spinal Cord: White Matter Structure & Function Medical Editor: Donya Moslemzadeh

OUTLINE Tract of Lissauer

Allow Pain and Temperature Fibers to Ascend or
I) INTRODUCTION Descend 1-2 segments before entering the gray
II) WHITE MATTER STRUCTURE
matter of the dorsal horn
III) WHITE MATTER FUNCTION
Let’s Imagine we have a receptor that picks up pain or
IV) REFRENCES
temperature sensations.
o It carries it via the sensory neuron
o Goes into the posterior grey horn,
I) INTRODUCTION  That’s not actually true
 Just before it enters the posterior grey horn, it
White Matter= Myelinated Axons
moves up one or two levels
Myelin
 Only then it will synapse on the cell body in the
o Made of Lipid and Protein →Whitish appearance
posterior grey horn
o Formed by oligodendrocytes (central nervous system)
 Cross over
and Schwann cells (peripheral nervous system).
 Ascends upwards through the spinothalamic tract
Tract = bundle of Axons in the CNS
If you developed a lesion in the tract of Lissauer.
o The loss of pain and temperature sensation isn’t from
the level of the lesion, it’s two levels below where that
lesion is.

Figure 1.1. Structure of the “Neuron” and the “tract”

Basic Anatomy

White matter
o Anterior (Ventral) Funiculus or Column
o Lateral Funiculus or Column
o Posterior (Dorsal) Funiculus or Column
o Anterior White Commissure
 Where fibers Cross

Ascending Tracts→ Sensory

Descending Tracts → Motor

Figure 1.3. Tract of Lissauer

Figure 1.2 The funiculi or columns of the spinal chord

Spinal Cord-White matter NEURO PHYSIOLOGY: Note #23. 1 of 2

 II) WHITE MATTER STRUCTURE III) WHITE MATTER FUNCTION
White Column Function

Ascending Tracts

Fasciculus Gracilis → T6 and below

Fasciculus Cuneatus → T5 and above

Dorsal Column Fine Touch

Vibrations
Proprioception

No Descending Tracts

Descending Tracts

Lateral Corticospinal Tract

o 85% of the fibers of the Pyramidal
Figure 1.4 Cross section of the spinal cord decussate
(A) DESCENDING MOTOR TRACTS o Stimulate Lower Motor Neurons →
voluntary Control of Skeletal
Lateral White Column Muscles
o Lateral Corticospinal Tract Rubrospinal Tract
o Rubrospinal Tract o Stimulate Lower Motor Neurons →
Flexors
Ventral White Column
Ascending Tracts
o Lateral Reticulospinal Tract Lateral Column
o Medial Reticulospinal Tract
o Vestibulospinal Tract Dorsal Spinocerebellar Tract
o Proprioception (C8-L2)
o Tectospinal Tract
o Anterior Corticospinal Tract Ventral Spinocerebellar Tract
o Proprioception (L2-Co 1)
Spino-Olivary Tract
Somatotopic Arrangement
o Proprioception → Inferior Olives
Lateral Corticospinal Tract →Cerebellum
o Lateral →→→ Medial Lateral Spinothalamic Tract
 Sacral → Lumbar →Thoracic →Cervical o Pain
o Fibers that control the upper extremity located medial o Temperature
to those that control the lower extremity

Descending Tracts
(B) ASCENDING SENSORY TRACTS
Lateral Reticulospinal Tract
Dorsal White Column o =Medullary Reticulospinal Tract
Fasciculus Gracilis o Flexors
Fasciculus Cuneatus Medial Reticulospinal Tract
o = Pontine Reticulospinal Tract
There is No Descending Tract in the Dorsal Funiculus o Extensors
Vestibulospinal Tract
o Extensors
Lateral White Column
Tectospinal Tract
Dorsal Spinocerebellar Tract o Head
Ventral Column
Ventral Spinocerebellar Tract o Neck
Lateral Spinothalamic Tract o Eye Movements
Spino-Olivary Tract
Anterior Corticospinal Tract
o Lower Motor Neurons→
Ventral White Column Voluntary Skeletal Muscle
Control
Ventral Spinothalamic Tract
Ascending Tract

Ventral Spinothalamic Tract

Somatotopic Arrangement o Crude Touch
o Pressure
Lateral Spinothalamic Tract
o Legs Laterally
Dorsal Column
o Fasciculus Gracilis → Lower extremities IV) REFRENCES
o Fasciculus Cuneatus→ Upper extremities ● AMBOSS: medical knowledge platform for doctors and students.
(n.d.). Amboss. Retrieved August 22, 2021, from
https://www.amboss.com/us/
● Blumenfeld, H. (2010). Neuroanatomy Through Clinical Cases
(2nd ed.). Sinauer Associates, Inc.

2 of 2 NEURO PHYSIOLOGY: Note #23. Spinal Cord-White matter

 Last edited: 8/25/2021

35. SPINAL CORD MENINGES

Neurology | Spinal Cord Meninges Medical Editor: Dr. Sofia Centenaro

o Potential space in the brain

OUTLINE o Real space in the spinal cord

I) CLINICAL SCENARIUM (vii) Outer Dura Mater (periosteal layer)

II) STRUCTURES (viii) Ligamentum flavum
III) REVIEW QUESTIONS
IV) REFERENCES o Connects the lamina of vertebrae together

(ix) Interspinous ligament

o Between the spinous processes
I) CLINICAL SCENARIUM (x) Supraspinous ligament
(1) Symptoms o Connects the tip of the spinous process of a
vertebra to the tip of the spinous process of another
bad headache vertebra
fever
stiffness in the neck for about 2 days (xi) Subcutaneous tissue
sensitivity to light and sound o filled with adipose
confusion
(2) Diagnosis
(xii) Skin
o Dermis and epidermis
Meningitis
(3) Definitive diagnostic step
Lumbar puncture
Safe area around L3- L4
The procedure:
Palpate the midline between the top of Iliac crests

Palpate above → L3 spinous process

Sterilize the patient skin area
Glove up
Numb up the area
Insert the spinal needle in the space between the
spinous processes of L3 and L4

Remember:
Spinal cord ends around L1-L2

II) STRUCTURES
From deep to superficial:

(i) Pia mater

o first inner layer
o ‘Soft mother’

(ii) Subarachnoid space

o Contains cerebrospinal fluid (CSF)

(iii) Arachnoid mater

Figure 1.1. Meningeal coverings of the Spinal Cord
o ‘Arachnid’ = spider + ‘oid’ = like → ‘spider-like mother’
o Usually in proximity to the pia mater, but from the end
of the spinal cord it breaks away
 creating a large space → sac that contains CSF
 Extending down to S2 level

(iv) Subdural space

o Contains veins

(v) Inner Dura Mater (meningeal layer of dura

mater)
(vi) Epidural space
o Filled with fat and veins

Spinal cord meninges NEURO PHYSIOLOGY: Note #35. 1 of 2

 (B) PIA MATER EXTENSIONS III) REVIEW QUESTIONS
(1) Filum terminale The space between the arachnoid mater and the pia
Pia Mater extension running from the tip of the spinal cord mater
(conus medullaris) through the cauda equina down to a. Subdural space
the coccyx b. Epidural space
c. Subarachnoid space
d. Interspinous ligament
Remember:
Cauda Equina: the spinal nerves from L2 to C1 Which of the following sentences is true about the
Conus Medullaris: the lower end of the spinal cord, Denticulate ligaments?
occurring around L1-L2 a. They are Pia mater lateral extensions attaching to
the outer Dura Mater
b. They connect the lamina of our vertebrae together
(2) Denticulate ligaments c. They run from the tip of the spinal cord down to the
coccyx
Pia mater lateral extensions on both sides of the spinal
d. They connect the tip of the spinous process of a
cord that extend and attach to the outer Dura Mater
vertebra to the tip of the spinous process of another
21 pairs
vertebra

The inner meningeal layer covering the spinal cord

a. Aracnoid Mater
b. Dura Mater
c. Subcutaneous tissue
d. Pia Mater

Which level is the safe area for a lumbar puncture?

a. L3-L4
b. L1-L2
c. L2-C1
d. L2-L3

CHECK YOUR ANSWERS

IV) REFERENCES

Figure 1.2. Frontal denticulate ligaments

2 of 2 NEURO PHYSIOLOGY: Note #35. Spinal cord meninges

 Last edited: 8/13/2021

1. SPINAL CORD BLOOD SUPPLY

Neurology | Spinal Cord Blood Supply Medical Editor: Dr. Sarah Abimhamed

OUTLINE

I) MAIN BRANCHES THAT SUPPLY SPINAL CORD

II) ARTERIES OF THE OF THE SPINAL CORD
III) CLINICAL CORRELATION
III) APPENDIX (D) RECALL - BRANCHES OF SUBCLAVIAN ARTERY:
IV) REVIEW QUESTIONS
V) REFERENCES 3 parts of subclavian artery:
The parts are split up by anterior scalene muscle.
The first part is medial to the muscle, the second is
posterior to it, and the third is lateral to it [Moore, Essential Clinical
Anatomy]
I) MAIN BRANCHES THAT SUPPLY SPINAL CORD I) Medial to the anterior scalene: vertebral artery
The main branches that supply the spinal cord and their II) Posterior to the anterior scalene: costo-cervical
divisions, according to different regions trunk which branches into deep cervical and
supreme intercostal branch
(A) UPPER PART OF THE SPINAL CORD III) Lateral to the anterior scalene: dorsal scapular
Supplied by: Left subclavian artery [Moore, Essential Clinical Anatomy]
- Which branches into:
→ Vertebral Artery
→ Deep Cervical Artery

(B) MIDDLE & POSTERIOR PART OF THE SPINAL CORD

Supplied by: Thoracic aorta,
- Which branches into:
→ Posterior Intercostal Arteries

(C) LOWER PART OF SPINAL CORD

Supplied by: Abdominal aorta
- Which branches into:
→ Lumbar Arteries
→ Lateral Sacral Arteries
Figure 2. Division of the Subclavian Artery

II) ARTERIES OF THE OF THE SPINAL CORD

(A) VERTEBRAL ARTERIES

The arteries of the spinal cord run longitudinally from the

medulla of the brainstem to the conus medullaris of the
spinal cord. [Essential Clinical Anatomy]

There is one that runs anterior called the anterior spinal

artery (ASA), and a pair of arteries running posteriorly
called the posterior spinal artery (PSA).

There are 3 main branches that supply the spinal cord:

Arteries of spinal cord Origin Supply
Anterior 2/3 of
Anterior spinal artery Vertebral artery
spinal cord
Vertebral artery or Posterior 1/3 of
Pair of posterior spinal
posterior inferior spinal cord
arteries
Figure 1. Main arteries that supply the spinal cord cerebellar artery

Table 1. Branches of the Vertabral Arteries

(B) POSTERIOR INTERCOSTAL ARTERIES

Posterior intercostal arteries branch into anterior and
posterior radicular arteries which supply ASA and PSA,
respectively.
The radicular arteries also provide vascular supply for the
nerve roots along which they track.

Spinal cord blood supply NEURO PHYSIOLOGY: Note #1. 1 of 3

 CLINICAL PRESENTATION:
These are all the result of damage to the anterior 2/3 of the
spinal cord. (See Table 3. Summary of Clinical Presentation
of ASA Syndrome)
(1) Paraplegia
Anterior grey horn contains nerve
supply to the somatic nervous
system  paralysis of skeletal
muscles of lower extremities (type of
Figure 3. Division of Posterior Intercostal Arteries
paraplegia)

Origin & Division of the Posterior Intercostal Arteries

Origin 1st Division 2nd Division 3rd Division
Anterior Anterior spinal artery Figure 5. Skeletal Muscle
radicular supplied by somatic nervous
Spinal artery system
branch of
Aorta posterior
intercostal Posterior Posterior spinal artery (2) Urinary and Fecal Overflowing/Incontinence
artery radicular
artery
Intermediomedial nuclei located in the anterior 2/3 of the
spinal cord, this nuclei is part of the parasympathetic
Table 2. Branches of Posterior Intercostal Arteries system. This results in:

Vasa corona: connection between the anterior and a. Detrusor muscle is not
posterior spinal artery getting proper nerve
supply, so cannot
Around T10-12, lumbar and sacral region, the main blood contract, it can overfill 
supply that feeds into anterior spinal artery is the artery of overflowing continence
Adamkiewicz (also called great anterior segmental
medullary artery).

Figure 6.Bladder overfilling due

III) CLINICAL CORRELATION
to lack of proper nerve supply to
detrusor muscle & lack of
ANTERIOR SPINAL ARTERY SYNDROME function of internal urinary
Anterior Spinal Artery Syndrome sphincter

This occurs when the anterior spinal artery is not getting

enough blood supply due to damage, occlusion, emboli,
b. Parasympathetic nerve
etc. of the artery of Adamkiewicz. This affects the anterior
supplies the smooth
2/3 of the spinal cord.
muscles of the sigmoid
colon  unable to
Note: affected area is the T10-T12 and lumbosacral region
contract and excreted
as that is the area where the ASA receives blood supply
feces therefore sigmoid
from artery of Adamkiewicz. (See Figure 3)
colon starts distending 
overflowing causes fecal
incontinence

c. Neurons also supply

internal (involuntary)
urinary and fecal
sphincters  urinary and
fecal incontinence
Figure 7. Sigmoid colon distending due to
lack of proper nerve supply, it affects
internal fecal sphincter to leading to fecal
incontinence

(3) Motor paralysis and loss of reflexes

Descending motor nerve fibers are affected. They start
from the cerebral cortex that terminates on lower motor
neurons and interneurons in the spinal cord, controlling
movements of the limbs and trunk [Fundamentals of human
neuropsychology]

Figure 4. Area of the spinal cord affected in ASA Syndrome
(4) Bilateral loss of pain and temperature
Anterolateral spinothalamic tract is found in the anterior
2/3 of the spinal cord  it carries pain temperature and
crude touch sensation. Therefore, in ASA syndrome there
is bilateral loss of pain and temperature sensation.

2 of 3 NEURO PHYSIOLOGY: Note #1. Spinal cord blood supply

 IV) III) APPENDIX

Area affected Result of the damage Reason for the damage

Anterior grey horn (somatic Paralysis of skeletal muscles of lower Anterior grey horn is located in the anterior 2/3 of the
Anterior Spinal Artery Syndrome

nervous system)
Intermediomedial nucleus
(parasympathetic nervous
system)
Anterolateral spinothalamic
tract
Descending autonomic fibers
extremities (type of paraplegia)
Urinary overflowing continence
Fecal incontinence
Bilateral loss of pain and temperature
sensation
Motor paralysis and loss of reflexes
spinal cord and contains nerve supply to the somatic
nervous system which controls the skeletal muscles
Detrusor muscle of the bladder does not get proper
nerve supply, so it cannot contract  overfills
Neurons also supply internal (involuntary) urinary
sphincters
Parasympathetic nerve muscles supply smooth
muscle of the sigmoid colon
Neurons also supply internal (involuntary) fecal
sphincters
Anterolateral spinothalamic tract carries pain
temperature and crude touch sensation
The descending nerve fibers control movements of the
limbs and trunk

Table 3. Summary of Clinical Presentation of ASA Syndrome

a. Lack of blood supply to the intermediomedial nuclei

V) REVIEW QUESTIONS b. Damage to the parasympathetic nervous system
c. Lack of blood supply to the skeletal muscles
Which artery supplies the vertebral arteries?
d. Lack of blood supply to the anterior grey horn
a. Deep cervical artery
b. Left subclavian artery
What does lack of blood supply to the anterolateral
c. Brachiocephalic trunk
spinothalamic tract cause?
d. Posterior intercostal artery
a. Unilateral loss of pain
b. Bilateral loss of temperature and pain
What is the origin of the posterior intercostal artery?
c. Unilateral loss of temperature
a. Subclavian artery
d. Bilateral loss of pain
b. Deep cervical artery
c. Thoracic Aorta
Which nervous system is affected in urinary
d. Lumbar artery
incontinence due to detrusor muscle not being able to
contract?
What is the origin of anterior and posterior radicular
a. Sympathetic nervous system
arteries?
b. Paraysmpathetic nervous system
a. Abdominal aorta
c. Somatic Nervous system
b. Spinal branch of posterior intercostal muscle
d. Intermediomedial nucleus
c. Vertebral Arteries
d. Costocervical trunk
Which part of the colon is affected in ASA
syndrome?
Which artery of the spinal cord runs longitudinally
a. Transverse Colon
and posteriorly from the medulla of the brainstem to
b. Ascending Colon
the conus medullaris of the spinal cord?
c. Sigmoid Colon
a. Anterior radicular artery
d. Descending Colon
b. Posterior radicular artery
c. Anterior and Posterior Spinal Arteries CHECK YOUR ANSWERS
d. Posterior Spinal Arteries
VI) REFERENCES
Which areas of the spinal cord does the anterior Moore, K. L., MD, Agur, A. M. R., PhD, & Dalley, A. F., II. (2014).
spinal artery supply? Moore Essential Clinical Anatomy (5th ed.). Lippincott Williams &
a. Anterior 2/3 of the spinal cord Wilkins.
b. Anterior 1/3 of the spinal cord Gofur, E. M. (2020, July 27). Anatomy, Back, Vertebral Canal
c. Nerve roots Blood Supply - StatPearls - NCBI Bookshelf. NCBI.
d. Anterior ½ of the spinal cord https://www.ncbi.nlm.nih.gov/books/NBK541083/#article-
36647.s11

Which artery supplies the anterior spinal artery at Kolb, B. & Whishaw, I. Q. (2009). Fundamentals of human
the T10-T12 and lumbosacral region? neuropsychology: Sixth edition. New York, NY: Worth Publishers.
a. Anterior segmental artery
b. Posterior Intercostal Artery
c. Artery of Adamkiewicz
d. Artery of Adam of Kiewicz

What is the cause of paraplegia of the lower

extremities in Anterior Spinal Artery Syndrome?

Spinal cord blood supply NEURO PHYSIOLOGY: Note #1. 3 of 3

 Last edited: 8/17/2021

1. STRETCH REFLEX – MUSCLE SPINDLE

Spinal Cord: Stretch Reflex | Muscle Spindle Medical Editor: Dr. Sarah Abimhamed

OUTLINE (C) TYPES OF INTRAFUSAL FIBERS

There are two types of IFF.
I) TYPES OF MUSCLE FIBERS
II) SENSORY FIBERS Nuclear bag fiber (dynamic & static) nuclear chain fibers
III) TYPES OF MOTOR NEURONS
IV) CLINICAL CORRELATION A bunch of IFF  Muscle Spindles
V) ALPHA-GAMMA COACTIVATION
VI) REVIEW QUESTIONS (1) Nuclear Bag Fibers
VII) REFERENCES
Nuclei are centrally located

Proprioceptive pick up two types of sensation:

- Length (degree of stretch)
I) TYPES OF MUSCLE FIBERS - Velocity

They are sensitive to both of them

(A) EXTRAFUSAL MUSCLE FIBERS
(1) Definition
Extrafusal fibers (EFF) makes up the most of skeletal
muscle. They’re attached to the tendon which is attached to
the bone.

Innervated by: alpha (α) motor neurons

(2) Function
They used to generate force. So when the EFF contract
they pull on the tendon which pulls on the bone  causing
movement

(B) INTRAFUSAL MUSCLE FIBERS

(1) Definition Figure 2. Nuclear Bag Fibers with innervations
Inside there’s a connective tissue capsule which contains
intrafusal muscle fibers (IFF). These are specialized fibers. (2) Nuclear Chain Fibers
They don’t connect to tendons but have proprioceptors. IFF
Nuclei are arranged in a chain like fashion.
are encapsulated in sheaths, forming muscle spindles that
Proprioceptive are more sensitive to length (degree of
run parallel to the EFF.
stretch)
Innervated by: gamma (γ) motor neurons

(2) Function
They are too small to generate significant force.
The proprioceptor pick up length and velocity

Figure 3. Nuclear Chain Fibers with innervations

Table 1. Summary of Muscle Fibers

Fibers Innervation Function
Extrafusal alpha (α) motor Generate force
Fibers neurons
Intrafusal gamma (γ) motor Pick up velocity and
Fibers neurons degree of stretch
Figure 1. Extrafusal & Intrafusal Fibers

Stretch Reflex – Muscle Spindle NEURO PHYSIOLOGY: Note #1. 1 of 4

 II) SENSORY FIBERS
Sensory innervation of the muscle spindle consists of a
single group 1a afferent nerve, they pick up degrees of
stretch. It innervates the central region of both the nuclear
bag fibers and the nuclear chain fibers, and group II afferent
nerves, which primarily innervate the nuclear chain fibers.
[Costanzo]
(A) TYPES OF SENSORY FIBERS
(1) Type 1a/ annulospiral fibers
(B) ALPHA MOTOR NEURONS
When the sensory fibers stretch:
1. Mechanical gated ion channels open at the nerve ending
2. Sodium enters the cell
3. This makes the nerve more positive
4. The nerve moves from a Resting Membrane Potential
(RMP)  Threshold Potential (TP)
5. At TP  Voltage gated ion channels open  More
sodium flows in at a higher rate  generates AP 
travels down the sensory fibers (type 1a or Type 2)

Function: pick up the stretching in both nuclear chain and

nuclear bag fibers.

Recall: group 1a fibers are among the largest nerves in the

body; thus they have among the fastest conduction
velocities. These fibers form primary endings in a spiral-
shaped terminal around the central region of the nuclear
bag and nuclear chain fibers. [Costanzo]

(2) Type 2 sensory fibers / flower spray endings:

Function: Pick up stretching in nuclear chain fibers

Figure 4. Alpha Motor Neuron Stimulation
On the ends of the nuclear bag fibers there are
myofilaments: IV) CLINICAL CORRELATION

Gamma motor neurons stimulate the nuclear chain  (A) STRETCH REFLEX
myofilaments contract  stretches the IFF  causes the
sensory fibers to stretch as well  release acetylcholine Extrafusal monosynaptic reflex  alpha motor neurons
Intrafusal monosynaptic reflex  gamma motor neuron

Recall: Group II fibers have intermediate diameters and
intermediate conduction velocities. They form secondary
endings primarily on the nuclear chain fibers. [Costanzo]
III) TYPES OF MOTOR NEURONS
First gamma motor neurons induced stretching then the
sensory fibers stimulate alpha motor neurons
(A) GAMMA MOTOR NEURONS
1. Gamma motor neurons release acetylcholine
2. Sodium ions to enter the neuron
3. Generates action potential (AP)
4. Activates sarcoplasmic reticulum
5. This pushes calcium out  calcium binds to the
cross bridge  Induces stretching
(1) Extrafusal Monosynaptic muscle reflex
Example, in the patellar reflex:
Hammer taps on patellar tendon  stretches EFF muscles
of quadriceps  sensory fibers (Type 1a & Type 2) pick up
the sensation of stretch  travel to the dorsal root ganglion
 then to dorsal root of the spinal cord (posterior grey
horn)  it can synapse with either:
 Alpha Motor neuron  goes to the muscle
causes to contract (ipsilateral monosynaptic
reflex)
Purpose: To prevent overstretching by contracting the
muscle
OR
 Interneuron  inhibits the motor neuron 
doesn’t send signal to the hamstring muscles
Purpose: For the quadriceps to contract the antagonistic
muscle (hamstring) need to relax / be inhibited. This is
called reciprocal inhibition

Figure 5. Gamma Motor Neuron Stimulation

Figure 6. Extrafusal Monosynaptic Muscle Reflex

2 of 4 NEURO PHYSIOLOGY: Note #1. Stretch Reflex – Muscle Spindle

 (2) Intrafusal Monosynaptic Muscle Reflex V) ALPHA-GAMMA COACTIVATION

Gamma motor neurons same thing happens

1. Patellar reflex activated When you stretch a muscle:
2. Quadriceps muscles stretch Stretch IFF  stimulates sensory fibers (Type 1a and Type
3. Activate IFF 2)  Stretch EFF
4. Activates sensory fibers (type 1a and type 2 fibers) 
send sensory impulses to spinal cord and synapse
with either:
 Gamma Motor Neuron  stimulate IFF of the
Quadriceps
 Interneuron (Inhibitory)  inhibit IFF of
hamstrings

Figure 8. Normal Muscle Fibers

If Extrafusal Fibers Contract & Intrafusal Fibers Don’t

→ Type 1a nerve fibers will not be stimulated
→ The IFF will become slack so the ion gated
channels will not open

Figure 7. Intrafusal Monosynaptic Muscle Reflex

Note: corticospinal tracts (from the upper motor neuron) 

can synapse and modulate activity of gamma motor neuron.

(3) UMN Lesions & Corticospinal Tract Figure 9. Slacking Intrafusal Muscle Fibers

UMN usually inhibits the gamma motor neurons but with a

lesion it gets activated.
How is this avoided
If there is a lesion that damages corticospinal tract (UMN - When there is ↓ type 1 a stimulation
lesion)  ↑↑↑ gamma motor neuron activation  - Gamma motor neuron will activate the Intrafusal
HYPERTONIA / SPASTICITY Fibers and open ion gated channels will open 
↑↑ AP
This is called alpha-gamma coactivation

Figure 10. Alpha-Gamma Coactivation

VI) ABBREVIATIONS:

- EFF: Extrafusal Fibers

- IFF: Intrafusal Fibers
- AP: Action potential
- RMP: Resting Membrane Potential
- TP: Threshold Potential

Stretch Reflex – Muscle Spindle NEURO PHYSIOLOGY: Note #1. 3 of 4

 VII) REVIEW QUESTIONS VIII) REFERENCES
● PhD, L. C. S. (2021). Costanzo Physiology (7th ed.). Elsevier.
Which muscle fiber does the Alpha Motor Neuron
innervate?
a. Intrafusal Muscle Fibers
b. Nuclear Chain Fibers
c. Extrafusal Muscle Fibers
d. Nuclear Chain Fibers

Which muscle fiber does the Gamma Motor Neuron

innervate?
a. Intrafusal Muscle Fibers
b. Nuclear Chain Fibers
c. Extrafusal Muscle Fibers
d. Nuclear Chain Fibers

Match the Following

1. Nuclear Bag a. Proprioceptors are more sensitive to length
2. Nuclear Chain b. Pick up stretching in intrafusal muscle fibers
3. Type 1a Sensory Fibers c. Proprioceptors sensitive to length & velocity
4. Type 2 Sensory Fibers d. Pick up stretching in nuclear chain fibers

a. 1c, 2a, 3d, 4b

b. 1a, 2c, 3b, 4d
c. 1c, 2a, 3b, 4d
d. 1d, 2a, 3b, 4c

What do the interneurons produce?

a. Reciprocal Inhibition
b. Reciprocal Innervation
c. Reciprocal Activation
d. Reciprocation Co-Activation

What happens if there is a lesion that inhibits the

corticospinal tract?
a. Decreased gamma motor neuron activation leading
to hypertonia
b. Increased gamma motor neuron activation leading to
hypotonia
c. Increased gamma motor neuron activation leading to
hypertonia
d. Increased gamma motor neuron activation leading to
hypotonia

Which order of events is correct?

a. Gamma motor neurons release acetylcholine 
Sodium ions to enter the neuron  Generates AP
 Induces stretching
b. Gamma motor neurons release acetylcholine 
Sodium ions to leave the neuron  Generates AP
 Induces stretching
c. Gamma motor neurons release Calcium  Sodium
ions to enter the neuron  Generates AP
Induces stretching
d. Sodium ions to enter the neuron  Gamma motor
neurons release acetylcholine  Generates AP 
Induces stretching

What is Alpha-Gamma Coactivation?

a. When there is ↓ type 2 stimulation, Gamma motor
neuron will activate the Intrafusal Fibers and open
ion gated channels will open  ↑↑ AP
b. When there is ↑ type 1 a stimulation, Gamma motor
neuron will activate the Intrafusal Fibers and open
ion gated channels will open  ↑↑ AP
c. When there is ↓ type 1 a stimulation, Gamma motor
neuron will activate the Intrafusal Fibers and open
ion gated channels will open  ↑↑ AP
d. When there is ↓ type 1 a stimulation, Gamma motor
neuron will activate the Extrafusal Fibers and open
ion gated channels will open  ↑↑ AP

CHECK YOUR ANSWERS

4 of 4 NEURO PHYSIOLOGY: Note #1. Stretch Reflex – Muscle Spindle

 Last edited: 8/30/2021

38. GOLGI TENDON ORGAN REFLEX (GTO)

Golgi Tendon Organ Reflex (GTO) Medical Editor: Jan Camille Santico

OUTLINE II) GOLGI TENDON ORGAN (GTO)

I) ANATOMY OF THE SKELETAL MUSCLE Whenever a muscle contracts, it shortens and pulls on
II) GOLGI TENDON ORGAN (GTO) the tendon
III) REVIEW QUESTIONS The tendon will pull on a bone and generate movement
IV) REFRENCES The Golgi tendon organ (GTO) can sense the degree of
tension generated in the tendons from muscle contraction
o They have proprioceptors, which are sensory
receptors that send information about the position of
I) ANATOMY OF THE SKELETAL MUSCLE
muscles, joints, and ligaments
Skeletal muscle is made up of two types of muscle fibers: When the Golgi tendon organs are stimulated, it activates
o Extrafusal muscle fibers the Type 1b sensory/afferent fibers
 Generate movement
 Attach to tendons (A) ACTIVATION OF SENSORY FIBERS
o Intrafusal muscle fibers At the ends of the sensory fibers are mechanically-gated
Tendons are collagen fibrils which attach skeletal muscle ion channels
to bone o They are sensitive to mechanical stimulation, such as
Weaved in and around these fibrils is the Golgi Tendon the tension detected within a tendon
Organ (GTO) In the presence of tension, the following happen:
o A type of sensory receptor located within a capsule o the GTO is stimulated
o The sensory fibers are called Type 1b fibers, which o the mechanically-gated ion channels within the
are afferent nerves that send signals to the CNS membrane of the type 1b fibers opens, allowing
extracellular cations, mainly sodium, to enter
When the cations enter, it makes the interior of the cell
more positive
o The voltage-gated ion channels along the axon
membrane are sensitive to a threshold potential, a
specific voltage at which the channels open
 These channels open and
 the sodium ions flush in very strongly,
 generating an action potential that
 propagates down the axon towards the
CNS/spinal cord

Figure 1. Skeletal Muscle

Figure 2. Activation of Type 1b Fibers

Golgi Tendon Organ Reflex (GTO) NEURO PHYSIOLOGY: Note #38. 1 of 3

 (B) GOLGI TENDON REFLEX
Also known as the inverse myotatic reflex
Golgi Tendon Reflex Pathway
o Muscle contraction
o  tendon is pulled
o  tension is generated within the tendon
o  GTO is activated
o  GTO stimulates Type 1b sensory neurons
o  action potential travels to the dorsal root ganglion
o  action potential travels to the posterior grey horn
From there, the afferent nerve will bifurcate and
synapse onto two types of interneurons
(1) Inhibitory Interneuron
The inhibitory interneuron synapses with a motor neuron
on the anterior grey horn, which exits the spinal cord to
innervate skeletal muscles
When muscle contraction is excessive, there is greater
risk of tendon avulsion; thus, the inhibitory interneuron is
stimulated
Example:
o When the biceps muscle contracts excessively, the
GTO detects the increased tension in the tendon
o The type 1b sensory fibers are stimulated, and they
activate the inhibitory interneuron
o The inhibitory interneuron then stimulates the alpha
motor neuron which innervates the biceps muscle,
signaling it to relax (consequently reducing the
tension)
o The neurotransmitter used for this interneuron is
Glycine, it generates Inhibitory Post Synaptic
Potentials (I.P.S.P.)
 Makes negative ions rush in or positive ions rush
out (makes the inside of the cell really negative or
hyperpolarized)
Figure 3. GTO Reflex
(C) NEUROTRANSMITTERS
The inhibitory neurotransmitter is glycine
o Generates inhibitory postsynaptic potentials, which
cause negative ions to rush in or positive ions to rush
out (hyperpolarization of the cell membrane)
2 of 3 NEURO PHYSIOLOGY: Note #38.
(2) Stimulatory Interneuron
The stimulatory interneuron also synapses with a motor
neuron on the anterior grey horn, which exits the spinal
cord to innervate skeletal muscles
The stimulatory interneuron stimulates the motor neurons
which innervate the antagonistic muscle
Example:
o When the biceps muscle contracts excessively, the
GTO reflex stimulates it to relax via the inhibitory
interneuron
o In addition to this action, the antagonistic muscle (i.e.,
triceps) needs to contract to pull the forearm in the
opposite direction, to stabilize the joint
o Thus, the stimulatory interneuron stimulates the
alpha motor neuron of the triceps muscle, causing it
to contract
o The neurotransmitter used for stimulatory interneuron
is Glutamate, it generates Excitatory Post Synaptic
Potentials (E.P.S.P.)
 Makes positive ions rush in or positive ions rush
out (activating the cell and generating action
potential (Depolarize))
Summary
When there is excessive contraction of a muscle, the GTO
reflex causes:
o Inhibition of contracting muscle
o Stimulation of antagonistic muscle
For this reason, the GTO reflex is also referred to as
“reciprocal activation” and “autogenic inhibition”
The stimulatory neurotransmitter is glutamate
o Generates excitatory postsynaptic potentials, which
causes cations to rush in the cells
Golgi Tendon Organ Reflex (GTO)
 III) REVIEW QUESTIONS

Which of the following is FALSE about the Golgi

Tendon Organ?
a. The GTO is located within the tendons of skeletal
muscles.
b. The GTO is stimulated whenever tension decreases
in the tendon.
c. The GTO stimulates Type 1b sensory fibers.
d. The GTO reflex is mediated by two interneurons.

The Golgi Tendon Reflex is also known as the

following, EXCEPT:
a. Inverse myotatic reflex
b. Autogenic inhibition
c. Reciprocal inhibition
d. Reciprocal activation

What type of ion channels are present along the

axon of the Type 1b sensory fibers?
a. Mechanically-gated ion channels
b. Voltage-gated ion channels
c. Ligand-gated ion channels
d. Pressure-gated ion channels

Assuming the triceps muscle contracts excessively,

which of the following is TRUE?
a. The inhibitory interneuron is stimulated, and the
biceps muscle relaxes
b. The stimulatory interneuron is stimulated, and the
triceps muscle contracts
c. The inhibitory interneuron is inhibited, and the triceps
muscle relaxes
d. The stimulatory interneuron is stimulated, and the
biceps muscle contracts

Which of the following statements is FALSE?

a. Both the inhibitory and stimulatory interneurons are
activated during excess muscle contraction
b. The stimulatory interneuron synapses with the alpha
motor neuron innervating the antagonistic muscle.
c. The GTO reflex is also known as “reciprocal
inhibition”.
d. The inhibitory neurotransmitter is glycine

CHECK YOUR ANSWERS

IV) REFRENCES

Golgi Tendon Organ Reflex (GTO) NEURO PHYSIOLOGY: Note #38. 3 of 3