Professor Yoon SH Spinal Cord Anatomy • Spinal cord is covered by pia, arachnoid, and dura • Cord suspended in dural sheath by denticulate ligament on each side – Attached along lateral surface of cord midway between dorsal and ventral roots Spinal cord anatomy • Cord is enlarged in cervical (C4-T1) and lumbosacral regions (L2-S3) • Cord contains grey matter, white matter tracts, and central canal • Central canal lined by ependyma Spinal cord anatomy • Gray matter • Dorsal root entry zone • White matter • Vascular anatomy Cross-section of the spinal cord with laminae of Rexed .
From G. Paxinos & C. Watson
Lamina of Rexed • Gray matter of spinal cord divided into ventral (anterior) and posterior (dorsal) horns • Posterior horn contains laminae 1-6 – Lamina 1 gives origin to the pathway relaying information about pain to the thalamus – Lamina 2 and 3 (substantia gelatinosa) functions in regulating afferent input to the spinal cord. Lamina of Rexed – Lamina 4 projects to the lateral cervical nucleus, the posterior column nuclei, and the thalamus (spinothalamic tract) – Lamina 5 and 6 receives proprioceptive input AND sensory information relayed by lamina 4. These are the sites of origin of ascending projections to higher centres. • From T1 to L3 is Clarke’s column, which is within lamina 6 and contains projections to the cerebellum via the dorsal spinocerebellar tract Lamina of Rexed • Anterior horn: • Lamina 9 contains motor neurons supplying the limbs and lamina 9M contains motor neurons supplying the trunk and neck. 9M is medial to 9. – Is further subdivided into flexor and extensors (flexors are dorsal) and into distal and proximal (distal is more lateral). Lamina of Rexed • Laminae 7 and 8 contain interneurons involved in motor control and motor neurons that project to brain. – Lamina 8 is highly related to lamina 9M, and participates in movements of muscles in the head and neck. – Lamina 7 is related to lamina 9 and participates in limb muscle movement – Lamina 8 and 9M are highly developed in high cervical and thoracic segments controlling neck and trunk, whereas laminae 7 and 9 are highly developed in the spinal enlargements controlling the arms and legs Lamina of Rexed • Intermediolateral cell column is present in thoracic and sacral segments, and is not considered part of the anterior or posterior horn • Contains neurons of origin of pre-ganglionic autonomic fibres • Lamina 10 surrounds central canal, and contains neurons that project to the opposite side of the cord. White matter • Divided into dorsal, lateral and ventral funiculi • Dorsal funiculus mostly comprised of ascending fibres whose bodies are located in dorsal root ganglia – Fibres are ipsilateral – Proprioception and fine discrimination (note that vibration is carried in both dorsal and lateral funiculi) White matter – dorsal funiculus • Fasciculus gracilis medial to fasciculus cuneatus • F. gracilis from lower limbs and cuneatus from upper limbs • Note that lowest segmental innervation is most medial in gracilis and highest innervation is most lateral in cuneatus • Nucleus gracilis and cuneatus in medulla • There are descending fibres in dorsal funiculus which modify sensory input to the cord White matter – lateral funiculus • Dorsolateral and lateral parts (fasciculi) • Dorsolateral contains lateral corticospinal tract (axons from contralateral frontal and parietal lobes); frontal fibres end in ventral horn – Lower limbs are lateral in tract and head is medial – Distal muscles are posterior to proximal muscles • Rubrospinal tract (from contralateral red nucleus) is rudimentary in humans; involved in increasing flexor tone Lateral funiculus • Raphespinal tract in dorsal part of lateral funiculus; modifies painful stimuli from dorsal horn; fibres may begin in reticular formation of medulla • Hypothalamospinal tract arises from paraventricular nucleus of hypothalamus and end in pre-ganglionic autonomic segments T1-L3 and S2-S4 Lateral funiculus • spinocervical tract ascends and terminates in lateral cervical nucleus, which is rudimentary in humans (significance is unknown) • Dorsal spinocerebellar tract is present above L3; arises from Clarkes column and terminates in ipsilateral cerebellum; forms part of pathway of conscious proprioception from lower limb Lateral funiculus • Ventrolateral fasciculus • Spinothalamic tract has its nuclei in lamina 4,5,6 mostly. – Axons cross midline in ventral white commissure and traverse the ventral horn – End in thalamus – Collateral branches to reticular formation – Pain and thermal sensations – Fibres from lower limb are most superficial and from upper limb are deepest Lateral funiculus • Ventral spinocerebellar tract arises from dorsal horn and border cells of ventral horn of lumbosacral cord • Crossed fibres • Ascends to midbrain, enters superior cerebellar peduncle, and decussates again, and enters cerebellar cortex • Concerned with proprioception Lateral funiculus • Spinotectal tract fibres from same part as spinothalamic tract end in superior colliculus and reticular formation (fibres are crossed • Spinoreticular tract originates in laminae 4- 8 ends in reticular formation; is important in perception of pain and other modalities originating in internal organs Lateral funiculus • Spino-olivary tract has uncertain role in humans • Ventrolateral fasciculus also contains descending medullary reticulospinal tract, which controls motor activities that do not require conscious effort Ventral funiculus • Ventral corticospinal tract contains uncrossed fibres • Vestibulospinal tract is uncrossed pathway from the lateral vestibular nucleus of medulla; axons terminate in lamina 8 – Mediates reflexes of equilibrium Ventral funiculus • Pontine reticulospinal tract • Medial longitudinal fasciculus (only in cord to upper cervical levels) is involved in movements of head required for equilibrium • Tectospinal tract from contralateral superior colliculus Fasciculus proprius • Present in all funiculi immediately adjacent to gray matter • Contains propriospinal fibres which connect different segmental levels of gray matter • Ascend and descend variable lengths and provide functional equivalent of interneurons Dorsal root entry zone • Each dorsal root branches into 6-8 rootlets • Axons segregated into two divisions within each rootlet: lateral and medial • Lateral contains unmyelinated (type C) fibres and enters dorsolateral tract of Lissauer • Medial contains larger, myelinated axons, and enter white matter medial to dorsal horn Vascular anatomy - Arterial • Cord is supplied by multiple radicular arteries, which form the anterior and posterior spinal artery • Radicular arteries arise from adjacent arteries at each vertebral segment – Pass through intervertebral foramina to supply nerve roots, but most do not reach the cord • Larger radicular arteries which also supply cord are called radiculomedullary arteries Vascular anatomy - arterial • Anterior spinal artery originates in upper cervical region, from anterior spinal branches of vertebral artery. • 6-10 anterior radicular arteries contribute to it throughout its length. • Supplies anterior two thirds of cord, via central branches and penetrating branches of pial plexus Vascular anatomy – arterial territories • Cervical and first two thoracic segments of cord are supplied by radicular a. that arise from subclavian a. or branches thereof – High degree of variability • mid-dorsal region of cord (T3-T7) is supplied from radicular a. accompanying T4 or T5 root • T8 to conus supplied by artery of Adamkiewicz Vascular anatomy - Adamkiewicz • Arises from left sided lumbar (segmental) artery in 80% • 85% reaches cord between T9-L2; 15% between T3-T8 (in these cases it is supplemented by a radicular artery arising more inferiorly) • Has large anterior and small posterior branch – Anterior branch ascends, then gives off a small ascending branch and larger descending branch – Descending branch goes inferior (to conus) and makes an anastomotic loop with posterior spinal a. Vascular anatomy – arterial • Cauda equina also supplied by branches from lumbar, iliolumbar, and lateral and median sacral a. Vascular anatomy – posterior spinal artery • Paired arteries • Run along posterolateral cord • Sometimes discontinuous • Originates from verterbral artery • Has contribution from 10-23 posterior radicular a. • Supplies posterior one third of cord Vascular anatomy • Anterior spinal a. gives off central branches and branches to pial plexus • Central branches run in anterior median fissure and supply central cord • Pial plexus is formed from both anterior and posterior spinal a. – Give penetrating branches which supply outer cord • Some overlap between supply of central and pial branches Vascular anatomy - venous • Internal and external vertebral venous plexuses • Form rings around each vertebra • Freely anastomose with each other Vascular anatomy - venous • External plexus has anterior part (anterior to vertebral body) and posterior part (over posterior elements including laminae and spinous processes) • Anterior and posterior parts freely anastomose Vascular anatomy - venous • Internal plexus: anterior part is on each side of PLL, posterior to vertebral body; posterior part is interior to ligamentum flavum • Vertebral body drained by basivertebral veins which enter anterior external plexus Vascular anatomy - venous • Veins of cord mirror related arteries in distribution • Venules drain into anterior and posterior veins, which drain into two median longitudinal veins, and into anterolateral and posterolateral longitudinal veins lying adjacent to the nerve roots • Radicular veins join branches from internal plexus forming intervertebral veins (have valves), which exit intervertebral foramina and join their respective segmental veins