SPINAL CORD

Dr. Sabeen Akbar Yezdani

TRACTS OF SPINAL CORD
ASCENDING TRACTS
 ASCENDING TRACTS
Dorsal Column/ Medial Lemniscal Pathway---- pressure, vibration,
discriminative touch & conscious proprioception.

Dorsal Spinocerebellar---- uncrossed unconscious muscle sense from

lower extremities and lower trunk.

Ventral Spinocerebellar----crossed unconscious muscle sense

Cuneocerebellar tract----- proprioceptive input to cerebellum from

upper extremeties & upper trunk

Lateral Spinothalamic----pain and temperature (crossed)

Ventral Spinothalamic----crude touch and pressure
DESCENDING TRACT
1. PYRAMIDAL TRACTS: These tracts originate in the cerebral cortex,
carrying motor fibers to the spinal cord and brain stem. They are responsible
for the voluntary control of the musculature of the body and face..
Corticospinal fibers originate from following nerve cells in cerebral cortex.
Primary Motor Cortex: 30%
Premotor & Supplementary motor area: 30%
Somatic sensory area: 40%
2. EXTRAPYRAMIDAL TRACTS: These tracts originate in the brain
stem, carrying motor fibers to the spinal cord. They are responsible for the
involuntary and automatic control of all musculature, such as muscle tone,
balance, posture and locomotion. These include:
1.Rubrospinal
2.Vestibulospinal
3. Reticulospinal
4. Tectospinal
LESIONS OF SPINAL CORD

COMPLETE TRANSECTION
Dorsal Column/Medial Lemniscal Pathway
Spinothalamic/ Anterolateral System
UPPER MOTOR NEURON LESION LOWER MOTOR NEURON
LESION

Spastic Paralysis Flaccid Paralysis

Large area of body involved Small area of body involved
Hyperreflexia Areflexia

Babinski sign present Babinski sign absent

Clasp Knife reflex Decreased Muscle tone/ Atonia

Increased muscle tone Fasciculation

Deficits are contralateral/ ipsilateral & Deficit is Ipsilateral & AT the level of
BELOW the lesion the lesion
Decrease speed of voluntary movement Loss of voluntary movement

Disuse atrophy of muscle Atrophy of muscles

LESIONS OF SPINAL CORD

INCOMPLETE TRANSECTION
 BROWN-SÉQUARD SYNDROME
An incomplete spinal cord
lesion characterized by a
clinical picture reflecting
hemi section injury of the
spinal cord, often in the
cervical cord region.
Patients suffer from
ipsilateral upper motor
neuron paralysis and loss of
proprioception, as well as
contralateral loss of pain and
temperature sensation.
BROWN-SÉQUARD SYNDROME
 STAGE OF SPINAL SHOCK
1. MOTOR EFFECTS:
 Flaccid paralysis below level of lesion
 Absence of reflexes – AREFLEXIA
2. SENSORY EFFECTS:
 Loss of sensation below the level of lesion.
3. VISCERAL EFFECTS:
 Retention of urine
 Constipation
 Blood pressure drops ( depending on the site of lesion as sympathetic
fibers leave spinal cord between T1 & L2).
 Bed sores may develop.
 STAGE OF REFLEX ACTIVITY
 After about 3 weeks period, reflex activity begins to return to the
segments below the level of lesion.
1. SMOOTH MUSCLE regain function. i.e. the Bladder becomes
automatic, even defecation reflex is established.
2. Sympathetic tone of blood vessels is regained which leads to
blood pressure is restored to normal.
3. SKELETAL MUSCLE Tone recovers slowly after 3-4 weeks.
4. Reflex activity returns after few weeks of muscle tone:
FLEXOR reflex returns first. EXTENSOR reflex returns after
1-5 weeks of appearance of flexor reflex.
5. MASS REFLEX can be elicited in some cases by scratching
skin over abdominal wall.
 STAGE OF REFLEX FAILURE

The failure of reflex activity may occur when general

condition of the patient starts detoriating.
 INCOMPLETE TRANSACTION OF
SPINAL CORD

1. STAGE OF SPINAL SHOCK

2. STAGE OF RELEX ACTIVITY:
Tone appears first in EXTENSOR muscles.
Extensor reflex (stretch reflex appears first) & flexor reflex
reappear later.
Mass discharge is not elicited.
3. STAGE OF REFLEX FAILURE
 MASS REFLEX
 After spinal injury at times the spinal cord becomes excessively
active due to a painful stimulus or overdistention of bladder or
gut.
 Effects are:
1. Strong flexor spasm
2. Bladder & colon evacuation.
3. Raised arterial pressure
4. Profuse sweating
MOTOR FUNCTION OF SPINAL CORD
 MOTOR NEURONS IN SPINAL CORD
1. Alpha motor neurons: largest neurons & are responsible for
contraction of muscles in upper limb, trunk & lower part of body.

2. Gamma motor neurons: these innervate the intrafusal fibers of muscle

spindle & are responsible for maintenance of muscle tone.

3. Interneurons: receive the bulk of synaptic input either from incoming

sensory information or descending motor commands from higher
centers.

4. Renshaw cells: are INHIBITORY INTERNEURONS that receive

input from collateral branches of alpha motor neurons & also carry
impulses to surrounding motor neurons.
 MUSCLE SENSORY RECEPTORS

1. MUSCLE SPINDLE: skeletal muscle sensory

receptors within the body of a muscle & are responsible for
conveying information to the CNS about absolute MUSCLE
LENGTH & CHANGES IN MUSCLE LENGTH. Spindles play
an important role in motor control and are used to help regulate
muscle length during movement.

2. GOLGI TENDON ORGAN: are sensitive to CHANGES

IN TENSION AND RATE OF TENSION. Located in the
musculo-tendinous junctions, they are responsible for sending
information to the brain as soon as they sense an overload.
 MUSCLE SPINDLE
 Each muscle spindle consists of upto 10 muscle fibers (INTRAFUSAL)
enclosed in a connective tissue sheath.
 Two types of fibers:
1. Nuclear bag: approx 2/spindle.
2. Nuclear chain: approx 4/spindle.

 Sensory Nerve Endings/ Afferents:

1. Primary (Annulospiral )endings: group Ia- afferent fibers. Innervate both
nuclear bag & chain fibers.
2. Secondary (Flowerspray) endings: group II sensory fibers. Present near the
ends of intrafusal fibers but only on nuclear chain fibers.

 Motor/ Efferent supply:

 γ- efferents, constitute 30% of fibers in ventral root. Two types of endings:
1. Plate endings: on nuclear bag fibers
2. Trail endings: on nuclear chain fibers.
Muscle spindles are STRETCH RECEPTORS within the body
of a muscle that primarily detect changes in the length of the
muscle. They convey length information to the CNS via afferent
nerve fibers.
MUSCLE SPINDLE
 FUNCTION OF MUSCLE SPINDLE
 Afferents are stimulated when spindle is stretched. They respond to
both changes in length and changes in the rate of stretch.

1. Dynamic response: nerves ending in NUCLEAR BAG fibers

show dynamic response i.e. they discharge more rapidly while the
muscle is being stretched & less rapidly during sustained stretch.
Only PRIMARY ENDINGS are involved.

2. Static response: nerves ending on NUCLEAR CHAIN fibers

show static response i.e. they discharge at an increased rate
throughout the period when a muscle is stretched. Both PRIMARY
& SECONDARY endings are involved.
 FUNCTION OF MUSCLE SPINDLE

 Stimulation of γ efferents cause the intrafusal fibers to

shorten, stretching the nuclear bag portion of the spindle,
initiating an impulse in Ia fibers through annulospiral
endings. ------- reflex contraction of muscle.
 Increased γ efferents discharge----- increases spindle
sensitivity.
 Stimulation of dynamic efferents increases spindle sensitivity
to the rate of change of stretch.
 Stimulation of static efferents increases spindle sensitivity to
steady maintained stretch.
 GOLGI TENDON ORGAN
 An encapsulated sensory receptor through which 10-15 muscle
fibers pass. It is stimulated by tension produced by this small
bundle of muscle fibers.
 Stimulated both by passive stretch & active contraction of
muscle. Detects muscle tension.
 Has both a dynamic & static response.
 Sensory innervation: Ib group of fibers, which end in spinal
cord on a single inhibitory interneurons, which in turn terminate
directly on motor neurons and produce an IPSP.
 This reflex provides a Negative Feedback…. Tension on muscle
becomes extreme----inhibitory effect of tendon organ leads to---
instantaneous relaxation of entire muscle----- LENGTHNING
REACTION.
GOLGI TENDON ORGAN
SPINAL REFLEXES
A spinal reflex is a sensory-motor nerve
pathway that occurs completely independent
of the brain.
REFLEX ARC
 CLASSIFICATION OF REFLEXES

1. MONOSYNAPTIC REFLEX: Stretch reflex –Myotatic

reflex (biceps, triceps, knee jerk).

2. POLYSYNAPTIC REFLEX: Withdrawal reflex, crossed

flexor reflex, crossed extensor reflex.
 CLASSIFICATION OF REFLEXES

 FLEXOR REFLEX: occur in response to nociceptive(pain)

stimuli & are characterized by flexion of joints. Also called
WITHDRAWL REFLEXES.

 EXTENSOR REFLEX: STRETCH reflexes are extensor reflexes.

They are the basis of muscle tone & posture of body. Also called
ANTIGRAVITY REFLEXES.
 MONOSYNAPTIC REFLEX

Reaction Time: Time between the application of stimulus &

the response. The reaction time for a stretch reflex is 19-24ms.

Central Delay: Time taken for the reflex activity to traverse

the spinal cord. For monosynaptic reflex it is 0.6-0.9ms.
STRETCH REFLEX
 INVERSE STRETCH REFLEX

 RECIPROCAL INNERVATION: Impulses in the Ia fibers

from muscle spindles of protagonist muscle cause postsynaptic
inhibition of motor neurons to the antagonists i.e. when a
stretch reflex occurs the muscle opposing the action of the
muscle involved, relaxes.
 INVERSE STRETCH REFLEX OR AUTOGENIC
INHIBITION: Relaxation is response to strong stretch. When
the tension becomes great enough, contraction suddenly ceases
& muscle relaxes. Receptor is Golgi tendon organ.
FLEXOR REFLEX
 FLEXOR REFLEX
 Shows:
1. Diverging Circuit: spread the reflex to necessary muscles
for withdrawal.
2. Reciprocal inhibition circuits: to inhibit the antagonist
muscles.
3. After-discharge: causes prolonged continuous after- discharge
after
stimulus is removed.
 Flexor reflex shows LOCAL SIGN i.e. the integrative centers of
cord causes all those muscles to contract that are needed to remove
the pained part of the body from the stimulus.
 CROSSED EXTENSOR REFLEX

 About 0.2-0.5 sec after a stimulus causes flexor reflex in one

limb, the other limb begins to extend.
 The crossed extensor reflex involves many interneurons &
continues for an even longer period of after-discharge,
 AUTONOMIC REFLEXES

1. Changes in vascular
tone
2. Sweating
3. Intestinointestinal
4. Peritoneointestinal
5. Evacuation
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