The Spinal cord

presented by : Vinod BPT 3rd year Roll no : 0071052607

Spinal cord
Lower part of CNS which establish contact between the brain in the cranial cavity and the peripheral end organ

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introduction
It is lower elongated , cylindrical part of CNS It is 45cm long and extends from the level of the atlas to the lower border of the vertebra L1 Lower end is conical called conus medullaris The apex of the conus is continued down as filum terminale It occupies the upper 2/3rd of the vertebral canal of the vertebral column and is surrounded by the menings , the dura mater , the arachnoid mater and pia mater
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Introduction contd…
Further protected by CSF which surrounds the spinal cord in the subarchnoid space Two thickening along the length of spinal cord is cervical and lumber enlargement Spinal cord gives off 31 pairs of spinal nerves Vertebral spine is lower than the spinal segment

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Diagram showing spinal cord

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Menings:

Drua mater Arachnoid membrane Pia mater
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Spinal cord structure
T.S. of spinal cord shows : ∞ H shaped grey matter ∞ white matter Grey matter is divisible by: ∞ The anterior grey column ∞ The posterior grey column ∞ The lateral grey column Grey matter of the right and left half is connected by grey commissure which is traverse by the central canal

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Spinal cord structure contd….
White matter is divisible by : ∞ In front by a deep anterior median fissure ∞ Behind by posterior median septum In each half white matter is divided in to i. The posterior white column ii. The lateral white column iii. The anterior white column The white matter of the right and left sides is continuous across the midline the white commisure Spinal nerve arise by two roots :
i. ii. Anterior or ventral Posterior or dorsal
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The Sectional Organization of the Spinal Cord

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The Sectional Organization of the Spinal Cord

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T.S. of Spinal cord & spinal nerves

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Nuclei of spinal cord
Nuclei in Anterior Grey Horn a) Medial group b) Lateral group i. Anterolateral ii. Posterolateral iii. Post posterolateral c) Central group Nuclei in lateral horn i. Intermediolateral nucleus ii. Intermediomedial nucleus Nuclei in Posterior Grey column i. Postromarginal nucleus ii. Substantia gelatinosa iii. Nucleus proprius iv. Nucleus dorsalis

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Laminar organisation of spinal cord
Ten layer of neuron known as laminae of Raxed Numbered by Roman numerals
Lamina I ------- posteromarginal nucleus Lamina ii------- substantia gelatinosa Lamina iii & iv---- nucleus proprius Lamina v & vi ---- base of dorsal column Lamina vii -------- intermediolateral, intermediomedial and nucleus proprius Lamina viii ------- ventral horn in thoracic segment Lamina ix --------- lateral group of nuclei of the ventral horn Lamina x ---------- surrounds the central canal

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Nuclei and laminae of spinal cord

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Difference of spinal cord at different spinal segment
Spinal segment
Cervical

Shape

White matter
Fasciculus cuneatus and F. gracilis present

Anterior gray column
Medial group of cells for neck muscles; central group of cells for assessory nucleus & phrenic nucleus Medial group of cells for trunk muscles

Posterior gray column
Substantia gelatinosa present , nucleus proprius present: nucleus dorsalis absent Substantia gelatinosa nucleus proprius nucleus dorsalis , & viceral afferent present

Lateral gray column
Absent

Oval

Thoracic

Round

Fasciculus cuneatus and F. gracilis present

Present , give rise to pre ganglionic sympathatic fibers

lumber

Round to oval

Fasciculus cuneatus absent F. gracilis present Small amount of F. cuneatus absent , F. gracilis present

Medial group of cells for lower limb muscles ; central group of muscles for lumbosacral nerve Medial group of cells for lower limb muscles and perineal muscles

-do-

-do-

Sacral

round

Substantia gelatinosa , nucleus proprius present

absent

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Difference of spinal cord at different spinal segment

cervical enlargement (C8)

thoracic cord (T8)

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lumbal enlargement (L3)

sacral cord (S1)

Tracts
Ascending tracts Descending tract

1) 2) 3) 4) 5) 6)

7) 8)

Lateral spinothalmic tract Anterior spinothalmic tract Faciculus gracilis Faciculus cuneatus Dorsal or posterior spinocerebellar tract Ventral or anterior spinocerebellar tract Spino- olivery tract Spinotectal

A. Pyramidal or corticospinal tract B. Extrapyramidal tracts
1) Rubrospinal tract 2) Medial & lateral Reticulospinal tract 3) Olivospinal tract 4) Vestibulospinal tract 5) Tectospinal tract

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Structure showing tracts
Descending tracts Ascending tracts

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Reflex arc
Definition: It may be defined as an involuntary response to a stimulus It consist of
1) A receptor organ : situated in skin , muscles , or tendon 2) An afferent neuron : the cell body is located in the posterior root ganglion and the central axon of the first order neuron 3) An effector neuron 4) An effector organ

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Reflex arc contd…
Five steps
a) Arrival of stimulus and activation of receptor b) Activation of sensory neuron c) Information processing d) Activation of motor neuron e) Response by effector

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Component of reflex arc

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Classification of reflex

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Law of Reciprocal inhibition
It states that the flexor and extensor reflexes of the same limb can’t be made to contract simultaneously

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The Flexor and Crossed Extensor Reflexes

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Peripheral nerve distribution of spinal cord
31 pairs spinal nerve Nerves consist of:
a. Epineurium : b. Perineurium c. Endoneurium

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Peripheral Distribution of Spinal Nerves

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Peripheral Distribution of Spinal Nerves

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Nerve plexus
Cervical plexus Brachial plexus Lumbar plexus Sacral plexus

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cervical plexus

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Brachial plexus

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Brachial plexus

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Lumber and sacral plexus

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Lumber and sacral plexus

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Blood supply of spinal cord
Arteries of spinal cord
Two posterior artery : Supply the dorsal 1/3 spinal cord One anterior artery : Supply the ventral 2/3 spinal cord Segmental arteries

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Blood supply of spinal cord

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Posterior spinal arteries
Arise either directly by vertebral arteries inside the skull or indirectly from posterior inferior cerebellar arteries Supply posterior 1/3rd of spinal cord Posterior spinal arteries are small in the upper thoracic region & first three thoracic segment of the spinal cord are particularly vulnerable to ischemia

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Anterior spinal Arteries
It is formed by the union of two arteries Each of which arises from the vertebral artery inside the skull Descend on the anterior surface of the spinal cord with in the anterior median fissure Anterior spinal arteries may be extremely small

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Segmental spinal arteries

Segmental arteries
Spinal branch
Anterior radicular artery Posterior radicular artery Posterior Spinal Artery
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Anterior Spinal Artery

Segmental spinal Arteries
Additional feeder arteries enter the vertebral canal and anastomose with the size of these vary considerably from one individual to another One large and important artery, the great anterior medullary artery of Adamkiewicz arise from the aorta in the lower thoracic or upper lumbar vertebral levels

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Spinal cord function
Function : A. Sensory function
i. in the dorsal column of same side which covers fine touch , tectile localiszation & discriminination, pressure ,proprioception and kinesthetic sensation In the spinothalmic tract of opposite; anterior tract conveys gross touch and tectile localization whereas lateral tract conveys pain & temp sensatin the tone and power of the muscles The movements of the muscle and joints Deep reflexes The superficial reflexes The body temp. The viceral function

ii.

B. motor function
1) 2) 3) 4) i. ii.

C. Autonomic function
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Spinal tap(lumbar puncture)
Spinal tap may be performed…..
to withdraw a sample of CSF fluid for microscopic or bacteriological examination or to inject drugs or induce anaesthesia

A needle introduced into the vertebral canal above and below the forth lumbar spine i.e. L3-L4 or L4-L5

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The needle pass through the following structure
1) Skin 2) Superficial facia 3) Supraspinous ligament 4) Interspinous ligament 5) Ligamentum flavum 6) Areolar tissue 7) Dura mater 8) Arachnoid mater The depth to which the needle introduce is 1 inch or 2.5 cm , in obese it may be 4 inch or 10 cm
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Lumbar puncture site

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Lumbar puncture

Site of lumbar puncture

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CSF pressure may be measure by attaching a manometer Normal pressure is about 60 to 150mm of water

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Transection of the spinal cord
3 types
A. Complete B. Incomplete C. hemisection

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Complete transection of the spinal cord
Causes
1) 2) 3) Gun shot injury Dislocation of spine Occlusion of the blood vessels

Commonest site is at the thoracic level Clinical states
a. b. Stage of spinal shock or flaccid paralysis Stage of reflex activity

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Stage of spinal shock or flaccid paralysis
Characterstic feature
1. Isolating segment of the spinal cord have lost their functions therfore muscle complete paralysed (flaccid paralysis) 2. Muscle tone is completely lost 3. All reflexes are markedly lost or decreased 4. All the sensation below the transection 5. The urinary bladder and rectum are gernally paralysed.

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Stage of reflex activity
Autonomic reflexes : with in days or week of cords transection , spinal sympathetic cell bodies appear to recover some tonic discharge, and moreover , are capable of responding by increased activity to noxious stmulation Muscle tone : Reflex movement
i. ii. iii. Flexor reflex or withdrawal reflex Mass reflex Deep reflex

Coitus (sexul) reflex
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Incomplete transection of the spinal cord
Stage of spinal shock Stages of reflex activity
Characterstics feature
1. All features of upper motor neuron lesion 2. Involuntary movement 3. Reflex movement
i. Extensor thrust reflex lost ii. Crossed extensor reflex iii. Phillipson’s reflex

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Hemisection of spinal cord contd…
Brown sequard syndrome
Lesion involving one lateral half of the spinal cord Changes below the level of hemisection

On the same side
1. Sensory changes i. Sense of movement and position is lost ii. Pain , temp. and crude touch remain unaffected 2. Motor changes i. Extensive paralysis of UMN ii. Temporary loss of vasomotor tone
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Hemisection of spinal cord contd…
On the opposite side 1. Sensory changes
i. Complete loss of pain ,temp. and crude touch ii. Kinesthetic sensation , fine touch remain unaffected

2.Motor changes
i. Either no paralysis or paralysis of few muslce occur Therefore , below the level of lesion on the same side there is extensive motor loss but little sensory loss while on the other side there is extensive sensory loss 55

Hemisection of spinal cord contd…
Changes at the level of hemisection On the same side
1. Sensory changes : complete anaestheia occurs 2. Motor changes 1. Complete lower motor neuron type paralysis 2. Complete and permanent vasomotor paralysis

On the opposite side
1. Sensory changes : some loss of pain sensation 2. Motor changes : nil

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Hemisection of spinal cord contd…
Changes above the level of the hemisection On the same side hyperaesthesia present On the opposite side hyperaesthesia may be referred

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Regional peculiarities
Hemisection in the cervical region
i. ii. Constriction of pupil on same side (T1,2,3) Loss of biceps triceps and supinater and pronater jerks (C4,5,6) iii. Paralysis of diaphragm on the same side (C3,4,5)

Hemi section in the lumber region
i. i. Loss of knee jerk (L3,4) Loss of control over the spincters of the urinary bladder and anus
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Hemisection in the lumberosacral region

Sensory disturbances
SYRINGOMYELIA :
involving the grey matter round to the central canal of the spinal cord in which excessive growth of neuroglial tissue occur with cavity formation

Charcteristic feature
1. Loss of pain and temp. sense 2. Touch sense is retained 3. At the level of lesion initially gliosis and cavitation spread and involve the ant. Horn cells producing paralysis of muscles ( usually hand)
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TABES DORSALIS:
– Syphilis of the spinal cord characterized by
degeneration of sensory neurons and stabbing pains in the trunk and legs and unsteady gait and incontinence and impotence

Characterstic feature
1. Lightning pain of varying Intensity 2. Loss or decrease in pain sensibility 3. Loss of deep sensibility i.e. loss of position sense . Passive movt. and vibration sense 4. DTR lost 5. Marked disturbance of voluntary movt.

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DEAFFERENTATION : section of dorsal nerve root 1. Loss of all form of sensation such as pain , temp, touch, muscles and viseral sensibility 2. Loss of all reflexes 3. Marked weakness in the movement of the part

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DISSEMINATED SCLEROSIS
• A chronic progressive nervous disorder involving loss of myelin sheath around certain nerve fibers

Characteristic feature
1. Demylinated disease of CNS which produce sensory and motor disturbances 2. Crippling disease asociated with delayed or block conduction in the demylinated axons 3. Sign and symptoms manifest A/c to the ascending and descending pathway involved
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Subacute combined degeneration of the spinal cord
This condition is associated with demylination of white fibers of the spinal cord affecting in the dosal columns and later lareral columns

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References
Richard S. Snell, clinical neurology, p135-162,

p476-477, p81
BDC Human anatomy volume 3, p309-316, p383 A.K. jain Textbook of physiology, p874, p958-963 www.google.co.in , for diagram

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