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Anatomy of Spinal Cord
 

Anatomy of Spinal Cord

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    Anatomy of Spinal Cord Anatomy of Spinal Cord Presentation Transcript

    • Anatomy of Spinal Cord
      Dr. E.THIRULOGACHANDAR
      PROF.S.TITO’S UNIT
    • 2. Structure: Grey matter
    • 1.NUCLEUS POSTEROMARGINALIS
      2.SUBSTANTIA GELATINOSA
      3&4.NUCLEUS PROPRIUS DORSALIS
      5.LAMINA5
      6.BASE OF DORSAL HORN
      7.INTERMEDIATE ZONE
      8&9 VENTRAL HORN
    • POSTERIOR COLUMN
      PYRAMIDAL
      TRACT
      SPINOTHALAMIC
      TRACT
    • POSTERIOR
      SENSATION CARRIED
      1.POSITION
      2.VIBRATION
      3.DISCRIMINATIVE TOUCH
      4.TWO POINT DISCRIMINATION
      5.STEROGNOSIS
      COLUMN
    • SPINOTHALAMIC
      TRACT
    • CORTIOCSPINAL
      TRACT
    • Posterior Spinocerebellar Tract
      Originates in thoracic and upper lumbar regions.
      Consists of uncrossed fibers that enter cerebellum through inferior cerebellar peduncles.
      Transmits ipsilateral proprioceptive information to cerebellum.
    • Anterior Spinocerebellar Tract
      Originates in lower trunk and lower limbs.
      Consists of crossed fibers that recross in pons and enter cerebellum through superior cerebellar peduncles.
      Transmits ipsilateral proprioceptive information to cerebellum.
    • Blood Supply of Spinal Cord
    • BLOOD SUPPLY OF SPINAL CORD
    • The spinal cord is supplied by
      1. Anterior spinal artery 2. Posteriorspinalartery3. Spinal branch from the 1st intercostal artery4. Spinal branch from the 11th intercostal artery
      Branches of the vertebral, deepcervical, intercostal, and lumbararteries contribute to three arteries that run the length of the spinal cord; the anterior spinal and the two posterior spinal arteries.
      Anterior spinal artery
      The anterior spinal artery is the larger
      It is a midlineartery – lies on the anterior median fissure
      It is formed at the foramen magnum by union of two arteries onefromeachvertebralartery
      Supplies the spinal cord anterior part namely the lateral columns and the anterior grey and white columns
      The posterior spinal arteries
      One or two on each side – derived from the vertebralartery (or from inferior cerebellar artery) at the level of foramen magnum
      Both the anterior and the posterior spinal arteries descend from the level of the foramen magnum
    • 21 pairs of segmental radicular arteries supply the nerve roots and about half of them contributeto the spinal arteries.
    • The arteries of Adamkiewicz
      Spinal branches (segmental radicular arteries) from the 1st and 11th intercostal arteries are large (T1 & T11)
      They pass along the nerve roots to the spinal cord and reinforce the anterior and posterior spinal arteries
      supplies the lower thoracic and upper lumbar parts of the cord.
      Spinal artery at T1 (Adamkiewicz)
      supplies the cord only downwards
      Spinal artery at T11 (Adamkiewicz)
      supplies the cord both above and below (radicularis magna)
    • Abnormal situation
      e.g. high take off – the iliac artery branch supplies the lower thoracolumbar region of the cord entering through intervertebral foramen of L4-5
    • Horizontal distribution
    • Generally the proportion of flow is greatest from the raducularis magna “feeder” artery to the thracolumbar region. In abnormal situations ( e.g. high take-off) the iliac artery branch may supply the lower thoracolumbar region of the cord entering by way of the intervertebral foramen in the vicinity of L4-5
    • Spinal Veins
      Spinal veins form plexuses anteriorly and posteriorly
      On each side the spinalveins are double, straddling the posterior nerve roots
      All of them draininto
      vertebralveins in the neck,
      azygos veins in the thorax,
      lumbar veins in the lumbar region,
      lateral sacral veins in the sacral region
      through intervertebral foramina
    • Venous Drainage of the Spinal Cord
      This is by 6 irregular, plexiform channels
      .
      There is one along the anterior and posterior midlines;
      Along the line of attachment of the dorsal roots of each side;
      Along the line of attachment of the ventral roots of each side.
      These are drained by the radicular veins.
      Each, in turn empty into the epidural venous plexus.
    • APPROACH TO SPINAL CORD DISEASES
      Patient symptoms –motor, sensory ,autonomic
      Clinical examination –motor ,sensory and reflex level
      Investigations-CSF analysis, CT ,MRI,MRA,CT myelogram,EMG &NCS
    • MOTOR SYSTEM
      -stiffness of legs and tripping of toes –s/o UMN lesion
      -buckling of knees ,wasting or fasciculations –s/0 LMN lesion
      -UMN signs will be below the level of lesion-hypertonia ,spasticity ,clonus ,brisk reflexes .pl.extensor
      -LMN signs –muscle wasting ,fasciculations sensory loss ,tender muscles ,
    • UMN signs –early with extramedullarylesions,late with intramedullary lesions
      Both UMN,LMN signs –with intramedullarylesions,MND,
      Symmetrical upper and lower girdle muscle involvement with myalgia-inflm.myopathies
      Asymmetrical distal and proximal muscle involvement –inlcusion body myositis
      Delayed relaxation of muscles,-myotonic disorders
      Episodic attacks of flaccid weakness –hypokalemic periodic paralysis
    • SENSORY SYSTEM
      --radicular pain-lancinatingdermatomal pain ,increased by cough, sneeze ,common with extradural lesions
      --vertebral pain ,aching ,localised to spine involved –neoplastic or inflammatory extradural lesions
      --funicular pain-deep ,illdefineddysaesthesia,due to intra-medullary lesions
    • Spinal cord-loss of pain&temp. over the opp.side,if AL funiculus involved
      -loss of position ,vibration sense if dorsal funiculus involved
      -sacral sparing if lesion is deep
      Dorsal root-radicular pain &sensory loss over the dermatome
      Dorsal root ganglion –diffuse pansensoryloss,with sensory ataxia
      Peripheral neuropathy-paresthesia,tingling sensation ,over the distribution without sensory loss
      Polyneuropathy-distal symm.sensory loss
    • Descending progression of paresthesia –intramedullary lesion
      Ascending progression of paresthesia –extramedullary lesions
      Definite sensory level of pain and temp.- extramedullary lesions(Brown-sequard)
      Dissociated sensory loss - intramedullary lesion
    • FORAMEN MAGNUM
      Lhermitte sign
      Spastic quadriparesis
      Long tract sensory signs
      Bladder disturbance
      9-12 cranial nerve inovlvement
      Elsberg phenomenon
      Downbeat nystagmus ,papilledema ,cerebellar ataxia
      EXAMPLES-meningioma,NF,glioma,syrinx ,MS,
    • LEVEL C7
      Diaphragm spared ,
      Biceps and supinator jerk preserved
      Finger flexor reflex exagg.
      Paradoxical triceps reflex
      Sensory loss over C7 dermatome
    • THORACIC SEGMENTS
      Paraplegia and sensory loss below the thoracic level;
      Bladder bowel and sexual dysfunction;
      If lesion above T6,supf.abdominal reflex(-)
      Lesion at T10 –BEEVOR’S SIGN
    • LEVEL L2
      Spastic paraparesis
      No weakness of abdominal muscles
      (--)cremasteric reflex
      Knee jerk depressed ,
      Ankle jerk exagg.
    • LEVEL S1,S2
      Ankle jerk (--)
      Knee jerk present
      Sensory loss over sole, heel &outer aspect of the foot
    • CONUS MEDULLARIS LESION
      Paralysis of pelvic floor muscles
      Symmetrical saddle anesthesia
      Autonomous neurogenic bladder-loss of voluntary initiation ,inc.residual urine &
      (-)bladder sensation
      Constipation ,impaired erection and ejaculation
    • CAUDA EQUINA LESION
      Early radicular pain ,
      Asymmetrical sensory loss
      Asymmetrical LMN type of paralysis
      Late bladder involvement
      (--)ankle jerk
    • THANK YOU