Anatomy of Spinal Cord

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Anatomy of Spinal Cord

  1. 1. Anatomy of Spinal Cord<br /> Dr. E.THIRULOGACHANDAR <br />PROF.S.TITO’S UNIT <br />
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  6. 6. 2. Structure: Grey matter<br />
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  8. 8. 1.NUCLEUS POSTEROMARGINALIS<br />2.SUBSTANTIA GELATINOSA<br />3&4.NUCLEUS PROPRIUS DORSALIS<br />5.LAMINA5<br />6.BASE OF DORSAL HORN <br />7.INTERMEDIATE ZONE<br />8&9 VENTRAL HORN<br />
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  11. 11. POSTERIOR COLUMN<br />PYRAMIDAL<br />TRACT<br />SPINOTHALAMIC<br />TRACT<br />
  12. 12. POSTERIOR<br />SENSATION CARRIED<br />1.POSITION<br />2.VIBRATION<br />3.DISCRIMINATIVE TOUCH<br />4.TWO POINT DISCRIMINATION<br />5.STEROGNOSIS<br />COLUMN<br />
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  15. 15. SPINOTHALAMIC<br />TRACT<br />
  16. 16. CORTIOCSPINAL<br />TRACT<br />
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  18. 18. Posterior Spinocerebellar Tract<br />Originates in thoracic and upper lumbar regions.<br />Consists of uncrossed fibers that enter cerebellum through inferior cerebellar peduncles.<br />Transmits ipsilateral proprioceptive information to cerebellum.<br />
  19. 19. Anterior Spinocerebellar Tract<br />Originates in lower trunk and lower limbs.<br />Consists of crossed fibers that recross in pons and enter cerebellum through superior cerebellar peduncles.<br />Transmits ipsilateral proprioceptive information to cerebellum.<br />
  20. 20. Blood Supply of Spinal Cord<br />
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  22. 22. BLOOD SUPPLY OF SPINAL CORD<br />
  23. 23. The spinal cord is supplied by<br /> 1. Anterior spinal artery 2. Posteriorspinalartery3. Spinal branch from the 1st intercostal artery4. Spinal branch from the 11th intercostal artery<br />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.<br />Anterior spinal artery<br />The anterior spinal artery is the larger<br />It is a midlineartery – lies on the anterior median fissure<br />It is formed at the foramen magnum by union of two arteries onefromeachvertebralartery<br />Supplies the spinal cord anterior part namely the lateral columns and the anterior grey and white columns<br />The posterior spinal arteries<br />One or two on each side – derived from the vertebralartery (or from inferior cerebellar artery) at the level of foramen magnum<br />Both the anterior and the posterior spinal arteries descend from the level of the foramen magnum<br />
  24. 24. 21 pairs of segmental radicular arteries supply the nerve roots and about half of them contributeto the spinal arteries.<br />
  25. 25. The arteries of Adamkiewicz<br />Spinal branches (segmental radicular arteries) from the 1st and 11th intercostal arteries are large (T1 & T11)<br />They pass along the nerve roots to the spinal cord and reinforce the anterior and posterior spinal arteries<br />supplies the lower thoracic and upper lumbar parts of the cord.<br />Spinal artery at T1 (Adamkiewicz)<br />supplies the cord only downwards<br />Spinal artery at T11 (Adamkiewicz)<br />supplies the cord both above and below (radicularis magna)<br />
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  27. 27. Abnormal situation<br /> e.g. high take off – the iliac artery branch supplies the lower thoracolumbar region of the cord entering through intervertebral foramen of L4-5<br />
  28. 28. Horizontal distribution<br />
  29. 29. 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<br />
  30. 30. Spinal Veins<br />Spinal veins form plexuses anteriorly and posteriorly<br />On each side the spinalveins are double, straddling the posterior nerve roots<br /> All of them draininto<br />vertebralveins in the neck, <br />azygos veins in the thorax,<br />lumbar veins in the lumbar region, <br />lateral sacral veins in the sacral region<br /> through intervertebral foramina<br />
  31. 31. Venous Drainage of the Spinal Cord<br />This is by 6 irregular, plexiform channels<br />.<br />There is one along the anterior and posterior midlines;<br />Along the line of attachment of the dorsal roots of each side;<br />Along the line of attachment of the ventral roots of each side.<br />These are drained by the radicular veins.<br />Each, in turn empty into the epidural venous plexus.<br />
  32. 32. APPROACH TO SPINAL CORD DISEASES <br />Patient symptoms –motor, sensory ,autonomic<br />Clinical examination –motor ,sensory and reflex level <br />Investigations-CSF analysis, CT ,MRI,MRA,CT myelogram,EMG &NCS<br />
  33. 33. MOTOR SYSTEM<br /> -stiffness of legs and tripping of toes –s/o UMN lesion <br /> -buckling of knees ,wasting or fasciculations –s/0 LMN lesion <br /> -UMN signs will be below the level of lesion-hypertonia ,spasticity ,clonus ,brisk reflexes .pl.extensor<br /> -LMN signs –muscle wasting ,fasciculations sensory loss ,tender muscles ,<br />
  34. 34. UMN signs –early with extramedullarylesions,late with intramedullary lesions<br />Both UMN,LMN signs –with intramedullarylesions,MND,<br />Symmetrical upper and lower girdle muscle involvement with myalgia-inflm.myopathies<br />Asymmetrical distal and proximal muscle involvement –inlcusion body myositis<br />Delayed relaxation of muscles,-myotonic disorders <br />Episodic attacks of flaccid weakness –hypokalemic periodic paralysis<br />
  35. 35. SENSORY SYSTEM<br /> --radicular pain-lancinatingdermatomal pain ,increased by cough, sneeze ,common with extradural lesions <br /> --vertebral pain ,aching ,localised to spine involved –neoplastic or inflammatory extradural lesions <br /> --funicular pain-deep ,illdefineddysaesthesia,due to intra-medullary lesions <br />
  36. 36. Spinal cord-loss of pain&temp. over the opp.side,if AL funiculus involved <br /> -loss of position ,vibration sense if dorsal funiculus involved <br /> -sacral sparing if lesion is deep <br />Dorsal root-radicular pain &sensory loss over the dermatome<br />Dorsal root ganglion –diffuse pansensoryloss,with sensory ataxia <br />Peripheral neuropathy-paresthesia,tingling sensation ,over the distribution without sensory loss <br />Polyneuropathy-distal symm.sensory loss<br />
  37. 37. Descending progression of paresthesia –intramedullary lesion <br />Ascending progression of paresthesia –extramedullary lesions<br />Definite sensory level of pain and temp.- extramedullary lesions(Brown-sequard)<br />Dissociated sensory loss - intramedullary lesion <br />
  38. 38. FORAMEN MAGNUM<br />Lhermitte sign <br />Spastic quadriparesis<br />Long tract sensory signs<br />Bladder disturbance <br />9-12 cranial nerve inovlvement<br />Elsberg phenomenon<br />Downbeat nystagmus ,papilledema ,cerebellar ataxia<br />EXAMPLES-meningioma,NF,glioma,syrinx ,MS, <br />
  39. 39. LEVEL C7<br />Diaphragm spared ,<br />Biceps and supinator jerk preserved <br />Finger flexor reflex exagg.<br />Paradoxical triceps reflex<br />Sensory loss over C7 dermatome<br />
  40. 40. THORACIC SEGMENTS <br />Paraplegia and sensory loss below the thoracic level;<br />Bladder bowel and sexual dysfunction;<br />If lesion above T6,supf.abdominal reflex(-)<br />Lesion at T10 –BEEVOR’S SIGN<br />
  41. 41. LEVEL L2<br />Spastic paraparesis<br />No weakness of abdominal muscles <br />(--)cremasteric reflex<br />Knee jerk depressed ,<br />Ankle jerk exagg.<br />
  42. 42. LEVEL S1,S2<br />Ankle jerk (--)<br />Knee jerk present <br />Sensory loss over sole, heel &outer aspect of the foot<br />
  43. 43. CONUS MEDULLARIS LESION <br />Paralysis of pelvic floor muscles <br />Symmetrical saddle anesthesia <br />Autonomous neurogenic bladder-loss of voluntary initiation ,inc.residual urine &<br /> (-)bladder sensation <br />Constipation ,impaired erection and ejaculation <br />
  44. 44. CAUDA EQUINA LESION <br />Early radicular pain ,<br />Asymmetrical sensory loss <br />Asymmetrical LMN type of paralysis<br />Late bladder involvement<br />(--)ankle jerk<br />
  45. 45. THANK YOU <br />

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