+ All Categories
Home > Documents > Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways...

Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways...

Date post: 21-Jun-2020
Category:
Upload: others
View: 7 times
Download: 0 times
Share this document with a friend
30
Spinal Cord
Transcript
Page 1: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Spinal Cord

Page 2: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Spinal Cord• Runs through the vertebral canal

• Extends from foramen magnum to second lumbar vertebra

• Regions

– Cervical

– Thoracic

– Lumbar

– Sacral

– Coccygeal

• Gives rise to 31 pairs of spinal nerves

– All are mixed nerves

• Not uniform in diameter

– Cervical enlargement: supplies upper limbs

– Lumbar enlargement: supplies lower limbs

• Conus medullaris- tapered inferior end

– Ends between L1 and L2

• Cauda equina - origin of spinal nerves extending inferiorly from conus medullaris.

Page 3: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Meninges• Connective tissue membranes

– Dura mater: outermost layer; continuous with

epineurium of the spinal nerves

– Arachnoid mater: thin and wispy

– Pia mater: bound tightly to surface

• Forms the filum terminale

– anchors spinal cord to coccyx

• Forms the denticulate ligaments that attach the

spinal cord to the dura

• Spaces

– Epidural: external to the dura

• Anesthestics injected here

• Fat-fill

– Subdural space: serous fluid

– Subarachnoid: between pia and arachnoid

• Filled with CSF

Page 4: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Cross Section

of Spinal Cord

• Anterior median fissure and posterior median sulcus

– deep clefts partially separating left and right halves

• Gray matter: neuron cell bodies, dendrites, axons

– Divided into horns

• Posterior (dorsal) horn

• Anterior (ventral) horn

• Lateral horn

• White matter

– Myelinated axons

– Divided into three columns (funiculi)

• Ventral

• Dorsal

• lateral

– Each of these divided into sensory or motor tracts

Page 5: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Cross section of Spinal Cord

• Commissures: connections between left

and right halves

– Gray with central canal in the center

– White

• Roots

– Spinal nerves arise as rootlets then

combine to form dorsal and ventral

roots

– Dorsal and ventral roots merge

laterally and form the spinal nerve

Page 6: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Organization of Spinal Cord Gray

Matter

• Recall, it is divided into horns

– Dorsal, lateral (only in thoracic region), and ventral

• Dorsal half – sensory roots and ganglia

• Ventral half – motor roots

• Based on the type of neurons/cell bodies located in each horn, it is specialized further into 4 regions

– Somatic sensory (SS) - axons of somatic sensory neurons

– Visceral sensory (VS) - neurons of visceral sensory neur.

– Visceral motor (VM) - cell bodies of visceral motor neurons

– Somatic motor (SM) - cell bodies of somatic motor neurons

Page 7: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Gray Matter: Organization

Page 8: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

White Matter in the Spinal Cord

• Divided into three funiculi (columns) – posterior, lateral, and

anterior

– Columns contain 3 different types of fibers (Ascend., Descend., Trans.)

• Fibers run in three directions

– Ascending fibers - compose the sensory tracts

– Descending fibers - compose the motor tracts

– Commissural (transverse) fibers - connect opposite sides of cord

Page 9: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

White Matter

Fiber Tract Generalizations• Pathways decussate (most)

• Most consist of a chain of two or three

neurons

• Most exhibit somatotopy (precise spatial

relationships)

• All pathways are paired

– one on each side of the spinal cord

Page 10: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

White Matter: Pathway

Generalizations

Page 11: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Descending (Motor) Pathways

• Descending tracts deliver motor

instructions from the brain to the spinal cord

• Divided into two groups

– Pyramidal, or corticospinal, tracts

– Indirect pathways, essentially all others

• Motor pathways involve two neurons

– Upper motor neuron (UMN)

– Lower motor neuron (LMN)

• aka ‘anterior horn motor neuron” (also, final common pathway)

Page 12: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Pyramidal (Corticospinal) Tracts

• Originate in the precentral gyrus of brain (aka, primary motor area)

– I.e., cell body of the UMN located in precentral gyrus

• Pyramidal neuron is the UMN

– Its axon forms the corticospinal tract

• UMN synapses in the anterior horn with LMN

– Some UMN decussate in pyramids = Lateral corticospinal tracts

– Others decussate at other levels of s.c. = Anterior corticospinal tracts

• LMN (anterior horn motor neurons)

– Exits spinal cord via anterior root

– Activates skeletal muscles

• Regulates fast and fine (skilled) movements

Page 13: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Corticospinal

tracts

1. Location of UMN cell

body in cerebral cortex

2. Decussation of UMN axon in pyramids or at

level of exit of LMN3. Synapse of UMN and

LMN occurs in anterior

horn of s.c.4. LMN axon exits via

anterior root

Page 14: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Extrapyramidal Motor Tracts

• Includes all motor pathways not part of the pyramidal system

• Upper motor neuron (UMN) originates in nuclei deep in cerebrum (not in

cerebral cortex)

• UMN does not pass through the pyramids!

• LMN is an anterior horn motor neuron

• This system includes

– Rubrospinal

– Vestibulospinal

– Reticulospinal

– Tectospinal tracts

• Regulate:

– Axial muscles that maintain balance and posture

– Muscles controlling coarse movements of the proximal portions of limbs

– Head, neck, and eye movement

Page 15: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Extrapyramidal

Tract

Note:

1. UMN cell body location

2. UMN axon decussates in pons3. Synapse between UMN and LMN

occurs in anterior horn of sc3. LMN exits via ventral root

4. LMN axon stimulates skeletal

muscle

Page 16: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Extrapyramidal (Multineuronal)

Pathways

• Reticulospinal tracts – originates at reticular formation of brain;

maintain balance

• Rubrospinal tracts – originate in ‘red nucleus’ of midbrain;

control flexor muscles

• Tectospinal tracts - originate in superior colliculi and mediate

head and eye movements towards visual targets (flash of light)

Page 17: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Main Ascending Pathways

• The central processes of first-order neurons branch diffusely

as they enter the spinal cord and medulla

• Some branches take part in spinal cord reflexes

• Others synapse with second-order neurons in the cord and

medullary nuclei

Page 18: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Three Ascending Pathways

• The nonspecific and specific ascending pathways send impulses to the sensory cortex

– These pathways are responsible for discriminative touch (2 pt. discrimination) and conscious proprioception (body position sense).

• The spinocerebellar tracts send impulses to the cerebellum and do not contribute to sensory perception

Page 19: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Nonspecific Ascending Pathway

• Include the lateral and anterior

spinothalamic tracts

• Lateral: transmits impulses concerned with pain and temp. to opposite side of brain

• Anterior: transmits impulses concerned with crude touch and pressure to opposite side of brain

• 1st order neuron: sensory neuron

• 2nd order neuron: interneurons of dorsal horn; synapse with 3rd order neuron in thalamus

• 3rd order neuron: carry impulse from thalamus to postcentral gyrus

Page 20: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Specific and Posterior Spinocerebellar Tracts

• Dorsal Column Tract

1. AKA Medial lemniscal pathway

2. Fibers run only in dorsal column3. Transmit impulses from receptors in

skin and joints4. Detect discriminative touch and

body position sense =proprioception

• 1st order neuron - a sensory neuron• synapses with 2nd order neuron in

nucleus gracilis and nucleus cuneatus of medulla

• 2nd order neuron.- an interneuron

• decussate and ascend to thalamus where it synapses with 3rd order

neuron• 3rd-order (thalamic neurons)

•transmits impulse to somato-

sensory cortex (postcentral gyrus)Spinocerebellar Tract

• Transmit info. about trunk and lower limb muscles and tendons to cerebellum

• No conscious sensation

Page 21: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Spinal Cord Trauma and Disorders

• Severe damage to ventral root results in flaccid paralysis (limp and unresponsive)

• Skeletal muscles cannot move either voluntarily or involuntarily

• Without stimulation, muscles atrophy.• When only UMN of primary motor cortex is damaged

• spastic paralysis occurs - muscles affected by persistent spasms and exaggerated tendon reflexes

• Muscles remain healthy longer but their movements are no longer

subject to voluntary control.• Muscles commonly become permanently shortened.

• Transection (cross sectioning) at any level results in total motor and sensory loss in body regions inferior to site of damage.

• If injury in cervical region, all four limbs affected (quadriplegia)

• If injury between T1 and L1, only lower limbs affected (paraplegia)

Page 22: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Spinal Cord Trauma and Disorders

• Spinal shock - transient period of functional loss that follows the injury• Results in immediate depression of all reflex activity caudal to lesion.• Bowel and bladder reflexes stop, blood pressure falls, and all muscles (somatic and visceral) below the injury are paralyzed and insensitive.• Neural function usually returns within a few hours following injury• If function does not resume within 48 hrs, paralysis is permanent.

• Amyotrophic Lateral Sclerosis (aka, Lou Gehrig’s disease)

• Progressive destruction of anterior horn motor neurons and fibers of the pyramidal tracts

• Lose ability to speak, swallow, breathe.• Death within 5 yrs• Cause unknown (90%); others have high glutamate levels

• Poliomyelitis

• Virus destroys anterior horn motor neurons• Victims die from paralysis of respiratory muscles• Virus enters body in feces-contaminated water (public swimming pools)

Page 23: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

2 Primary Systems

Dorsal column-Medial

Lemniscal SystemCorticospinal Tract

Page 24: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Dorsal Column (SC) -Medial Lemniscal (brain stem) System

• 1° sensory function – brings info from

sensory receptors in the periphery all the

way to the 1° somatic sensory cortex.

• Refer to the postcentral gyrus of parietal

lobe!

• Via the SC, brainstem, and thalamus.

• A 3-neuron-circuit (sites of synaptic

contact):

Page 25: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Dorsal Column (SC) -Medial Lemniscal (brain stem) System

i. DRG cells – bipolar (pseudounipolar) neurons receive

info from peripheral sensory receptors and bring it to SC

and bs, where the info is 1st processed (through dorsal

column). *synapse at relay nucleus in medulla: dorsal

column nucleus.

ii. Axons of these neurons from the dorsal column nucleus

cross over (decussate) here at the medulla and continue

as the medial lemniscus � thalamus.

iii. These next thalamic neurons send their axons into the

internal capsule (white mattter underlying the cortex) �

synapse at 1° somatic sensory cortex.

Page 26: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Corticospinal Tract

• This pathway serves a 1° motor function –

bringing information down from the

primary motor cortex (where?) all the way

down to skeletal muscle in the periphery

(activating muscle contraction).

• This pathway contains only 1 synapse

(unlike the DCML system, which contains __

(how many)?

Page 27: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Corticospinal Tract

i. 1° motor cortical neuron (pre-central

gyrus of the frontal lobe) � internal

capsule � ventral surface of midbrain �

pyramids on ventral surface of medulla.

These axons decussate at caudal medulla and

travel in the lateral column of the SC �

synapse at motor neurons in the ventral

horn � these axons travel to the spinal

nerve (through ventral nerve roots) � to

synapse at the muscles.

Page 28: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Overview of SC Anatomy –as it relates to

these systems

• Gray matter:

- dorsal (sensory) and ventral (motor) horns.

- intermediate zone – integration of sensory and motor

functions (inter-neurons, reflexes), which serve direct

spinal reflexes.

• White matter:

- nerve tracts (myelin)

- dorsal column (contains dorsal column)

- lateral column (contains motor descending axons)

- ventral column (will discuss later).

Many of the CNS slices we will view, such as this next slide,

are myelin-stained – so white mater appears dark.

Central canal – lowest component of ventricular system

Page 29: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Myelin-Stained Spinal Cord Sect.

Page 30: Spinal Cordlibvolume7.xyz/physiotherapy/bsc/3rdyear/... · Descending (Motor) Pathways •Descending tracts deliver motor instructions from the brain to the spinal cord •Divided

Recommended