THE SPINAL CORD

A FIXED LEARNING MODULECOMPILED BY

Assoc Prof dr Hamiadji Tanuseputro

HAMIADJI 2009.

THE VERTEBRAL COLUMNTHE VERTEBRAL COLUMN

• GIVE THE DIVISION OF VERT. CL.• WHAT IS KYPHOSIS, LORDOSIS,

AND SCOLIOSIS?

THE VERTEBRAL COLUMNTHE VERTEBRAL COLUMNDISCUSS THE MOVEMENTS OF

THE VERTEBRAE.

THE VERTEBRAL COLUMNTHE VERTEBRAL COLUMN(INTERVERTEBRAL DISC)(INTERVERTEBRAL DISC)

DESCRIBE THE INTERVERTEBRAL DISCS.

VERT. COLUMN & SPINAL CORDVERT. COLUMN & SPINAL CORD•MAJOR REFLEX CENTRE - 45 cm

•EXTENT--FORAMEN MAGNUM TO LOWER BORDER L-1, NEWBORN- UPPER BORDER L-3

•TWO ENLARGEMENTS-CERVICAL, LUMBAR•ANT.MEDIAN FISSURE, POST.MEDIAN SULCUS

•CONUS MEDULLARIS --FILUM TERMINALE•CAUDA EQUINA (spinal roots)

•ASCENDING, DESCENDING TRACTS.

GIVE THE SALIENT FEATURESOF THE SPINAL CORD.

BECAUSE THE SPINAL CORD IS SHORT & VERTEBRAL COLUMN IS LONG

SPINAL SEGMENT ≠ VERTEBRAL LEVEL VERTEBRAL LEVEL SPINAL SEGMENTSPINAL SEGMENT

CERVICAL VERTEBRAE---- ADD 1 (e.g. C-3 vert. = C4 spinal segment)

UPPER THORACIC (T-1 to 6) -- ADD 2 (e.g. T-4 vert. = T-6 spinal segment) LOWER THORACIC (T-7 to 9)- ADD 3 (e.g. T-9 vert. = T-12 spinal segment)

T-10 THORACIC -------- L-1 & L-2 segment

T-11 THORACIC---------L-3 & L-4 segment

T-12 THORACIC---------L-5 segment

LUMBAR 1--Sacral & coccygeal segment

EXAMPLE. Most common cervical spinal injuries involve C4 or C5. A person who has had a burst fracture of the C5 vertebral body- injures C6 spinal cord segment and also the C4 spinal

roots that exits the spinal column between the C4 and C5 vertebra. will cause a loss of sensations in C4 dermatome and

weak deltoids (C4) due to injury to the C4 roots.. The wrist extensors (C6) should remain weak and sensation at and

below C6 should be severely compromised.

EXPLAIN REGARDING

THE DIFFERENCEBETWEEN

VERTEBRAL LEVELAND

. SPINAL SEGMENT.

THE SPINAL MENINGESTHE SPINAL MENINGES

SPINAL MENINGES

DURA MATER-Outer most- dense, fibrous (Foramen magnum to S-2) EPIDURAL SPACE

(NEGLIGIBLE SUBDURAL SPACE)

ARACHNOID MATER-Middle- delicate impermeable ( Foramen magnum to S-2)

( SUBARACHNOID SPACE-CSF, Fine strands of conn. Tissue)

PIA MATER- INNER - fine vascular ( Foramen Magnum to coccyx-as FILUM TERMINALE) Thickened on either side of nerve roots-pairs of LIGAMENTUM DENTICULATUM

• DESCRIBE THE SPINAL MENINGES.• WHAT IS THE EPIDURAL SPACE?• LIGAMENTUM DENTICULATUM?

• FILUM TERMINALE?

THE SPINAL MENINGESTHE SPINAL MENINGES

IDENTIFY:CONUS MEDULLARIS

FILUM TERMINALECAUDA EQUINA

DURAMATERARACHNOIDPIAMATER

LIG. DENTICULATUMSPINAL GANGLION

ROOTLETSSPINAL NERVE

THE SPINAL MENINGESTHE SPINAL MENINGES

STUDY THESE PICTURESCAREFULLY.

CONTENTS OF EPIDURAL SPACE?

POSTERIOR

DURAMATER

LIGAMENTUMDENTICULATUM

ROOT

GANLION

DURA

EPIDURAL

SPINAL SEGMENTSPINAL SEGMENT

SPINAL SEGMENT--CIRCULAR PART OF SPINAL CORD FROM WHICH ROOTLETS OF 1 SPINAL NERVE EMERGE. 31 spinal segments

corresponding to 8 CERVICAL, 12 THORACIC, 5 LUMBAR , 5 SACRAL & 1 coccygeal SPINAL NERVES.

DEFINE THE SPINAL SEGMENT!HOW MANY SEGMENTS ARE THERE?

HOW MANY SPINAL NERVES ARE THERE?

DERMATOME-THE AREA OF SKIN SUPPLIED BY A SINGLE

SPINAL NERVE

STUDYTHE

LOCATIONSOF THE

DERMATOMES

S3

T10

T4

C7

L5

C2

BRANCHES OF A SPINAL NERVE

COMMUNICATING TO SYMPATHETIC TRUNK

Gray rami communicantes White rami communicantes

POST.PRIMARY RAMUS

Dorsal cutaneous br. Muscular br. To erector spinae Articular to joints of vert. Col.

ANT.PRIMARY RAMUS

Lateral cutaneous br. Anterior cutaneous br. Proximal muscular br Distal muscular br.

NAME THE BRANCHESOF A TYPICAL SPINAL

NERVE.

BRANCHES OF A SPINAL NERVE

PLEASE LABEL THEBRANCHES OF THIS

SPINAL NERVE.

COMMUNICATING TO SYMPATHETIC TRUNK

Gray rami communicantes White rami communicantes

POST.PRIMARY RAMUSDorsal cutaneous br.

Muscular br. To erector spinae Articular to joints of

vert. Col.ANT.PRIMARY RAMUS

Lateral cutaneous br. Anterior cutaneous br. Proximal muscular br.

Distal muscular br.

DISTRIBUTION OF A TYPICAL SPINAL NERVE

FUNCTIONAL COMPONENTS OF A TYPICAL SPINAL NERVE

1. GENERAL SOMATIC AFFERENT

2. GENERAL SOMATIC EFFERENT

3. GENERAL VISCERAL AFFERENT

4. GENERAL VISCERAL EFFERENT

FUNCTIONAL COMPONENTS OF A TYPICAL SPINAL NERVE

1. GENERAL SOMATIC AFFERENT

2. GENERAL SOMATIC EFFERENT

3. GENERAL VISCERAL AFFERENT

4. GENERAL VISCERAL EFFERENT

FUNCTIONAL COMPONENTS OF A TYPICAL SPINAL NERVE

PLEASE EXPLAIN THE ROLEOF THE COMPONENTS

INDICATED BELOW.

43

21

THE CAUDA EQUINATHE CAUDA EQUINATHE CAUDA EQUINA IS MADE

OF ROOTS OF SPINAL NERVES.TRUE OR FALSE.

The arteries of the spinal cord form an anastomotic network

(vasocorona) that will give off branches into the spinal cord as

endarteries. There are no anastomoses inside the spinal cord

except at the capillary level.

ARTERIAL SUPPLY OF SC.ARTERIAL SUPPLY OF SC.

GIVE IN SHORT THE ARTERIALSUPPLY OF THE SPINAL CORD.

VASOCORONA

RADICULAR ART.

• The veins of the spinal cord have the same distribution as the arteries. They course along with the arteries and drain outward via the ventral and dorsal

roots into the massive internal vertebral venous plexus in the epidural space. • The veins are valueless and have ample connections with the veins in the

thoracic, abdominal and pelvic cavities!! (metastases).

THE VENOUS DRAINAGE OF SC.THE VENOUS DRAINAGE OF SC.

GIVE IN SHORT THE VENOUSDRAINAGE OF THE SPINAL CORD.

THE LUMBAR PUNCTURETHE LUMBAR PUNCTURE

L4

L3

LUMBAR PUNCTURE (Lumbar puncture)

a median puncturesitting or reclining positionthe body should be flexed

needle insertion between L3 – L4 (how to determine?)

Insertion should be in the direction toward the umbilicus

depth of insertion approx. 5 – 7 cm

HOW TO PERFORMTHE LUMBAR PUNCTURE?

THANK YOUTHANK YOU

FOR STUDYING THISFIXED LEARNING MODULE

HAMIADJI 2009.

ASCENDING & DESCENDING TRACTASCENDING & DESCENDING TRACT

ASCENDING

DESCENDING

ASCENDING & DESCENDING TRACTASCENDING & DESCENDING TRACT

DORSAL COLUMNSYSTEM

&ANTERO-LATERAL

SYSTEM&

SPINO-CEREBELLARSYSTEM

LATERAL CORTICOSPINAL

SYSTEM&

ANTERIOR-CORTICOSPINALSYSTEM

LABEL THESE PRINCIPALASCENDING & DESCENDING

TRACTS.

ASCENDING & DESCENDING TRACTASCENDING & DESCENDING TRACT

Crossing of Motor & Sensory Pathways

GENERALLY THE CEREBRAL CORTEX CONTROLS &RECEIVES THE CONTRALATERAL BODY. TRUE / FALSE.

WHAT IS THE ROLE OF THE THALAMUS?

THE ASCENDING TRACTSTHE ASCENDING TRACTS

DESCRIBE THE 3 PRINCIPALASCENDING TRACTS.

Post. Column. Syst. Anterolateral. Syst. Spinocerebellar. Syst.

THE ASCENDING TRACTSTHE ASCENDING TRACTS

THE DESCENDING TRACTSTHE DESCENDING TRACTS

DESCRIBEPYRAMIDAL

&EXTRAPYRAMIDAL

TRACTS&

COMMON MOTORPATHWAY

PYRAMIDAL TRACT

SENSORY FIBRES MOTOR FIBRES

THREE SENSORY SYSTEM

1. POSTERIOR COLUMN2. ANTERO-LATERAL3. SPINO-CEREBELLAR

THREE MOTOR SYSTEM1. EXTRAPYRAMIDAL2. PYRAMIDAL3.CEREBELLAR

COMMON MOTOR PATHWAY (ANTERIOR HORN CELLS)

AUTONOMIC SYSTEM

SYMPATHETIC

PARASYMPATHETIC

GENERAL SOMATIC AFFERENT GENERAL SOMATIC EFFERENT

GE

NE

RA

L V

ISC

ER

AL

AF

FE

RE

NT G

EN

ER

AL

VIS

CE

RA

L E

FF

ER

EN

T

SPINAL NERVESCRANIAL NERVES*

PERIPHERAL NERVOUS SYSTEM (SCHEMATIC)

* Special Visceral Afferent

Special Somatic Afferent

Special Visceral Efferent

THREE SENSORY SYSTEM

1. POSTERIOR COLUMNPOSTERIOR COLUMN2. ANTERO-LATERAL3. SPINO-CEREBELLARSPINO-CEREBELLAR

THREE SENSORY SYSTEM

1. POSTERIOR COLUMN2. ANTERO-LATERALANTERO-LATERAL3. SPINO-CEREBELLAR

THREE MOTOR SYSTEM1. EXTRAPYRAMIDAL2. PYRAMIDAL3.CEREBELLAR

COMMON MOTOR PATHWAY (ANTERIOR HORN CELLS)

THREE MOTOR SYSTEM1. EXTRAPYRAMIDAL1. EXTRAPYRAMIDAL2. PYRAMIDAL3.CEREBELLAR3.CEREBELLAR

COMMON MOTOR PATHWAY (ANTERIOR HORN CELLS)

THANK YOUTHANK YOU

FOR STUDYING THISFOR STUDYING THIS

FIXED LEARNING MODULEFIXED LEARNING MODULE

HAMIADJI 2009.

•MAJOR REFLEX CENTRE - 45 cm•EXTENT--FORAMEN MAGNUM TO LOWER BORDER

•L-1, NEWBORN- UPPER BODER L-3•2 ENLARGEMENTS-CERVICAL, LUMBAR

ANT.MEDIAN FISSURE, POST.MEDIAN SULCUS•CONUS MEDULLARIS --FILUM TERMINALE

•CAUDA EQUINA (spinal roots)•ASCENDING & DESCENDING TRACTS

GIVE THE SALIENT FEATURESOF THE SPINAL CORD.