Spinal Cord:

Sensory Systems
Anatomy and Physiology
2022-2023

Nursing (HTHSCI 1H06)

Health Sciences & iBioMed
(HTHSCI 2F03)
Engineering (HTHSCI 2L03)
Midwifery (HTHSCI 1D06
 OUTLINE

• Anatomy of spinal cord and nerves

• Overview of sensory modalities

and the mechanisms of perception
– pain, temperature, mechano-
reception (touch, pressure, stretch),
and proprioception

• Integration of sensory and motor function - reflexes

• Endogenous and exogenous pain modulation

• Clinical examples of sensory deficits and diagnosis

 OUTLINE anterior
Overview of the central nervous system and its
primary functions

posterio
1) CEREBRAL CORTEX
thinking, memory, voluntary motor
movements & sensory perception

2) DIENCEPHALON
sensory/motor relay center &
autonomic functions

3) BRAINSTEM
autonomic functions &
cranial nerves

4) CEREBELLUM
coordination of movement &
balance

5) SPINAL CORD
motor output, sensory input,
reflexes & interface with the PNS
 SPINAL CORD
Cranial nerves and brainstem

brainstem
(within skull)

foramen magnum

beginning of spinal cord

(within vertebral canal)
 SPINAL CORD
Grey matter (neurons) of the spinal cord is inside and
the white matter (axon tracts) is outside

CNS
white matter
grey matter

exits vertebral
column

PNS
spinal nerve
dorsal ramus
ventral ramus
SPINAL NERVES

A spinal nerve is composed of millions of axons

• sensory (afferent)
• motor (voluntary efferent)
• postganglionic sympathetic
(autonomic efferent)

unmyelinated 50% sensory

(pain & temperature) 40% sympathetic
myelinated 10% motor
(motor, touch, pressure & proprioception)
 SPINAL CORD Posterior
spinal arteries
Blood supply

CNS Radicular
white matter arteries
grey matter

exits vertebral
column Anterior spinal artery

Blood is supplied to the

PNS spinal cord via one
spinal nerve
dorsal ramus
anterior spinal artery,
ventral ramus two posterior spinal
arteries that are
connected by radicular
arteries.
 SPINAL LEVELS
Mid-sagittal view of spinal column
(vertebrae) and spinal cord cervical (8)

thoracic (12)

• spinal cord is shorter than

the vertebral canal
• spinal cord ends at
vertebral level L2
• nerve roots extend further lumbar (5)
via cauda equina

sacral (5)

coccygeal (…)
 SPINAL NERVES
Dorsal view of brain, spinal cord and
spinal nerves (including plexuses)

cervical (8)
brachial plexus (C5 - T1)
(motor & sensory to upper limbs)

intercostal nerves (T1 - T12) thoracic (12)

(motor & sensory to body wall)

lumbar (5)
lumbosacral plexus (L2 - S4)
(motor & sensory to lower limbs)

sacral (5)

coccygeal (…)
 SPINAL LEVELS
DERMATOMES
Spinal levels supplying areas of
skin (sensory)

CERVICAL
Brachial Plexus:
C5 - T1
THORACIC
Intercostals:
T1 - T12
LUMBAR
Lumbar Plexus:
L2 - L5
SACRAL
Sacral Plexus:
S1 – S4
SENSORY SYSTEMS

QUANTITATIVE SENSATIONS QUALITATIVE SENSATIONS

SENSORY SYSTEMS 5 Sensory Modalities

MECHANORECEPTION DRG
1) TOUCH
2) PRESSURE

3) PROPRIOCEPTION

4) NOCICEPTION (PAIN)

5) THERMORECEPTION
SENSORY SYSTEMS Testing the 5 Sensory Modalities

PAIN TEMPERATURE PRESSURE TOUCH

pinprick cold/hot tuning fork standardized with cotton
(sharp/dull discrimination) heated with water monofilament hair or brush

FREE NERVE ENDING

(PAIN)

FREE NERVE ENDING

epidermis (THERMORECEPTOR)

MEISSNER’S CORPUSCLE

dermis MERKEL CELL

RUFFINIAN CORPUSCLE
subcutaneous
tissue PACINIAN CORPUSCLE
SENSORY SYSTEMS
motor fibres

Muscles and Joints

CORPUSCLE
pressure

MUSCLE SPINDLE
proprioception
CORPUSCLE
pressure
FREE NERVE ENDING
pain
TENDON ORGAN
proprioception TENDON ORGAN
proprioception
CORPUSCLE
pressure

FREE NERVE ENDING

pain

Elbow joint
SENSORY SYSTEMS Intraspinal Organization

NOCICEPTION Dorsal
THERMORECEPTION horn
(small afferents with laminae
no or little myelin)

MECHANORECEPTION
(medium afferents
with light-heavy myelin)

PROPRIORECEPTION
(large afferents
with heavy myelin)
SPINAL BIOLOGY Sensory & Motor Integration
Spinal Cord
Posterior (dorsal)
Spinal
cord
Arachnoid mater

Dura mater
Pia
mater

Vertebra

Sensory
receptor (in skin)

Gray matter Dorsal root

Axon
Dorsal horn terminal Cell body

Dorsal root ganglion

Dorsal Afferent axon

Ventral

Spinal nerve
Ventral horn
Efferent
Central Cell body
axon Axon
canal
White Ventral root terminals
matter

Effector (in muscle)

 STRETCH REFLEX Monosynaptic Reflex Arc
Spinal reflex Proprioception
Somatic reflex
Ipsilateral

Afferent
neuron

Muscle
spindle
Quadriceps

Stimulus

Patellar
tendon
 STRETCH REFLEX Monosynaptic Reflex Arc
Spinal reflex Proprioception
Somatic reflex
Ipsilateral

Afferent
neuron
To brain

Muscle
spindle
Quadriceps

Stimulus

Patellar
tendon
 STRETCH REFLEX Monosynaptic Reflex Arc
Spinal reflex Proprioception
Somatic reflex
Ipsilateral

Afferent
neuron
To brain

Muscle
spindle
Quadriceps

Stimulus

Patellar
tendon

Efferent neurons
 STRETCH REFLEX Polysynaptic Reflex Arc
Reciprocal innervation of antagonistic (reciprocal innervation)
muscle compartment
Polysynaptic

Afferent
neuron
To brain

Muscle *
spindle
Quadriceps

Stimulus

1 2
Hamstrings
Patellar
tendon
Interneuron

Efferent neurons
 STRETCH REFLEX Deep Tendon Reflexes
One, two, buckle your shoe… testing the spinal cord pathway

Achilles Patellar Biceps brachii Brachioradialis Triceps

tendon reflex tendon reflex tendon reflex tendon reflex tendon reflex

S1,2 L3,4 C5,6 C5,6 C7,8

 sensory neuron excitatory interneuron
SPINAL REFLEX motor neuron inhibitory interneuron

Crossed-Extensor Reflex To thalamus

2 3
1. Painful stimulus activates nocioceptor

2. Primary sensory neuron enters spinal

cord and diverges
3. One collateral activates projection
neuron in ascending pathways for Afferent
neuron
sensation (pain) Efferent
neurons
4. Withdrawal reflex pulls foot away
from painful stimulus – activation of 4
hamstring, inhibition of quadriceps 5
Quadriceps
5. Crossed extensor reflex supports
body as weight shifts – activation of
quadricep, inhibition of hamstring Hamstrings

Nociceptor
1

Stimulus
SENSORY SYSTEMS Spinal Cord Sensory Pathways
Touch, Pressure,
Proprioception ascending pathways to the
brain Pain & Temperature
dorsal fasciculus gracilis
columns fasciculus cuneatus

primary sensory neuron

secondary sensory neurons lateral spinothalamic tract

SENSORY SYSTEMS Sensory Pathways
POST CENTRAL GYRUS
SOMATOSENSORY
HOMUNCULUS
(right hemisphere)
Medial cortex
(ant. cerebral a.)

thalamus

Lateral cortex
(mid. cerebral a.) internal capsule
lentiform
nuclei (BN)

head of caudate
SENSORY SYSTEMS postcentral
gyrus

TOUCH & PRESSURE internal

CORTEX
capsule
crossed at medulla
thalamus

CEREBELLUM

MIDBRAIN
medial lemniscus

PONS
Dorsal Column
Medial Lemniscal Pathway

MEDULLA
gracile nucleus
cuneate nucleus

medial lemniscus

SPINE
gracile fasciculus
cuneate fasciculus
from touch and pressure
receptors in skin
SENSORY SYSTEMS postcentral
gyrus

PROPRIOCEPTION internal

CORTEX
capsule
crossed at medulla
spinocerebellum thalamus

CEREBELLUM

MIDBRAIN
medial lemniscus

PONS
inferior cerebellar
peduncle

Dorsal Column
Medial Lemniscal Pathway

MEDULLA
gracile nucleus
cuneate nucleus
Spinocerebellar Tract
medial lemniscus
dorsal spinocerebellar
(direct)

SPINE
gracile fasciculus
cuneate fasciculus
from spindles & tendon organs
SENSORY SYSTEMS postcentral
gyrus

PAIN TEMPERATURE internal

CORTEX
capsule
crossed at spinal level thalamus

CEREBELLUM

MIDBRAIN
periaqueductal
grey matter

PONS
pontine reticular
formation

Anterolateral Pathway:
• Spinothalamic tract

MEDULLA
medullary reticular

• Spinoreticular tract
formation

• Spinomesencephalic tract
lateral spinothalamic

SPINE
tract
from free nerve endings in skin
(pain and temp) & muscles (pain)
PAIN TRANSMISSION

Types of Pain:
1. Nociceptive Pain
• Activation of nociceptors at
the tissue
2. Neuropathic Pain
• Abnormal activation of
pain afferents (e.g., nerve
damage)
3. Centralized Pain
• Abnormal perception of
painful stimuli

High level of co-morbidity:

- Rheumatoid and osteoarthritis
- Fibromyalgia
- Tension headache, migraine
- Phantom limb pain
- Chronic fatigue syndrome
- Irritable bowel syndrome
- PTSD, etc.
Woolf, C. (2011) Central sensitization. Pain 152 (2): S1-15
PAIN MODULATION Endogenous Pain Control
SPINAL CORD “GATE”
CONTOL OF PAIN
pain relayed through
spinothalamic tract

small C fibres carrying

noxious signals

large A fibres carrying gate interneuron

mechanoreceptor signals
PAIN MODULATION Endogenous Pain Control
CENTRAL CONTOL OF
PAIN – PAG & RF PAIN MODULATORS
Input from hypothalamus, Capsaicin, endorphins & enkephalins
amygdala, thalamus and
cortex To thalamus

Periaqueductal Midbrain
gray matter
Spinothalamic
Lateral reticular tract
formation Descending
neuron
Afferent
neuron Interneuron
Rostral Medulla Enkephalin
ventral medulla
Substance P
Afferent
neuron Second-order
neuron
Spinal cord
Skin
Nociceptor
PAIN MODULATION Exogenous Pain Control

Common pharmacological agents used for

exogenous pain relief act at different levels in
the pain pathway. For example, NSAID’s act
peripherally, and opioids act centrally.

Nonpharmacologic Therapy Pharmacologic Therapy

• Exercise • Nonsteroidal anti-
• Multidisciplinary inflammatory drugs (first-
rehabilitation line)
• Acupuncture • Tramadol or duloxetine
• Mindfulness-based stress (second-line)
reduction • Opioids (if previous therapies
• Tai-chi, Yoga have failed)
• Motor control exercises
• Progressive relaxation
therapy
• EMG biofeedback
• Low-level laser therapy
• CBT
• Spinal manipulation
PAIN MODULATION Exogenous Pain Control

Opioids act on opioid receptors expressed

throughout the nervous system and act to
block pre- and post-synaptic activity.
• Presynaptic = reduced NT release
• Postsynaptic = IPSP

The importance of treating pain:

• Reduces pain intensity
• Helps accelerate wound healing
• Helps to increase functional
capacity
• Helps to promote positive affect
(mood)
Synthetic opioid-related deaths in Canada (2021) • Improves quality of life!
 SUMMARY

• There are five sensory modalities

that are sensed across organized
dermatomes corresponding to
specific spinal levels.

• The two primary somatosensory

pathways are the Dorsal Column-
Medial Lemniscal Pathway and the
Anterolateral Pathway.

• Sensory and motor function

integrate at the level of the spinal
cord and produce spinal reflexes.

• Different types of pain originate from

different levels within the Understanding the anatomical design of
somatosensory pathways can help
spinothalamic pathway and can be
diagnose potential causes and locations of
modulated endogenously or sensory deficits.
exogenously.
SENSORY DEFICITS Clinical Examples

EXERCISE

Test your understanding of

sensory pathways by answering
the following questions:

Does the lesion occur…

- In the cortex, brainstem,
spinal cord or periphery?
- Is it ipsilateral or
contralateral?
SENSORY DEFICITS Clinical Examples
Identify where the lesion is if sensory loss is shown by the
shaded area (in purple).

Mechanoreception, Proprioception
Nociception, Thermoreception
SENSORY DEFICITS Clinical Examples
Trigeminal Nerve (CN V)

CN V CN V
ventral surface
of brainstem

The trigeminal nerve:

• Innervates the entire face via three
primary nerves (V1, V2, V3)
• Relays sensory information from
the face to the contralateral
somatosensory cortex via the
brainstem (Pons)
SENSORY DEFICITS Clinical Examples
Identify where the lesion is if sensory loss is shown by the
shaded area (in purple).

How would the symptoms

compare if the lesion was
within the brainstem, such
as in the pons?

Mechanoreception, Proprioception
Nociception, Thermoreception
SENSORY DEFICITS Clinical Examples

A patient reports problems walking and a loss of sensation in

their right foot, with progressive numbness and tingling. Upon
examination, the patient is found to have decreased vibration
and position discrimination on the right foot and leg. Pain
sensation appears completely normal on the right and left side.

Where is the lesion? What pathway(s) are damaged?

Posterior spinal arterial supply

Radicular spinal arterial supply

(limited compensation)

Anterior spinal arterial supply