The spinal cord Lec-11-

Dr.maysoon alkazzaz
Objectives
By the end of this lecture the students should be able to understand the
following:
1-The shape and the extension of the spinal cord.
2-The structure of the spinal cord.
3-The ascending and descending tracts within the spinal cord.
4-what is lumbar puncture? Why and how we do lumbar puncture.
5-Blood supply of the spinal cord.
The spinal cord is cylindrical in shape extends from foramen magnum
where it is continuous with the medulla oblongata and ends inferiorly in
adult at the lower border of L1, it is longer in young ends at the upper
border of L3. The spinal cord about 45 cm occupies 2/3 of the vertebral
column and it is protected by:
1-The vertebral column.
2-The meninges which surround it, the pia, arachnoid and the dura
mater.
3- The presence of the cerebrospinal fluid (CSF) in the subarachnoid
space.
The spinal cord enlarged in the cervical region where it gives the
brachial plexus and in the lower thoracic and upper lumbar region
where it gives the lumbar plexus, called the cervical and lumbar
enlargements.
 Inferiorly the spinal cord tapers off into conus medullaris from its
apex a prolongation of pia mater extends down to attached to the
dorsum of the coccyx called filum terminale.
The spinal cord gives 31 pairs of spinal nerves along its length, each
nerve attached to the spinal cord by two roots anterior motor and
posterior sensory roots. Each posterior sensory root has a posterior root
ganglia these are, 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1
coccygeal.
Structures of the spinal cord
The spinal cord has a deep anterior fissure called anterior median
fissure and a shallow posterior furrow called the posterior median
sulcus.
Cross section of the spinal cord showed that it consists of inner
Gray mater arranged in H shape pattern with
Two anterior motor gray horns or columns and
Two posterior sensory gray horns or columns.
A small lateral gray horn present in the thoracic and upper lumbar
segments.
The two anterior and posterior horns connected by thin gray
commissure contain the central canal, this canal is connected superiorly
with the central canal of the medulla oblongata and inferiorly the
central canal extends to the terminal ventricle around the conus
medullaris.
The thickness of the gray mater depend on the number of the
muscles innervated so it shows enlargement in the cervical and upper
lumbar segments where it innervates the muscles of the upper and
lower limbs respectively. Maximum thickness is in the C6 and T12
vertebrae.
The gray mater of the spinal cord consist of nerve cells and their
processes, neuroglia and blood vessels. The nerve cells are of multipolar
type.
The white mater of the spinal cord divided into anterior,
lateral and posterior columns. It consists of nerve fibers, neuroglia and
blood vessels. Its white color due to the high proportion of myelinated
nerve fibers.
The spinal cord tracts divided into:
1 Ascending tracts.
2 Descending tracts.
3 Intersegmental tracts.
Ascending tracts
Tracts in the posterior white column these are fasciculus gracilis and
fasciculus cuneatus. These tracts convey information of proprioceptive
sensibility, vibration sense, and tactile discrimination.
Tracts in the lateral white column
1 The anterior and posterior spinocerebellar tracts conveys
proprioceptive information and from touch and pressure receptors.
2 The lateral spinothalamic tract conveys information of pain and
temperature sensibility.
3 The spinotectal tract concerned with spinovisual reflex.
4 The posterolateral tract ( Lissauers’ tract ).
5 Spinoreticular tract.
6 Spino-olivary tract.

Tracts in the anterior white column

The anterior spinothalamic lies medial to the anterior nerve roots and it
convey tactile and pressure sensibilities.

Descending tracts
There are no descending
Tracts in the lateral white column
1 The lateral corticospinal tract, it is an important motor pathway
concerned with voluntary movement.
2 The rubrospinal tract, convey impulses concerned with muscular
activity.
3 The lateral reticulospinal tract, this tract is thought to play an
important role in muscular activity.
4 The descending autonomic fibers. They are concerned with
controlling visceral function.
5 The olivospinal tract. Their function is unknown.

Tracts in the anterior white column

1 The anterior corticospinal tract, forms an important pathway
concerned with voluntary movement.
2 The vestibulospinal tract, associated with the control of muscle tone.
3 The tectospinal tract, forms part of reflex nervous pathway
associated with rotation of the head and moving of the arms in
response to visual stimuli.
4 The reticulospinal tract, they concerned with motor function.

Intersegmental tracts
Short ascending and descending tracts that originate and end within the
spinal cord exist in the anterior , posterior and lateral white columns. Its
fibers run from one segment of the cord to another, thus establishing
important intersegmental spinal reflexes.
Relationship of the spinal cord segments to the vertebral numbers
In the adult the spinal cord terminates at the lower border of
L1 thus the spinal segments do not correspond with the vertebrae that
lie at the same level.
Thus the levels of the spinal nerves are as follows: -
In the cervical region add 1 to the number of vertebra e.g. the 5 th
cervical vertebral spine, lies opposite the 6th cervical segment of the
spinal cord.
In the upper half of thoracic region add 2 to the number of the thoracic
vertebral spine.
In the lower thoracic & upper lumbar region add 3 to the number of the
vertebra.
The lower lumbar & sacral region (conus medullaris) lie opposite the 12 th
thoracic & first lumbar vertebrae.
Lumbar puncture
It is a process of taking sample of CSF by introducing a special
needle into the dural sac between L3 and L4 or L4 and L5.
The spinal cord terminates inferiorly at the lower border of L1 in adult,
the subarachnoid space extends inferiorly as far as the lower border of
the S2 vertebra, this space called the terminal ventricle or dural sac
which contains :
1-The lumbar and sacral nerve roots (cauda equine).
2-The filum terminale.
3-The CSF.
A needle introduced into the subarachnoid space between L3 and L4 or
L4 and L5 in this region usually pushes the nerve roots to one side
without causing damage.
The needle will pass through the following anatomical structures:
1 Skin.
2 Superficial fascia.
3 Supraspinous ligament.
4 Interspinous ligament.
5 Ligamentum flavum.
6 Areolar tissue containing the internal vertebral venous plexus.
7 Dura mater.
8 Arachnoid mater.
The depth to which the needle will have pass will vary from 1 inch (2.5
cm) or less in a child, and as much as 4 inches (10 cm) in an obese adult.
 Applications of LP puncture:
I. Lumbar puncture done to obtain a sample of CSF for bacterial and
microscopical examination.
II. Caudal anesthesia inserts into the sacral canal through the sacral
hiatus to obtain block for the spinal nerve roots during operations.
III. Injection of drugs for the treatment of some diseases as in
meningitis.
IV. Injection of a dye to get myelogram of the spinal cord.

Blood supply of the spinal Cord

1 The posterior spinal arteries, arise from the vertebral arteries.
2 The anterior spinal artery arises from both vertebral arteries.
3 Radicular arteries from the deep cervical, intercostals, and lumbar
arteries.
4 Arteria radicularis magna arise from the descending aorta in the
lower thoracic or upper lumbar vertebral level. The importance of
this artery that it may be the major source of blood to the lower
two-third of the spinal cord.
The veins of the spinal cord drain into 6 longitudinal channels which
ends mainly into the internal vertebral venous plexus.
I. One runs in the median plane anteriorly.
II. One runs in the median plane posteriorly.
III. A pair runs vertically close to the ventral roots of spinal nerves.
IV. A pair runs vertically close to the dorsal roots of spinal nerves.
 The autonomic nervous system Lec-12-
Dr.maysoon alkazzaz
Objectives
By the end of this lecture the students should be able to understand the
following:
1 Parts of the autonomic nervous system.
2 The functions of sympathetic and parasympathetic system.
3 The efferent and afferent fibers of sympathetic and parasympathetic
systems.
4 The higher centers which control the activity of the autonomic
nervous system.
The autonomic nervous system concerned with the innervations of
the involuntary structures such as the heart, smooth muscles, and
glands throughout the body, consists of two parts sympathetic and
parasympathetic both have afferent and efferent nerve fibers.
The activity of the sympathetic system is to prepare the body for
emergency, it
1 Accelerates heart rate.
2 Constricts the arterioles of the skin and intestine but dilates those of
the skeletal muscles.
3 Increases blood pressure.
4 Dilates the pupil.
5 Inhibit smooth muscles of the bronchi, intestine and bladder wall and
closes the sphincters.
 6 Causes the hair to stand up and the skin to sweat.
The sympathetic system bring about redistribution of blood so that it
leaves the skin and intestine and becomes available in brain, heart, and
skeletal muscles.

The activities of the parasympathetic is in conserving and restoring

body energy, they
1-Slows the heart rate.
2-Constricts the pupil.
3-Increases the peristalsis of intestine and glandular activity.
4-Opens the sphincters and contracts the wall of the urinary bladder.

The efferent fibers of the Sympathetic part

The gray mater of the spinal cord from T1 segment to L2 or
sometime L3 segment posses lateral gray horn in which located the cell
bodies of sympathetic neurons, the myelinated axon of these cells leave
the spinal cord in the anterior nerve roots of the spinal nerves and then
pass through the white rami communicants to the ganglia of the
sympathetic trunk, these nerve fibers called preganglionic nerve fibers,
these fibers once entered the sympathetic ganglia they may pass to one
of the following directions:

1 They may terminate in the ganglia then the axons of the

postganglionic nerves fibers leave the ganglia and pass to the
thoracic spinal nerves through the gray rami communicants and
 distributed with the spinal nerves to the smooth muscles of the
blood vessels, sweat glands and arrector pilli muscles of the skin.

2 The preganglionic nerve fibers enter the ganglia of the sympathetic

trunk high up in the thoracic segments may travel up to the ganglia in
the cervical region where they synapse, and the postganglionic
neurons leave the sympathetic trunk as gray rami communicants and
distributed through the cervical spinal nerves.

3 The preganglionic nerve fibers enter the ganglia of the sympathetic

trunk lower down in the thoracic segments may travel down to the
ganglia in the lumbar and sacral regions where they synapse, and the
postganglionic neurons leave the sympathetic trunk as gray rami
communicants and distributed through the lumbar and sacral spinal
nerves.

4 The preganglionic nerve fibers pass through the ganglia in the

thoracic part of the sympathetic trunk without synapse with the cells
of the ganglia, these nerves form the splanchnic nerves. There are
three nerves:
The greater splanchnic nerve arise from 5-9 thoracic ganglia of the
sympathetic trunk pierce the diaphragm and synapse in the celiac
plexus.
 The lesser splanchnic nerve arise from 10 and 11 thoracic ganglia
of the sympathetic trunk pierce the diaphragm and synapse in the lower
part of the celiac plexus.
The least splanchnic nerve (when present) arise from 12 thoracic
sympathetic ganglia pierce the diaphragm and synapse in the renal
plexus.
The afferent fibers of the sympathetic part
The afferent sympathetic fibers pass from the viscera through the
sympathetic ganglia without synapse, they enter the spinal nerves
through the white rami communicants and reach their cell bodies in the
posterior root ganglia of the spinal nerves then pass upward to higher
autonomic centers such as hypothalamus in the brain.

The parasympathetic part of the autonomic nervous system

Efferent fibers
The nerve cells of the efferent fibers located in the brainstem and
sacral segment of the spinal cord (crainosacral).
Those nerve cells in the brainstem (cranial part) form part of the
nuclei of the cranial nerves, oculomotor, facial, glossopharyngeal and
vagus nerves. The efferent fibers are preganglionic nerve fibers they
synapse in the parasympathetic ganglia which is usually situated close to
the viscera.
The parasympathetic gangliae are; ciliary, pterygopalatine,
submandibular and otic.
 The sacral part of the efferent nerve cells found in the gray mater
of S2, S3, S4 segment of the spinal cord they leave the spinal cord
through the anterior roots of the sacral spinal nerves then leave the
spinal nerves and form the pelvic splanchnic nerves. These
preganglionic nerve fibers synapse in the ganglia of the hypogastric
plexus.

The afferent nerve fibers

The afferent fibers travel from the viscera to their cell bodies located either
in the sensory ganglia of the cranial nerves or in the posterior root ganglia
of the sacral spinal nerves and pass to higher centers of the autonomic
nervous system, such as the hypothalamus.

Higher control of the autonomic nervous system

The hypothalamus has a controlling influence on the autonomic nervous
system and appears to integrate the autonomic and neuroendocrine
systems, the hypothalamus regarded as a higher nervous center for the
control of lower autonomic centers in the brainstem and spinal cord.
Stimulation of the anterior region of the hypothalamus can influence
parasympathetic responses, whereas stimulation of the posterior part of
the hypothalamus gives rise to the sympathetic responses.