Presentation spinal cord

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Presentation spinal cord
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Spinal cord

• Origin
• foramen megnum continous
  with medulla oblongata of brain
• Termination
• in adult
• at the lower
  boarder of L1
• in child
• at the upper
  boarder of L3

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Menings

• The spinal cord is surrounded by three membranes
• 1 dura mater
• 2 arachnoid mater
• 3pia mater
• Function
• Protection
• Also by cerebrospinal fluid
  present in the subarachnoid space

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• In the cervical region
• it gives origin to the brachial plexus
• lower thoracic region and lumber region
• it gives origin to lumbosacral plexus .
• superiorly
• the spinal cord is fusiformly enlarge the
  enlargement is referred as the cervical and
  lumber enlargement
• inferiorly
• the spinal cord tapers off into the conus
  medullaris from the apex of which a prolongation
  of pia mater the filum terminale descend to be
  attached to the posterior surface of the coccyx.

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location

• The cord lie in midline
• anterior median fissure
• posterior median sulcus.
• Along the entire length of the spinal cord are
  attached 31 no of spinal nerves by the
• anterior or motor roots and
• Posterior root or sensory
• posterior root ganglion
• cells which gives rise to peripheral and center
  nerve fibber

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Structure of spinal cord

• gray mater
• inner
• white mater
• Outer
• GRAY MATER
• On croos section the gray mater is seen H-shaped
  pillar with
• anterior column or horns
• posterior column or horns
• lateral gray column or horn (THORACIC AND
  LUMBER)
• united by
• gray commissure
• With central canal

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Nerves cell groups in the anterior gray column

• Alpha efferent nerve
• large
• Multipolar
• It innervates the skeletal muscle
• Axon pass out in anterior roots of spinal nerves

• Gamma efferent
• Small
• Multipolar
• It innervates intrafusal muscle fibers of
  neuromuscular spindles
• Axon may pass out in anterior roots of the spinal
  nerves

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Nerve cell of the anterior gray column is divided
into three basic groups

• (1) MEDIAL GROUP
• (2) CENTRAL GROUP
• (3) LATERAL GROUP

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Medial group

• EXTENTION
• WHOLE SPINAL CORD
• innervate
• muscle of
• neck,
• trunk,
• intercostal
• abdominal

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(2)Central group

• EXTENTION
• 
  cervical, lumber, sacral segments
• Three nuclei
• (a) phrenic nucleus
• (C345)
• INERVATE
• DIAGHPHRAM
• (b)accessory nucleus)
• (C5 OR 6)
• INNERVATION
• sternocliedomastoid and trapezius
  muscle
• (c) lumbosacral nucleus
• (L2 TO S1)
• INNERVATION
• unknwon distribution

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Lateral group

• Extention
• cervical and lumbosacral segment
• Innervation
• Muscles
• (1) upper limb
• (2) lower limb

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Nerve cells of the posterior gray column

• four nerve cell group
• 1 substantia gelatinosa
• 2 nucleus propius
• 3 nucleus dorsalis (clarks column)
• 4 visceral afferent nucleus
• First two
• extention
• through out the length of the
  cord
• other two
• extention
• lumber and thoracic segments

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Substantia gelatinosa

• location
• apex of the posterior gray column
• composed
• Golgi type 2 neuron
• function
• receives afferent fiber associated with
• pain ,
• temperature
• touch.
• Furthermore it receive input from the descending
  fibers from the supraspinal level .

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Nucleus propius

• Location
• Below s g
• Function
• senses of
• position
• movement (proprioception)
• two points discrimination
• vibration

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Nucleus dorsalis

• Location
• base of the posterior gray column
• extending
• C8 to L3 4
• FUNCTION
• proprioceptive endings
• neuromuscular spindles and tendon spindle

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Visceral afferent nucleus

• LOCATION
• lateral to the nucleus dorsalis
• EXTENTION
• T1 to L2
• FUNCTION
• receiving visceral afferent information

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Nerve cell group lateral gray column

• Extend
• T1 TO S4
• Cells
• T1 TO L3
• preganglionic sympathetic
  nerve fiber
• CELLS
• S 2,3,4
• preganglionic parasympathetic
  fiber

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The gray commissure and central canal

• LOCATION
• the anterior and posterior gray columns on each
  side are connected by a transverse gray
  commissure so that the gray column r in the
  central of the gray commissure is situated
  central canal.
• Superiorly
• above this it open into the cavity of the fourth
  ventricle
• continuous with the central canal of the caudal
  half of the medulla oblongata
• Inferiorly
• It is closed
• conus medullaris it expend into the fusiform
  terminal ventricle
• terminate below with in the root of the filum
  terminale
• It is filled with cerebrospinal fluid and is
  lined with epithelium called the ependyma

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• IT resembles letter H
• posterior gray commissure
• The part of the gray commissure that is situated
  posterior gray canal
• Anterior gray commisure
• lie anterior to the canal

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White mater

• It is divided into
• anterior lateral
• posterior white columns or finiculi.
• anterior column
• location
• lie on each side lie in between the midline and
  the point of emergence of the anterior nerve root
  .
• lateral column
• location
• between the emergence of the anterior nerve root
  and the entry of the posterior nerve root the
• posterior column
• location
• in between the entry of posterior nerve root and
  midline

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Structure

• composition
• in centrral nervous system the white mater of
  spinal cord consist of a mixture of
• nerve fiber
• neuroglia
• blood vessel
• it surrounds the gray mater
• its white color is due to the high proportion of
  myelinated nerve fiber

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• Blood Supply of the Spinal Cord
• The spinal cord receives its arterial supply from
  three small, longitudinally running arteries the
  two posterior spinal arteries and one anterior
  spinal artery. The posterior spinal arteries,
  which arise either directly or indirectly from
  the vertebral arteries, run down the side of the
  spinal cord, close to the attachments of the
  posterior spinal nerve roots. The anterior spinal
  arteries, which arise from the vertebral
  arteries, unite to form a single artery, which
  runs down within the anterior median fissure.
• The posterior and anterior spinal arteries are
  reinforced by radicular arteries, which enter the
  vertebral canal through the intervertebral
  foramina.
• The veins of the spinal cord drain into the
  internal vertebral venous plexus.

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• INJURIES

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Injuries in children

• Children account for 1-10 of all spinal
  injuries.
• Motor vehicle accidents account for most
  injuries, followed by falls and sports.
• Most serious spinal injuries in children involve
  the cervical spine.

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• In children less than 8 years of age, most
  injuries are between the occiput and C2
• Fulcrum of movement located at C2-3 in children,
  C5-6 in adults
• Significant ligamentous and joint capsule laxity
• Relatively large head and weak neck muscles
• Horizontal orientation of facet joints
• Incomplete ossicification of odontoid process

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• Injuries in
• adults

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Terminology

• Plegia complete lesion
• Paresis some muscle strength is preserved
• Tetraplegia (or quadriplegia)
• Injury of the cervical spinal cord
• Patient can usually still move his arms using the
  segments above the injury (e.g., in a C7 injury,
  the patient can still flex his forearms, using
  the C5 segment)
• Paraplegia
• Injury of the thoracic or lumbo-sacral cord, or
  cauda equina
• Hemiplegia
• Paralysis of one half of the body
• Usually in brain injuries (e.g., stroke)

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What are the differences between UMN and LMN?
(e.g., cauda equina vs. myelopathy)
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Thoracic injuries (T2-L1)

• Paraparesis or paraplegia
• UMN (upper motor neuron) signs

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Cauda equina injuries (L2 or below)

• Paraparesis or paraplegia
• LMN (lower motor neuron) signs
• Thigh flexion is almost always preserved to some
  degree

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What is the difference between cauda equina and
conus medullaris syndrome?