Motor Spinal Cord (Sosnowski)

Sosnowski

_ cervical spine nerve and _ cervical vertebrae

8; 7

__ thoracic spine nerves and vertebrae

12

_ lumbar spinal nerves and vertebrae

5

Spinal cord ends around ___

L1

__ pairs of sacral spinal nerves

5

_______ compress spinal cord in canal itself

Myelopathy

_________ Compression of nerve roots

Radiculopathy

Spine disease at or below vL2 does not produce _______, only _______!

myelopathy; radiculopathy

C1 spinal nerve is ____ C1 vertebrae

above

C8 spinal nerve exits ____ C7 vertebrae

below

T2 spinal nerve exits ____ T1 vertebrae

below

Lumbar nerves are contained in the ____ ____

Lumbar cistern

___ mater directly connected to spinal cord

Pia

Most peripheral is ____ mater

dura

Pia arachnoid and dura mater

Dentate (denticulate) ligament collection of arachnoid creating a tuft along cord triangle holds spinal cord in the _____ connecting pia to dura

middle

Cona ______ is where the spinal cord end

medullaris

______ ________ are the lumbar nerves

Cauda equina

pia mater that attached to the cord tethered to the sacrum (coccyx)

Filum terminale

Termination of pia mater holding conus medullaris in place.

Filum terminale

Too tight growing up can pull on conus medullaris and have fecal incontinence etc.

Tight Filum Terminale Syndrome

Dorsal and ventral roots come together to form _____ ______

spinal nerve

Dorsal root ganglia sensory ___ order neurons bringing in sensory

first

Vertebral body is ______ to spinal cord

anterior

Spinal cord images

Spinal cord is diameter of ______

pencil

Largest diameter of spinal cord is at ___

C8 because it contains the cervical enlargements for arms and legs.

Where is the enlargement for arms and legs?

Cervical enlargement C8

___ all axons coming in for lower extremities bulges are the enlargements where motor neuron cell bodies are kept

L4

Where is the enlargement for legs?

L4 Lumbar enlargement

What spinal region has the most white matter?

Cervical

Honda symbol has lateral cell column where sympathetic neurons are between T1 and L2

Thoracic spine

Honda symbol

Thoracic spine

Sympathetic neurons are between ___ and __

T1 and L2

Round, no lateral columns, half the white matter.

Lumbar enlargements

Cord levels C8 and L4 have the largest _____ horns (neuronal soma) for serving the arm and leg

ventral

The ____ horn is present from T1-L2

Lateral

The higher the cord level the more _____ fibers it contains

vertical

The tip of the conus medullaris descends to the inferior limit of the __ vertebral body

L1

Cervical C8

Thoracic T2

Lumbar L4

Gray matter location in spinal cord?

Inside

C1 is ____: ring with no vertebral body fused with ligaments to occipital bone

Atlas

C2 ____ rotates the head on ____ through dens

axis; atlas

Dens is what __ rotates on

C1

no room for __ to slip off base of the skull fused with strong ligaments

C1 atlas

Cervical cord landmarks

largest vertebrae

Lumbar

Angle between sacrum and L5 count back

how to count lumbar vertebrae

Lumbar puncture spinal tap in _____ _______ access to CSF. Between L3 and L4 (slowly nerves move around the needle) Dural tap

lumbar cistern (subarachnoid space)

Spinal anesthesia is in _____ plane above injecting anesthesia around the dura as nerve routes come out get bathed in anesthesia

epidural (do not want to get into the subarachnoid space because it can travel up)

How to count lumbar spine vertebrae

Lumbar lifting injury can cause _____

herniation

Grandparent picking up grandchild and hears a pop and feels the pain

Could be lumbar herniation

Nerve roots come out of _______ inbetween vertebrae

foramina

In Lumbar L4/L5 intervertebral disk herniate laterally pinch ___, herniate medially (paracentral) pinch __

L4 (match)

L5

Cervical C5/C6 intervertebral disk herniate lateral or central pinch ____

C6 (mismatch)

Lumbar vs cervical spine herniation

What nerve would L4-L5 intervertebral lateral herniated disk compress?

L4 (medial would be L5)

Immediate temporary loss of motor and sensory at level and below of injury (I cannot move or feel anything after injury)

Spinal shock

Sudden loss of sympathetic tone (maybe drug related)

Neurogenic shock

Spinal shock left

Neurogenic shock right

What happens to BP and pulse in spinal shock and neurogenic shock

Hypotension

Bradycardia

perineal region gloved finger do digital rectal exam stimulate clitoris or penis and cause anal sphincter to contract (normally it does contract)

Bulbocavernosus reflex

absent in spinal shock

variable in neurogenic shock

______ primary neurons are between T1 and L2 (hr breathing etc)

Sympathetic

Lesions between ___ and __ shut down adrenals (homeostasis and stress events cannot manage stress)

T1 and T6

Lesions above ___ eliminate all sympathetic outflow

T1

Lesions between T1 and T6 block sympathetic flow to the _____ and lower extremities

adrenals

Lesions below ___ block sympathetic flow to the lower extremities

T6

______ spinal artery is 1 artery supply by many different branches

Anterior

intercostal artery in the thoracic region that is very pronounced and supply a good portion of the anterior spinal artery to the thorax

Adamkiewicz artery

Important during surgery, trauma, cancer because injury could result in anterior cord stroke.

Adamkiewicz artery

__ posterior spinal arteries

2

ASA vs. PSA Perfusion Territories

Anterior spinal stroke can be caused by damage to _____ artery

Adamkiewicz

______ funiculus All sensory all axons bundled up in highways to make mega highways

posterior

tend to be motor some sensory and autonomic but mostly motor

Lateral and anterior funiculus

Anterior funiculus and lateral funiculus tend to be motor some sensory and autonomic but mostly motor

Posterior funiculus all sensory

Lateral corticospinal

Anterior corticospinal

Corticobulbar

Vestibulospinal

Reticulospinal

Origin of lateral corticospinal tract

Primary motor Cotex, premotor Frontal

Origin of anterior corticospinal tract

Primary motor Cotex, premotor Frontal

Decussation of lateral corticospinal tract

Cervicomedullary junction

Termination of lateral corticospinal tract

Entire cord

Function of lateral corticospinal tract

Contralateral limb movement

Contralateral limb movement

Lateral corticospinal tract

Termination of anterior corticospinal tract

cervical and thoracic

Function of anterior corticospinal tract

Control of bilateral axial and girdle muscles

Control of bilateral axial and girdle muscles

Anterior corticospinal tract

Origin of corticobulbar tract

Primary motor

Termination of corticobulbar tract

Cranial nerve nuclei

Function of corticobulbar tract

Skeletal muscles of the head and neck via cranial nerves

Skeletal muscles of the head and neck via cranial nerves

Corticobulbar tract

Origin of vestibulospinal tract

Medial and Lateral VSTs

vestibular nuclei in pons and medulla

Termination of vestibulospinal tract

Medial VST: Cervical and Thoracic

Lateral VST: entire cord

Function of vestibulospinal tract

Medial VST: position of head and neck

Lateral VST: Balance

position of head and neck

balance

Medial vestibulospinal tract

Lateral vestibulospinal tract

Origin of reticulospinal tract

Reticular formation

Termination of reticulospinal tract

Entire cord