Spinal Column Product

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae.

Dorn Spinal Therapy Summary


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Spinal Cord Stimulation

Spinal cord stimulation (SCS) has been proposed as a novel treatment strategy that may be effective in end-stage ischemic heart disease patients with intractable angina. The efficacy of spinal cord stimulation on the relief of otherwise intractable angina pectoris was studied in a 2-mo randomized study with 1-yr follow-up by quality-of-life parameters, cardiac parameters, and complications. Twenty-four patients were randomized to either an actively treated group A (12 patients received the device within a 2-wk period) or a control group B (10 patients had implantation after the study period). Spinal cord stimulation improved both quality-of-life and cardiac parameters. The latter included a trend towards reduction in ischemia after implantation of the device in both exercise testing with a treadmill (ETT) and 24-h ambulatory Holter recordings, with a concomitant improvement in exercise capacity (55). Indices of ischemia were studied with and without SCS in 10 patients with otherwise...

Upper inset cervical spinal cord crosssection

The neurons of the spinal cord are organized as nuclei, the gray matter, and the various pathways are known as white matter. In the spinal cord, the gray matter is found on the inside, with the white matter all around. The divisions of the gray matter are introduced with Figure 4 the functional aspects will be described with the sensory (see Figure 32) and motor (see Figure 44) systems. The tracts of the spinal cord are described with the pathways in Section B (e.g., see Figure 33 and Figure 45). All the pathways are summarized in one cross-section (see Figure 68). Histological cross-sections of the spinal cord are also presented (see Figure 69).

Spinal Cord Injury Without Radiological Abnormality

Spinal cord injury without radiological abnormality (SCIWORA) is said to have occurred when the spinal cord has been injured without an obvious accompanying injury to the vertebral column. It occurs almost exclusively in children (usually those younger than eight years). The cervical spine is affected more frequently than the thoracic spine. SCIWORA occurs in up to 55 of all paediatric complete cord injuries. Since the upper segments of the cervical spine have the greatest mobility, the upper cervical cord is most susceptible to this injury. Children who are seriously injured should have immobilisation of the spine maintained until such time as a full neurological assessment can be carried out, since normal X-rays do not exclude a cord injury. If there is any doubt, MRI scans should be obtained.

Spinal cord compression

Compression of the spinal cord occurs in up to 5 of patients with cancer. The main problem in clinical practice is failure of recognition. It is not uncommon for a patient's weak legs to be attributed to general debility and urinary and bowel symptoms to be attributed to medication. Neurological symptoms and signs can vary from subtle to gross, from upper motor neurone Presentation of spinal cord compression can be subtle in the early stages. Any patient with back pain and subtle neurological symptoms or signs should have radiological investigations, with magnetic resonance imaging when possible

Abnormalities of the Spinal Canal

The limitations of plain film radiography in the assessment of the spinal canal and its content have long been recognized. Although osseous alterations are usually outlined, soft tissue abnormalities escape radiographic detection. Several common causes of spinal canal stenosis or widening, including intervertebral disc herniation, space-occupying intrame-dullary lesions, and dysraphic states, cannot be visualized. Similarly, compression effects on the spinal cord and nerve roots are not detected. Therefore, cross-sectional imaging, such as CT or MRI, is now routinely applied to assess the spinal canal and its content.

The blood supply of the spinal cord the spinal cord is supplied

With blood by spinal arteries that are derived from the vertebral, intercostal, lumbar and lateral sacral arteries. Each artery divides into dorsal and ventral branches that follow the corresponding nerve roots to the spinal cord where they form longitudinally arranged anterior and paired posterior spinal arteries. These longitudinal anastomoses, however, are incomplete and the spinal arteries themselves vary in size. The largest are in the lower thoracic and upper lumbar regions, and the blood supply of the cord may be jeopardized if some of these larger spinal arteries are damaged, for example in resection of the thoracic aorta.

Clinical Picture of Spinal Muscular Atrophy SMA

Spinal muscular atrophies are a genetically heterogeneous group of neuromuscular disorders with an autosomal or X-linked, recessive or dominant mode of inheritance. The majority of patients presents autosomal recessive inheritance with proximal manifestation of muscle weakness and atrophy, defined as autosomal recessive proximal spinal muscular atrophy (SMA). With an incidence of about 1 6,000 to 1 10,000, SMA is the second most frequent autosomal recessive disorder in humans (Pearn 1978 Czeizel and Hamula 1989). The carrier frequency, determined by direct molecular genetic testing, is 1 35 (Feldkotter et al. 2002 Cusin et al. 2003). The clinical features of the disease are basically caused by the progressive loss of alpha motor neurons in the anterior horns of the spinal cord, which leads to symmetrical weakness and atrophy of the proximal voluntary muscles of legs, arms, and even of the entire trunk during disease progression. Electromyographic investigations in patients show a...

Cervical Spine Immobilisation

All children with serious trauma must be treated as though they have a cervical spine injury. It is only when adequate investigations have been performed and a neurosurgical or orthopaedic consultation obtained, if necessary, that the decision to remove cervical spine protection should be taken. In-line cervical stabilisation should be continued until a hard collar has been applied, and sandbags and tape or head blocks are in position as described below. Two techniques are described. It is necessary to apply both to achieve adequate cervical spine control.

Cervical spine immobilisation techniques are described in Chapter 24 Injuries Of The Thoracic And Lumbar Spine

Injuries to the thoracic and lumbar spine are rare in children. They are most common in the multiply injured child. In the second decade, 44 of reported injuries result from sporting and other recreational activity. Some spinal injuries may result from non-accidental injury. When an injury does occur, it is not uncommon to find multiple levels of involvement because the force is dissipated over many segments in the child's mobile spine. This increased mobility may also lead to neurological involvement without significant skeletal injury. The most important clinical sign is a sensory level. Neurological assessment is difficult in children, and such a level may only become apparent after repeated examinations. Because of the difficulties of assessment, a child with multiple injuries should be assumed to have spinal injury, and should therefore be immobilised on a long spine board until investigations and examinations are complete. If injury is confirmed, further treatment is similar to...

Spinal Muscular Atrophy and Therapeutic Prospects

The molecular genetic basis of spinal muscular atrophy (SMA), an autosomal recessive neuromuscular disorder, is the loss of function of the survival motor neuron gene (SMN1). The SMN2 gene, a nearly identical copy of SMN1, has been detected as a promising target for SMA therapy. Both genes are ubiquitously expressed and encode identical proteins, but markedly differ in their splicing patterns While SMN1 produces full-length (FL)-SMN transcripts only, the majority of SMN2 transcripts lacks exon 7. Transcriptional SMN2 activation or modulation of its splicing pattern to increase FL-SMN levels is believed to be clinically beneficial and therefore a crucial challenge in SMA research. Drugs such as valproic acid, phenylbutyrate, sodium butyrate, M344 and SAHA that mainly act as histone deacetylase inhibitors can mediate both they stimulate the SMN2 gene transcription and or restore the splicing pattern, thereby elevating the levels of FL-SMN2 protein. Preliminary phase II...

Spinal routes of drug delivery

With improvements in catheter and pump technology, use of spinal lines is becoming more common in pain control. If the technique is carried out by appropriately trained personnel, complication rates are low, allowing flexible, long term analgesia that can be used in an outpatient setting. Catheters can be inserted either into the epidural space or into the subarachnoid (intrathecal) space, where the cerebrospinal fluid is found. The line may be tunnelled subcutaneously to reduce risks of infection and movement of the catheter. The choice of technique depends on several factors.

Cerebrospinal Fluid Pathway

Answer Key Brain

Both the brain and spinal cord have layers that cover the nervous tissue. These are known as the meninges. The cerebrospinal fluid (CSF) is produced in the choroid plexuses and then exits to the outside of the brain where it is absorbed in the venous sinus. Label and color the structures and trace the flow of cerebrospinal fluid in the schematic from its source to its reabsorption in the cardiovascular system. Answer Key a. Cerebrospinal fluid, b. Choroid plexus, c. Venous sinus, d. Interventricular foramen, e. Third ventricle, f. Cerebral aqueduct, g. Fourth ventricle

Spinal Cord And Spinal Nerves

Central Canal And Dura Layer

When seen in cross section, the spinal cord is composed of an internal arrangement of gray matter resembling a butterfly and an external white matter. The two thin strips of gray matter are the posterior gray horns and the more rounded sections are the anterior gray horns. The lateral gray horns are found in the thoracic and lumbar regions. The hole in the middle of the spinal cord is the central canal and the gray matter that surrounds the central canal is the gray commissure. The spinal cord has two main depressions in it, the posterior median sulcus and the anterior median fissure. Label the parts of the spinal cord and color in the regions. Attached to the spinal cord are the spinal nerves that take impulses from the spinal cord to the peripheral nerves and impulses to the spinal cord. The spinal nerves are mixed nerves that pass through the intervertebral foramina of the vertebral column. The spinal nerve splits into a dorsal root and a ventral root. The dorsal root ganglion is a...

Tethered Spinal Cord Images

Tethered Cord

Infant with a large dermal sinus tract associated with cord tethering and spinal dysraphism. On MRI there was a tethered cord and spina bifida both above and below the lesion. Figure 3.84. Small finger-like dermal tag extending from the mid-line of the back at the T4 level. Underlying the skin tag there was bony dysraphism with a small band of soft tissue extending toward the spinal cord. There were multiple rib anomalies with fusion of several upper thoracic ribs. MRI showed a spina bifida of the upper thoracic spine and tethering of the spinal cord distally. Figure 3.84. Small finger-like dermal tag extending from the mid-line of the back at the T4 level. Underlying the skin tag there was bony dysraphism with a small band of soft tissue extending toward the spinal cord. There were multiple rib anomalies with fusion of several upper thoracic ribs. MRI showed a spina bifida of the upper thoracic spine and tethering of the spinal cord distally.

Differential diagnosis Spinal cord epiconus medullary lesions

Guigui P, Benoist M, Benoist C, et al (1998) Motor deficit in lumbar spinal stenosis a References retrospective study of a series of 50 patients. J Spinal Disord 11 283-288 Hoffman HJ, Hendrick EB, Humphreys RB, et al (1976) The tethered spinal cord its protean manifestation, diagnosis and surgical correction. Childs Brain 2 145-155 Tyrell PNM, Davies AM, Evans N (1994) Neurological disturbances in ankylosing spondylitis. Ann Rheum Dis 53 714-717 Yates DAH (1981) Spinal stenosis. J R Soc Med 74 334-342

Cerebrospinal Ventricle

Csf Circulation

Cerebrospinal Fluid (CSF) Circulation of CSF Figure 2.11 Circulation of Cerebrospinal Fluid Figure 2.11 Circulation of Cerebrospinal Fluid CSF circulates through the four brain ventricles (two lateral ventricles and a third and fourth ventricle) and in the subarachnoid space surrounding the brain and spinal cord. Most of the CSF is Spinal Cord Ventral Rami

Hair At Lower End Of Spinal Cord In Newborn


A midline hair tuft in the lumbosacral area. This infant had a tethered cord on MRI study. Hair tufts, skin tags, sinuses, and abnormal pigmentation that occur in the midline along the length of the spinal column should always alert one to the possibility of an associated underlying neurologic abnormality. With a tethered cord the neural tissue is firmly attached at its caudal end, being bound by a stout connective tissue band to the interior of the bony canal. With growth, the spinal canal normally grows more rapidly than the spinal cord resulting in traction on the cord. This may gradually pull the lower end of the brainstem down into the foramen magnum like a cork into a bottle. This is the Arnold-Chiari malformation. Figure 3.58. A midline hair tuft in the lumbosacral area. This infant had a tethered cord on MRI study. Hair tufts, skin tags, sinuses, and abnormal pigmentation that occur in the midline along the length of the spinal column should always alert one to...

Spinal cord longitudinal view

The spinal cord is the extension of the CNS below the level of the skull. It is an elongated structure that is located in the vertebral canal, covered with the meninges dura, arachnoid, and pia and surrounded by the subarachnoid space containing cerebrospinal fluid (CSF) (see Figure 21). There is also a space between the dura and vertebra, known as the epidural space. Both of these spaces have important clinical implications (see Figure 2C and Figure 3). The spinal cord, notwithstanding its relatively small size compared with the rest of the brain, is absolutely essential for our normal function. It is the connector between the central nervous system and our body (other than the head). On the sensory (afferent) side, the information arriving from the skin, muscles, and viscera informs the CNS about what is occurring in the periphery this information then ascends to higher centers in the brain. On the motor (efferent) side, the nerves leave the spinal cord to control our muscles....

Osteoblastoma Of Spine

Tuberculous Spondylitis

Campomelic dysplasia in a newborn. Note marked kyphosis of the cervical spine. (From Lachman 1997 184252) vary in severity from minimal to severe (Spranger et al. 1974), they can be indistinguishable from those of metatropic dwarfism in older children and adolescents. In fact, generalized platyspondyly, kyphoscoliosis, and anteriorly wedged vertebrae are common to both disorders. Distinctive features in metatropic dwarfism include the pelvic shape (round, crescent-shaped iliac wings, underdevelop-ment of the basilar portions of the ilia) and the changes in the tubular bones (marked epiphyseal dysplasia). In infants with spondyloepiphyseal dysplasia congenita (OMIM 183900) the vertebral bodies are flat and dorsally wedged (pear-shaped), especially in the thoracic and upper lumbar spine. Thora- columbar kyphoscoliosis and lumbar lordosis, often of severe degree, are frequently found. The vertebral changes result in marked shortening of the spine in adulthood. Early-onset,...

Spinal cord mri t1 longitudinal view radiograph

Subarachnoid Mri Dog

This is a magnetic resonance image (MRI) of the vertebral column and spinal cord, viewed in a midsagittal plane. This is called a TI-weighted image, in which the cerebrospinal fluid (CSF) is dark. (The various radiological techniques used to image the nervous system are discussed below.) This image is from an adult, in which no pathology was found in the spinal cord radiological examination. Because of the length of the spinal cord, it is being shown in two parts upper and lower. The vertebral bodies, the intervertebral discs and the spinous processes posteriorly have been labeled, as well as the ligamentum flavum (discussed with the previous illustration). The vertebral bodies have been numbered at various levels C2, T1, L1, and S1. The UPPER portion shows the spinal cord to be a continuation of the medulla of the brainstem, at the lowermost border of the skull, the foramen magnum. The pons, medulla, and cerebellum are seen above foramen magnum occupying the posterior cranial fossa....

Spinal cord mri t2 axial views radiograph

Mri Spinal Root Axial View

MRI views of the spinal cord are shown in the axial plane at the C4 (fourth cervical vertebral) level the orientation should be noted with anterior (ventral) at the top. The CSF is bright in these T2-weighted images. The position of the spinal cord can be easily visualized within the vertebral canal, with the surrounding CSF space. The vertebral bodies and lamina are dark the muscles of the neck can be visualized. In both images it is possible to see the butterfly shape of the gray matter of the spinal cord (see Figure 1 and Figure 4). The orientation of the cord should be noted. In the upper image, the dorsal root and ventral root can be seen, as they head for the intervertebral foramen to form the spinal nerve (see Figure 1) neuroradiologists often call this the neural foramen. In the lower image, taken just a few millimeters below, the spinal nerve can be seen in the intervertebral (neural) foramen. Any abnormal protrusion of a vertebra or disc could be visualized, as well as...

Figure 49a pontine medial reticulospinal tract

Reticulospinal Tract

This tract originates in the pontine reticular formation from two nuclei the upper one is called the oral portion of the pontine reticular nuclei (nucleus reticularis pontis oralis), and the lower part is called the caudal portion (see Figure 42B). The tract descends to the spinal cord and is located in the medial region of the white matter (see Figure 68 and Figure 69) this pathway therefore is called the medial reticulo-spinal tract. The location of the tract in the brainstem is shown at cross-sectional levels of the mid-pons, the lower pons, the mid-medulla, and cervical and lumbar spinal cord levels. The tract is intermingled with others in the white matter of the spinal cord. FIGURE 49A Pontine (Medial) Reticulo-Spinal Tract

Spinal cord cauda equina photograph

Conus Medullaris Syndrome

This is a higher magnification photographic image of the lowermost region of the spinal cord, the sacral region. The tapered end of the spinal cord is called the conus med-ullaris, and this lower portion of the cord corresponds approximately to the sacral segments. The collection of dorsal and ventral nerve roots, below the level of the termination of the cord, is collectively called the cauda equina. These roots, which belong to the lumbar and sacral segments of the spinal cord, fill the expanded subarachnoid space in this region, known as the lumbar cistern (see Figure 3). The roots are traveling from the spinal cord levels to exit at their appropriate (embryological) intervertebral level (see Figure 1). The roots are floating in the CSF of the lumbar cistern. Sampling of CSF for the diagnosis of meningitis, an inflammation of the meninges, or for other neurological diseases, is done in the lumbar cistern. This procedure is called a lumbar puncture and must be performed using...

Spinal cord crosssectional views upper diagram

Dorsal Root

The upper diagram is a cross-section through the spinal cord at the C8 level, the eighth cervical segmental level of the spinal cord (not the vertebral level, see Figure 1). The gray matter is said to be arranged in the shape of a butterfly (or somewhat like the letter H). The gray matter of the spinal cord contains a variety of cell groups (i.e. nuclei), which subserve different functions. Although it is rather difficult to visualize, these groups are continuous longitudinally throughout the length of the spinal cord. The ventral gray matter, called the ventral or anterior horn, is the motor portion of the gray matter. The ventral horn has the large motor neurons, the anterior horn cells, which are efferent to the muscles (see Figure 44). These neurons, because of their location in the spinal cord, which is below the brain, are also known as lower motor neurons. (We will learn that the neurons in the cerebral cortex, at the higher level, are called upper motor neurons discussed with...

Spinal cord cervical region photograph

Ventral Dorsal Roots Spinal Cord

This is a higher magnification photographic image of the cervical region of the spinal cord. Most of the attached roots are the motor ventral roots, coming from the ventral horn of the spinal cord (discussed with Figure 4) a few of the dorsal sensory roots can be seen, which enter the cord in the dorsal horn. These roots exit the vertebral canal and carry a sleeve of arachnoid-dura with them for a very short distance, as they head for the intervertebral spaces (see Figure 1). The somewhat tortuous artery running down the mid-line of the cord is the anterior spinal artery. This artery, which is the major blood supply to the ventral portion of the upper part of the cord, is formed by a branch from each of the vertebral arteries (see Figure 58). This artery receives supplementary branches from the aorta along its way, called radicular arteries, which follow the nerve roots. There are two very small posterior spinal arteries. The most vulnerable area of the spinal cord blood supply is...

Spinal cord longitudinal view photograph

Cauda Equina Spinal Cord

This is a photographic image of the spinal cord removed from the vertebral canal. The dura-arachnoid has been opened and the anterior aspect of the cord is seen, with the attached spinal roots from this anterior perspective, most of the roots seen are the ventral (i.e., motor) roots. The spinal cord is divided into parts according to the region innervated cervical (8 spinal roots), thoracic (12 spinal roots), lumbar (5 spinal roots), sacral (5 spinal roots), and coccygeal (1 root). The nerve roots attached to the spinal cord, connecting the spinal cord with the skin and muscles of the body, give the cord a segmented appearance. This segmental organization is reflected onto the body in accordance with embryological development. Areas of skin are supplied by certain nerve segments each area is called a dermatome (e.g., inner aspect of the arm and hand C8 umbilical region T10), with overlap from adjacent segments. The muscles are supplied usually by two adjacent segments, called myotomes...

Defects of Spinal Alignment

This chapter provides an overview of the causes and characteristics of congenital scoliosis and kyphosis and of other varieties of spinal malalignment related to skeletal dysplasias, metabolic disorders, and malformation syndromes. A brief discussion of idiopathic scoliosis is also included. In patients with an abnormal spinal curve, plain film radiography is employed after clinical examination to confirm the presence of the spinal defect, estimate its magnitude and location, and rule out structural vertebral anomalies. In addition,plain film radiography can be used to estimate the rate of progression of the abnormal spinal curve on serial examinations.

What is kyphoplasty Would it help my spinal fractures

Spine Exercise

Spinal (or vertebral) fractures are a major concern for men and women with osteoporosis because they can lead to severe pain and disability (see Question 84). These fractures can also lead to kyphosis (see Figure 13 in Question 83). The spine deteriorates and curves due to fractures in individual vertebrae. Most osteoporotic vertebral fractures are traditionally treated with pain medications and a gradual return to normal activities. Although back braces to prevent twisting and support the spine were used in the past, they are infrequently For kyphoplasty, an incision is made in the spine under local anesthesia. The patient can be awake so that pain and neurological problems arising from the surgery can be immediately identified. An uninflated balloonlike instrument is inserted into the vertebra. The balloon is inflated, increasing the space within the vertebra. Sometimes this maneuver straightens the vertebra. Sometimes it doesn't. The balloon is removed and a special cement compound...

Surgical Spinal Cord Protection

The role of the perfusion of the distal aorta in preventing ischemic damage of the spinal cord and renal failure during surgery for traumatic aortic rupture has yet to be clarified. All surgical techniques that imply the use of aortic clamping at the level of the descending aorta disrupt the balance of blood pressure. Above the cross-clamp, a hypertensive regimen is established with an overload of work for the left ventricle below, a low blood pressure is established with ischemia that primarily affects the spinal cord and subsequently the kidneys and other abdominal organs. The risk of paraplegia, common in operations on the thoracic descending aorta, is particularly elevated in patients with traumatic aortic rupture, probably due to the lack of a collateral circulation that can potentially develop in cases of chronic disease (such as coarctations, atherosclerotic aneurysms, and chronic dissections). This complication is directly correlated For this reason, several efforts have been...

Spinal muscular atrophies

Emg Ncv Testing For Winged Scapula

The spinal muscular atrophies (SMAs) are hereditary motor neuron diseases that Anatomy cause the loss of alpha motor neurons in the spinal cord. At autopsy, the spinal SMN deletions in 95 of patients. Carrier testing is available. EMG and muscle biopsy show signs of denervation. Nerve conduction studies are normal. While these tests are often done early in the diagnosic process, they are unnecessary if a genetic diagnosis has been established. Cerebrospinal fluid analysis and serum creatine kinase are normal. impairment is detected using EMG with high frequency nerve stimulation. Stool examination for botulism can also confirm the diagnosis. SMA2 and 3 can be distinguished from chronic inflammatory demyelinating polyneuropathy by the presence of normal nerve conduction and cerebrospinal fluid protein studies. References Dubowitz V (1995) Disorders of the lower motor neurone the spinal muscular atrophies. In Muscle disorders in childhood, 2nd edn. Saunders, London, pp 325-369 Wang CH,...

Introduction To Motor Function Of Spinal Cord

Incoming sensory fibers, called afferents, have their input into the spinal cord as well as the brainstem, except for the special senses of vision and olfaction (which will be discussed separately). This sensory input is processed by relay nuclei, including the thalamus, before the information is analyzed by the cortex. In the cortex, there are primary areas that receive the information, other cortical association areas that elaborate the sensory information, and still other areas that integrate the various sensory inputs. On the motor side, the outgoing motor fibers, called efferents, originate from motor neurons in the brainstem and the spinal cord. These motor nuclei are under the control of motor centers in the brainstem and cerebral cortex. In turn, these motor areas are influenced by other cortical areas and by the basal ganglia, as well as by the cerebellum. Simpler motor patterns are organized as reflexes. In all cases, except for the myotatic (muscle) reflex, called the...

Spinal cord

The spinal cord ends inferiorly level with L3 at birth, rising to the adult level of L1-2 (sometimes T12 or L3) by 20 years. Below this level (the conus medullaris) the lumbar and sacral nerve roots (comprising the cauda equina) and filum terminale occupy the vertebral canal. The main ascending and descending tracts are shown in Fig. 10.4. Fig. 10.4 Ascending and descending tracts, spinal cord. Reproduced with permission from Yentis, Hirsch & Smith Anaesthesia and intensive care A-Z, 2nd edn, Butterworth Heinemann, 2000. The blood supply of the spinal cord is of relevance to obstetric anaesthetists, since Anterior spinal artery this descends in the anterior median fissure and supplies the anterior two-thirds of the cord. The anterior spinal artery syndrome (e.g. arising from profound hypotension) thus results in lower motor neurone paralysis at the level of the lesion, and spastic paraplegia, reduced pain and temperature sensation below the level and normal joint position sense and...

Spinal Deformities

These are the most commonly associated malformations with ARM. The most common of the spinal deformities are aberrations in the numbers and symmetrical development of the pelvic vertebrae. There are usually hemivertebrae present that will tilt the pelvis to a varying degree and, if extensive, may result in severe deformity of the lower body. The absence of several pelvic vertebrae is more often associated with urinary incontinence than with bowel incontinence. At times the spinal malformation may be very severe with lack of development of the sacrum and sacral nerve plexus, a condition know as caudal regression or caudal dysgenesis sequence. In these instances the baby's buttocks are flat and the gluteal crease is barely discernable. The clinical import of this condition is that the pelvic musculature and innervation are impossible to utilize. The establishment of an anal opening on the perineum will result in a perineal colostomy with little or no bowel control and no possibility of...

Spinal anaesthesia

High blocks associated with spinal anaesthesia are related to greater spread rather than deposition of local anaesthetic into the wrong space. This may result from use of hypobaric solutions, or compression of the dural sac from the outside as a result either of recent epidural top-up or of aortocaval compression, or it may represent an extreme of normal variation as anaesthetists have sought higher and higher blocks in order to avoid pain during surgery. The continuous presence of the anaesthetist and the immediate availability in the operating theatre of the necessary equipment and assistance ensure that further supportive measures are readily available if needed. Prevention of excessive block is achieved by using the minimum necessary dose of local anaesthetic, which should be hyperbaric to allow control of spread. Excessive barbotage should also be avoided. Maintenance of the natural kyphosis of the thoracic spine if in lateral tilt, or the use of pillows under the shoulders and...

Curves of the spine

In the fetus, the whole developing spine is curved so that it is concave forwards (primary curvature). A few months after birth the baby begins to hold its head up and the cervical spine develops a forward convexity (secondary curvature). Later in the first year the baby begins to stand up and another forward convexity develops in the lumbar region (secondary curvature). The primary curves are mainly due to the shape of the vertebral bodies but the secondary curves are due to the shape of the intervertebral discs.

Spinal injury

The casualty with suspected spinal injuries requires careful handling and should be managed supine, with the head and cervical spine maintained in the neutral anatomical position constant attention is needed to ensure that the airway remains patent. The head and neck should be maintained in a neutral position using a combination of manual inline immobilisation, a semi-rigid collar, sandbags, spinal board, and securing straps. The usual semi-prone recovery position should not be used because considerable rotation of the neck is required to prevent the casualty lying on his or her face. If a casualty must be turned, he or she should be log rolled into a true lateral position by several rescuers in unison, taking care to avoid rotation or flexion of the spine, especially the cervical spine. If the head or upper chest is injured, bony neck injury should be assumed to be present until excluded by lateral cervical spine radiography and examination by a specialist. Further management of the...

The spine

Spine Spine Spine Cervical vertebrae (Fig. 71.1) small bodies, bifid spines, transverse processes with anterior and posterior tubercles and a foramen transversarium for the passage of the vertebral artery. The body of the first vertebra (atlas) fuses with that of the second (axis) during development to produce its dens (odontoid process) which is held in place by a transverse ligament (Fig. 71.2). Thoracic vertebrae (Fig. 71.3) heart-shaped bodies, upper and lower demifacets for the heads of the ribs, long downturned spine, long transverse processes with a facet for the tubercles of the rib. Lumbar vertebrae (Fig. 71.4) a massive body, large transverse processes, a triangular vertebral canal and large, backwardly projecting spines so that a needle may be inserted between them in the operation of lumbar puncture. The articular facets face mediolaterally so that they prevent rotation.

Spinal column

The patient should be log rolled to examine the spine for tenderness and deformity. Sensory and motor deficits, priapism, and reduced anal tone will indicate the level of any cord lesion. Neurogenic shock is manifest by bradycardia and hypotension, the severity of which depends on the cord level of the lesion.

The spinal nerves

As has been described in Chapter 2, the spinal nerves from T2 to L1 supply segmental areas of skin and muscles but elsewhere they form plexuses so that the areas supplied by each nerve become more complicated. Each named peripheral nerve may contain components of more than one spinal nerve and each spinal nerve may contribute fibres to more than one peripheral nerve. However, the area of skin supplied by any one spinal nerve (a dermatome) can be mapped out and these are shown in Fig. 72.1. Knowledge of the dermatome map is of great value in diagnosing lesions of the spinal nerves but it must be remembered that these areas are subject to some variation from one person to another and there is also a good deal of overlap. Thus a lesion of, say, T4 may cause little or no loss of sensation because of overlap with T3 and T5. Similarly, certain groups of muscles (myotomes) can be recognized as being supplied by particular spinal nerves. For example, C5 supplies the abductors of the shoulder,...

What is spinal MS

Spinal MS was a term used for primary progressive MS but has not generally been used for the last 30 years or so. It was a good descriptor for this illness because the predominant symptoms were those of slowly progressive weakness and sensory problems, predominantly affecting the legs. In the past, it was especially difficult to distinguish from cervical spondylosis. Modern imaging has made this distinction much easier. For the sake of clarity, the term primary progressive MS is preferable.

Spinal Cord Gangliae

Thoracic Cavity Lateral View Anatomy

Regions of spinal cord Regions of spinal cord Spinal cord Spinal cord three numbered routes (1) the spinal nerve route, (2) the sympathetic nerve route, or (3) the splanchnic nerve route. Name the parts of the spinal cord where the somas of the sympathetic and somatic efferent neurons are located. Nerve fibers leave the paravertebral ganglia by three routes spinal, sympathetic, and splanchnic nerves. These are numbered in figure 15.5 to correspond to the following descriptions 1. The spinal nerve route. Some postganglionic fibers exit by way of the gray ramus, return to the spinal nerve or its subdivisions, and travel the rest of the way to the target organ. This is the route to most sweat glands, piloerector muscles, and blood vessels of the skin and skeletal muscles. The splanchnic6 nerve route. This route is formed by fibers that originate predominantly from spinal nerves T5 to T12 and pass through the ganglia without synapsing. Beyond the ganglia, they form greater, lesser, and...

Spinal Cord Sensory

Spinal Cord Posterior Horn Sensory

The peripheral nervous system (PNS) consists of all of the neural elements outside of the CNS (brain and spinal cord) and provides the connections between the CNS and all other body organ systems. The PNS consists of somatic and autonomic components. The somatic component innervates skeletal muscle and skin and is

Spinal Dysraphism

These defects will be discussed in terms of the sacrum, the vertebral canal, and the spinal cord 68,81 . The Spinal Cord, Cauda Equina It can be concluded that spinal dysraphism occurs in the absence of any osseous vertebral anomaly, in both anal and rectal malformations in both sexes, and that if abnormal anatomy is detected, its functional role in the physiological derangement of anorectal function has yet to be quantified accurately in these cases. There may be early and late defects, with agenesis of the spinal cord being a disturbance of primary neu-rilation (early embryonic period). Tethered cord may be a disturbance of degeneration or differentiation (late embryonic period). The conus medullaris 131 22. Cohen AR (1991) The mermaid malformation cloacal exstrophy and occult spinal dysraphism. Neurosurgery 28 834-843 23. Davidoff AM, Thompson CV, Grimm JM, Shorter NA, Filston (1991) Occult spinal dysraphism in patients with anal agenesis. J Pediatr Surg 26 1001-1005 27....

Spinal Dermal Sinus

Sacral Dermal Sinus

Left, photograph of another variant of a dermal sinus. Right, close-up of the same sinus. Dermal sinuses occur mid-line anywhere along the spinal cord and warrant examination of the central nervous system. Figure 3.86. Left, photograph of another variant of a dermal sinus. Right, close-up of the same sinus. Dermal sinuses occur mid-line anywhere along the spinal cord and warrant examination of the central nervous system. Figure 3.87. Midline skin defect with an inferior deep pilonidal dimple. MRI of the spinal column revealed a tethered spinal cord. A pilonidal sinus may connect with the underlying distal end of the spinal canal. This should be suspected when the bottom of a midline pit over the sacrum cannot be seen, if there is any fluid emerging from the depths of such a pit, or when the pit contains hairs.

Reticulospinal tract

Reticulospinal Tract

This tract originates in the medullary reticular formation, mainly from the nucleus gigantocellularis (meaning very large cells, see Figure 42A, Figure 42B, and Figure 67C). The tract descends more laterally in the spinal cord than the pontine pathway, and is thus named the lateral reticulo-spinal tract (see Figure 68 and Figure 69) some of the fibers are crossed. The tract lies beside the lateral vestib-ulo-spinal pathway. The location of the tract in the brainstem is shown at the cross-sectional levels of the mid-pons, the lower pons, the mid-medulla, and cervical and lumbar spinal cord levels, intermingled with other tracts in the white matter of the spinal cord (see Figure 68 and Figure 69). Lesions involving parts of the motor areas of the cerebral cortex, large lesions of the white matter of the hemispheres or of the posterior limb of the internal capsule, and certain lesions of the upper brainstem all may lead to a similar clinical state in which a patient is paralyzed or has...

The Spinal Cord

Such autonomic responses as the defecation and micturition (urination) reflexes are integrated in the spinal cord (see details in chapters 23 and 25). Fortunately, the brain is able to inhibit these responses consciously, but when injuries sever the spinal cord from the brain, the auto-nomic spinal reflexes alone control the elimination of urine and feces. 15. Name some visceral reflexes controlled by the spinal cord.

Reference to other figures

For certain parts of the nervous system, knowledge of the development contributes to an understanding of the structure seen in the adult. This is particularly so for the spinal cord, as well as for the ventricular system. Knowledge of development is also relevant for the cerebral hemispheres, and for the limbic system (i.e., the hippoc-ampal formation).

Nonvoluntary motor regulation

This pathway is very important in that it provides a link between the vestibular influences (i.e., gravity and balance) and the control of axial musculature, via the spinal cord. The main function is to provide corrective muscle activity when the body (and head) tilt or change orientation in space (activation of the vestibular system, CN VIII, see Figure 8B). The lateral vestibular nucleus receives its major inputs from the vestibular system and from the cerebellum there is no cerebral cortical input. This tract descends through the medulla and traverses the entire spinal cord in the ventral white matter (see Figure 68 and Figure 69). It does not decussate. The fibers terminate in the medial portion of the anterior horn, namely on those motor cells that control the axial musculature (see Figure 44). The same cross-sectional levels have been used as with the reticular formation, starting at the mid-pons. The vestibular nuclei are found at the lower pontine level and are seen through...

Motor systems introduction

There are multiple areas involved in motor control, which is the reason for the title Motor Systems (plural). The parts of the CNS that regulate the movement of our muscles include motor areas of the cerebral cortex, the basal ganglia (including the substantia nigra and the subthalamic nucleus), the cerebellum (with its functional subdivisions), nuclei of the brainstem including portions of the reticular formation, and finally the output motor neurons of the cranial nerve motor nuclei and the spinal cord (the anterior horn cells, also known as the lower motor neurons). The direct voluntary pathway, for the control of fine motor movements, includes the cortico-bulbar fibers to cranial nerve nuclei and the cortico-spinal fibers and its pathway continuation in the spinal cord, the lateral cortico-spinal tract. culus. The large neurons of the motor strip (in the deeper cortical layers) send their axons as projection fibers to form the cortico- bulbar and cortico-spinal tracts. It is this...

Figure 65 figure 65a and figure 65b

The midbrain area is easily recognizable from the anterior view in a dissected specimen of the isolated brain-stem (see Figure 7). The massive cerebral peduncles are located most anteriorly. These peduncles contain axons that are a direct continuation of the fiber systems of the internal capsule (see Figure 26). Within them are found the pathways descending from the cerebral cortex to the brainstem (cortico-bulbar, see Figure 46 and Figure 48), to the cerebellum via the pons (cortico-pontine, see Figure 48 and Figure 55), and to the spinal cord (cortico-spinal tracts, see Figure 45 and Figure 48).

Indirect voluntary and nonvoluntary motor regulation

The indirect voluntary pathway, the cortico-reticulo-spinal pathway, is thought to be an older pathway for the control of movements, particularly of proximal joints and the axial musculature. Therefore, some voluntary movements can still be performed after destruction of the cor-tico-spinal pathway (discussed with Figure 45). Muscle tone and reflex responsiveness are greatly influenced by activity in the reticular formation as part of the nonvolun-tary motor system it is important to note that cortical input to the reticular formation is part of this regulation. There are two pathways from the reticular formation to the spinal cord one originates in the pontine region (this illustration) and one in the medullary region (next illustration).

The medulla figure 67 figure 67a figure 67b and figure 67c

The pyramids, located ventrally, are an elevated pair of structures located on either side of the midline (see Figure 6 and Figure 7). They contain the cortico-spinal fibers that have descended from the motor areas of the cortex and now emerge as a distinct bundle (see Figure 45 and Figure 48). Most of its fibers cross (decussate) at the lowermost part of the medulla. The inferior olive (nucleus) is a prominent structure that has a distinct scalloped profile when seen in cross-section. It is so large that it forms a prominent bulge on the lateral surface of the medulla (see Figure 6 and Figure 7). Its fibers relay to the cerebellum (see Figure 55). Cranial nerves IX, X, and XII are attached to the medulla and have their nuclei here part of CN VIII is also represented in the uppermost medulla. The most prominent nucleus of the reticular formation in this region is the nucleus gigantocellularis (see Figure 42A and Figure 42B) the descending fibers form the lateral reticulo-spinal tract...

Figure 66 figure 66a figure 66b and figure 66c

The pons is characterized by its protruding anterior (ventral) portion, the pons proper, also called the basilar portion of the pons, with the basilar artery lying on its surface (see Figure 15A and Figure 58). This area contains the pontine nuclei, the site of relay of the cortico-pontine fibers (see Figure 48) the ponto-cerebellar fibers then cross and enter the cerebellum via the middle cerebellar peduncle (see Figure 55). Intermingled with the pontine nuclei are the dispersed fibers, which belong to the cortico-spinal system (see Figure 45 and Figure 48).

Midsagittal Brain To Label

Midsagittal Section Human Brain

When seen from an inferior view, many different features can be seen on the brain. The frontal lobe is anterior and the temporal lobe and cerebellum are visible as well. The cerebellum has small folds called folia. The medulla oblongata is attached to the spinal cord and the pons is anterior to the medulla oblongata. Anterior to the pons are the mammillary bodies which are responsible for the olfactory (smell) reflex. The pituitary gland is next to the mammillary bodies. Anterior to

Overview Of The Nervous System

Label The Parts The Synapses

The body must react to the external environment and the internal environment and communicate information between regions of the body. This job is primarily the task of the nervous system. Proper response to the external environment is critical for thermal regulation, response to threats, taking advantage of opportunities such as food availability, and a host of other stimuli. Response to the internal environment is important for sensing muscle tension, digestive processes, maintenance of blood pressure, and other functions. Communication is important for coordination of activities such as walking, digestion, and maintenance of blood pressure. The nervous system also integrates information from the environment, relates past information to the present and interprets new experiences. The brain and the spinal cord make up the central nervous system. The nerves of the body make up the peripheral nervous system. The peripheral nervous system is divided into the somatic nervous system which...

Ilium Ischium Pubis Labeling

Anterior Portion The Acetabulum

When seen from a lateral view, several features are apparent in the os coxa. Locate the posterior superior iliac spine and the posterior inferior iliac spine along with the greater sciatic notch, the spine of the ischium, and the lesser sciatic notch. The ischial tuberosity is at the posterior, inferior edge of the ischium. Just anterior to the tuberosity is a strip of bone called the ischial ramus that attaches to the inferior pubic ramus. The body of the pubis is the most anterior part of the pubis and the superior pubic ramus is the portion that forms part of the acetabulum. Label and color these features on the illustration.

Male And Female Pelvis

Posterior Inferior Iliac Spine

Posterior superior iliac spine, c. Posterior inferior iliac spine, d. Greater sciatic notch, e. Spine of the ischium, f. Lesser sciatic notch, g. Ischial tuberosity, h. Ischial ramus, i. Anterior superior iliac spine, j. Anterior inferior iliac spine, k. Superior pubic ramus, I. Inferior pubic ramus, m. Obturator foramen, n. Acetabulum, o. Iliac blade, p. Subpubic angle, q. Male (less than ninety degrees), r. Female (more than ninety degrees)

Cervical Thoracic And Lumbar Vertebrae

Canine Thoracic Vertebrae

The opening where the spinal cord passes through the vertebra is known as the vertebral foramen. The body of the vertebra is the weight-bearing part of the vertebra and the spinous process is the part that extends posteriorly. This process is an extension from the vertebral arch that curves from the body enclosing the vertebral foramen. This arch is composed of the two pedicles and the two laminae. The superior articular process and the superior articular facet (the flat surface on the process) are the parts that join with the vertebra above. The inferior articular process and the inferior articular facet are the parts of the vertebra that join with the vertebra below.

Nerves Of Brachial Plexus

Nerves And

The brachial plexus is associated with spinal nerves C4-8 and T1. It leads to major nerves of the shoulder and arm. The axillary nerve arises from the brachial plexus and innervates the deltoid and the teres minor muscles. It also receives stimulation from the skin of the shoulder and lateral upper limb. The radial nerve innervates the triceps brachii muscle and the extensors of the forearm and hand. The musculocutaneous nerve innervates the anterior muscles of the arm (biceps brachii,

Cervical Curvature Labeled

Spinal Nervous System Without Labels

We are unique as animals because of our upright posture. The vertical position of the spine is reflected in the increase in size of the vertebra from superior to inferior. The vertebral column is divided into five major regions. There are 7 cervical vertebrae that occur in the neck while the 12 thoracic vertebrae have ribs attached to them. The 5 lumbar vertebrae are found in the lower back and the sacrum consists of 5 fused sacral vertebrae. The coccyx is the terminal portion of the vertebral column consisting of 4 coccygeal vertebrae. The vertebral column in the adult has curves. The uppermost is the cervical curvature and the lower ones are the thoracic, lumbar, and pelvic curvatures. Label the illustration with the regions and the curvatures and color in the regions with different colors. Color in the curved arrows for the curvatures.

Superior Laryngeal Nerve

Sacral Outflow

Vagus nerve (X) Internal carotid nerve and plexus Superior cervical sympathetic ganglion C4 spinal nerve Middle cervical sympathetic ganglion Vertebral ganglion Cervicothoracic (stellate) ganglion Sympathetic trunk 6th intercostal nerve (ventral ramus of T6 spinal nerve)

Dorsal Root Filaments

Ventral Dorsal Rami

Spinal Cord Membranes and Nerve Roots Ventral root of spinal nerve Dorsal root of spinal nerve Spinal sensory (dorsal root) ganglion Ventral ramus of spinal nerve Dorsal ramus of spinal nerve Dura mater Subarachnoid space Pia mater overlying spinal cord Filaments of dorsal root Ventral ramus of spinal nerve Dorsal ramus of spinal nerve Dura mater Subarachnoid space Pia mater overlying spinal cord Filaments of dorsal root Figure 2.13 Spinal Membranes and Nerve RootsP Dorsal root of spinal nerve Spinal sensory (dorsal root) ganglion Dorsal ramus of spinal nerve Ventral ramus of spinal nerve Ventral root of spinal nerve Spinal nerve Figure 2.13 Spinal Membranes and Nerve RootsP The spinal cord gives rise to 31 pairs of spinal nerves that distribute segmentally to the body. Motor fibers of these spinal nerves innervate skeletal muscle, and sensory fibers convey information back to the central nervous system from the skin, skeletal muscles, and joints. The spinal cord is ensheathed in...

Internal Vertebral Venous Plexus

How Dissect Dorsal Root Ganglion

Spinal Nerve Origin Cross Sections Spinal nerve Recurrent meningeal branches of spinal nerve Spinal nerve of dorsal ramus of spinal nerve Spinal sensory (dorsal root) ganglion Lateral horn of gray matter of spinal cord Spinal sensory (dorsal root) ganglion Lateral horn of gray matter of spinal cord Dorsal and ventral roots of lumbar and sacral spinal nerves forming cauda equina Dorsal and ventral roots of lumbar and sacral spinal nerves forming cauda equina Arachnoid mater Ventral root Spinal nerve Spinal sensory (dorsal root) ganglion Dorsal root Conus medullaris of dorsal ramus of spinal nerve

Plexuses And Thoracic Nerves

Sacral Plexus And Spinal Cord

There are 31 pairs of spinal nerves grouped by region of the vertebral column. The cervical nerves are the most superior and there are eight pairs of them. The first cervical nerves arise superior to the first cervical vertebra. The thoracic nerves arise as twelve pairs. They lead to nerves that innervate the muscles between the ribs and associated skin. There are five pairs of lumbar nerves and five pairs of sacral nerves. The last pair of spinal nerves is the coccygeal nerves. A plexus is a web-like arrangement of nerves that is near the spinal cord and gives rise to the terminal nerves. The most superior plexus is the cervical plexus which arises from the first five cervical spinal nerves. The brachial plexus receives input from the fifth through eighth cervical nerves and the first pair of thoracic nerves. The lumbar plexus arises from the first four pairs of lumbar nerves and the sacral plexus is associated with the last two pairs of lumbar nerves and the first four pairs of...

Brainstem and diencephalon ventral view

Cerebellar Flocculus

The brainstem is the lowermost part of the brain and is located above the spinal cord. It can be seen by viewing the brain from below (see Figure 15A also Figure OA and Figure OL). This specimen has been obtained by dissecting out the brainstem, and cerebellum, along with the diencephalon a photographic view of this specimen is shown in the next illustration (Figure 7). The dienceph-alon will be described subsequently (see Figure 11 and Figure 12). In the human brain, the brainstem is a relatively small mass of brain tissue compared to the large hemispheres, but it is packed with various nuclei and tracts. Among these nuclei are those of 10 of the cranial nerves (CN III to CN XII). Many basic brain activities are located in the brainstem, including key vital functions (control of blood pressure, pulse, and respiration). Some motor functions are found at various brainstem levels, some as part of the reticular formation the reticular formation is also part of a system that is...

Figure 66 upper pons photographic view

Pontocerebellar Fibers

The ventral region has the distinctive appearance of the pontine nuclei, with the cortico-spinal and cortico-pontine fibers dispersed among them. The pontine tegmen-tum seems quite compressed. The space in the middle of the tissue section is the fourth ventricle, as it begins to widen. Behind the ventricle is a small area of white matter, called the superior medullary velum (see Figure 10 and Figure 41B). The thin folia of the cerebellum are easily recognized, with an inner strip of white matter bounded on either side by the thin gray matter of the cerebellar cortex. Cortico-spinal fibers

Mlf and associated tracts

Medial Longitudinal Fasciculus

This diagram shows the brainstem from the posterior perspective (as in Figure 10 and Figure 40). Note the orientation of the spinal cord (with the ventral horn away from the viewer). The MLF is a tract within the brainstem and upper spinal cord that links the visual world and vestibular events with the movements of the eyes and the neck, as well as linking up the nuclei that are responsible for eye movements. The tract runs from the midbrain level to the upper thoracic level of the spinal cord. It has a rather constant location near the midline, dorsally, just anterior to the aqueduct of the midbrain and the fourth ventricle (see brainstem cross-sections, e.g., Figure 65A, Figure 66A, and Figure 67A). Vestibular fibers Of the four vestibular nuclei (see previous illustration), descending fibers originate from the medial vestibular nuclei and become part of the MLF this can be named separately the medial vestibulo-spinal tract. There are also ascending fibers that come from the medial,...

Pain temperature crude touch

Anterolateral Tract

These incoming fibers (sometimes called the first order neuron) enter the spinal cord and synapse in the dorsal horn (see Figure 4 and Figure 32). There are many collaterals within the spinal cord that are the basis of several protective reflexes (see Figure 44). The number of synapses formed is variable, but eventually a neuron is reached that will project its axon up the spinal cord (sometimes referred to as the second order neuron). This axon will cross the midline, decussate, in the ventral (anterior) white commissure, usually within two to three segments above the level of entry of the peripheral fibers (see Figure 4 and Figure 32). These axons now form the anterolateral tract, located in that portion of the white matter of the spinal cord. It was traditional to speak of two pathways one for pain and temperature, the lateral spino-thalamic tract, and another for light (crude) touch, the anterior (ventral) spino-thalamic tract. Both are now considered together under one name. The...

Sensory nuclei and ascending tracts

Spinal Nucleus Trigeminal

This diagrammatic presentation of the internal structures of the brainstem is shown from the dorsal perspective (as in Figure 10 and Figure 36). The information concerning the various structures will be presented in an abbreviated manner, as most of the major points have been reviewed previously. The orientation of the cervical spinal cord representation should be noted. The dorsal columns (gracile and cuneate tracts) of the spinal cord terminate (synapse) in the nuclei gracilis and cuneatus in the lowermost medulla (see Figure 9B). Axons from these nuclei then cross the midline (decussate) as the internal arcuate fibers (see Figure 67C), forming a new bundle called the medial lemniscus. These fibers ascend through the medulla, change orientation in the pons, and move laterally, occupying a lateral position in the mid-brain. This tract, having already crossed in the spinal cord, ascends and continues through the brainstem. In the medulla it is situated posterior to the inferior olive....

Septal region and limbic midbrain

The two major limbic pathways, the medial forebrain bundle and a descending tract from the mammillary nuclei (the mammillo-tegmental tract), terminate in the midbrain reticular formation. From here, there are apparently descending pathways that convey the commands to the parasympathetic and other nuclei of the pons and medulla (e.g., the dorsal motor nucleus of the vagus, the facial nucleus for emotional facial responses), and areas of the reticular formation of the medulla concerned with cardiovascular and respiratory control mechanisms (discussed with Figure 42A and Figure 42B). Other connections are certainly made with autonomic neurons in the spinal cord (i.e., for sympathetic-type responses).

Figure 66a upper pons crosssection

Trochlear Nerve Pathway

Anteriorly, the pontine nuclei are beginning to be found. Cortico-pontine fibers will be terminating in the pontine nuclei. From these cells, a new tract is formed that crosses and projects to the cerebellum forming the middle cerebellar peduncle. The cortico-spinal fibers become dispersed between these nuclei and course in bundles between them (see Figure 45 and Figure 48). Cortico-spinal tract Cortico-spinal tract

Discriminative touch pain temperature

Lateral Medullary Syndrome

The fibers enter the brainstem along the middle cere-bellar peduncle (see Figure 6 and Figure 7). Within the CNS there is a differential handling of the modalities, comparable to the previously described pathways in the spinal cord. Those fibers carrying the modalities of pain and temperature descend within the brainstem. They form a tract that starts at the mid-pontine level, descends through the medulla, and reaches the upper level of the spinal cord (see Figure 8B) called the descending or spinal tract of V, also called the spinal trigeminal tract. Immediately medial to this tract is a nucleus with the same name. The fibers terminate in this nucleus and, after synapsing, cross to the other side and ascend (see Figure 40). Therefore, these fibers decussate over a wide region and do not form a compact bundle of crossing fibers they also send collaterals to the reticular formation. These trigeminal fibers join with those carrying touch, forming the trigeminal pathway in the mid-pons....

Vestibular nuclei and eye movements

Lateral Vestibular Spinal Tract

The vestibular information is carried to four vestibular nuclei, which are located in the upper part of the medulla and lower pons superior, lateral, medial, and inferior (see Figure 8B also Figure 66C, Figure 67A, and Figure 67B). The lateral vestibular nucleus gives rise to the lateral vestibulo-spinal tract (as described in the previous illustration see also the following illustration). This is the pathway that serves to adjust the postural musculature to changes in relation to gravity. The medial and inferior vestibular nuclei give rise to both ascending and descending fibers, which join a conglomerate bundle called the medial longitudinal fasciculus (MLF) (described more fully with the next illustration). The descending fibers from the medial vestibular nucleus, if considered separately, could be named the medial vestibulo-spinal tract (see Figure 68). This system is involved with postural adjustments to positional changes, using the axial musculature. There is a small nucleus in...

Figure 66c lower pons crosssection

Anterolateral System Caudal Pons

This section is very complex because of the number of nuclei related to the cranial nerves located in the tegmental portion, including CN V, VI, VII, and VIII. Some of the tracts are shifting in position or forming. Anteriorly, the pontine nuclei have all but disappeared, and the fibers of the cortico-spinal tract are regrouping into a more compact bundle, which will become the pyramids in the medulla (below). CN V The fibers of the trigeminal nerve carrying pain and temperature, that entered at the mid-pontine level, form the descending trigeminal tract, also called the spinal tract of V medial to it is the corresponding nucleus (see Figure 8B). The descending fibers synapse in this nucleus as this pathway continues through the medulla, cross, and then ascend (see Figure 35), eventually joining the medial lemniscus in the upper pons (see Figure 36). CN VIII Vestibular division Of the four vestibular nuclei (see Figure 51A and Figure 51B), three are found at this level. The lateral...

Discriminative touch joint position vibration

Dorsal Column Tract

The axons enter the spinal cord and turn upward, with no synapse (see Figure 32). Those fibers entering below spinal cord level T6 (sixth thoracic spinal segmental level) form the fasciculus gracilis, the gracile tract those entering above T6, particularly those from the upper limb, form the fasciculus cuneatus, the cuneate tract, which is situated more laterally. These tracts ascend the spinal cord between the two dorsal horns, forming the dorsal column (see Figure 32, Figure 68, and Figure 69). The cross-sectional levels for this pathway include the lumbar and cervical spinal cord levels, and the brainstem levels, lower medulla, mid-pons, and upper midbrain. In the spinal cord, the pathways are found between the two dorsal horns, as a well myelinated bundle of fibers, called the dorsal column(s). The tracts have a topographical organization, with the lower body and lower limb represented in the medially placed gracile tract, and the upper body and upper limb in the laterally placed...

Figure 67c lower medulla crosssection

Area Postrema Anatomy Pictures

The medulla seems significantly smaller in size at this level, approaching the size of the spinal cord below. The section is still easily recognized as medullary because of the presence of the pyramids anteriorly (the cortico-spinal tract) and the adjacent inferior olivary nucleus. The dorsal aspect of the medullary tegmentum is occupied by two large nuclei the nucleus cuneatus (cuneate nucleus) laterally, and the nucleus gracilis (gracile nucleus) more medially. These are found on the dorsal aspect of the medulla (see Figure 9B and Figure 40). These nuclei are the synaptic stations of the tracts of the same name that have ascended the spinal cord in the dorsal column (see Figure 33, Figure 68, and Figure 69). The gracilis is mainly for the upper limb and upper body the cuneatus carries information from the lower body and lower limb. The fibers relay in these nuclei and then move through the medulla anteriorly as the internal arcuate fibers, cross (decussate), and form the medial...

Figure 67a upper medulla crosssection

Anterior Ventral Cochlear Nucleus

The cortico-spinal voluntary motor fibers from areas 4 and 6 go through the white matter of the hemispheres, funnel via the internal capsule (posterior limb), continue through the cerebral peduncles of the midbrain and the pontine region, and emerge as a distinct bundle in the medulla within the pyramids. The cortico-spinal tract is often called the pyramidal tract because its fibers form the pyramids (discussed with Figure 45). The other prominent tract in the upper medullary region is the inferior cerebellar peduncle. This tract is conveying fibers to the cerebellum, both from the spinal cord and from the medulla, including the inferior olivary nucleus (discussed with Figure 55). The core area is occupied by the cells of the reticular formation (see Figure 42A and Figure 42B). The most prominent of its nuclei at this level is the gigantocellular nucleus (noted for its large neurons), which gives rise to the lateral reticulo-spinal tract (see Figure 49B). The other functional aspects...

Functional neuroanatomy of the cns

The basic unit of the CNS is the spinal cord (see Figure 1 and Figure 2), which connects the CNS with the skin and muscles of the body. Simple and complex reflex circuits are located within the spinal cord. It receives sensory information (afferents) from the skin and body wall, which are then transmitted to higher centers of the brain. The spinal cord receives movement instructions from the higher centers and sends motor commands (efferents) to the muscles. Certain motor patterns are organized in the spinal cord, and these are under the influence of motor areas in other parts of the brain. The autonomic nervous system, which supplies the internal organs and the glands, is also found within the spinal cord. As the functional systems of the brain become more complex, new control centers have evolved. These are often spoken of as higher centers. The first set of these is located in the brainstem, which is situated above the spinal cord and within the skull (in humans). The brain-stem...

Direct voluntary pathway

Pyramidal System

The cortico-spinal tract, a direct pathway linking the cortex with the spinal cord, is the most important one for voluntary motor movements in humans. This pathway originates mostly from the motor areas of the cerebral cortex, areas 4 and 6 (see Figure 14A, Figure 17, and Figure 60 discussed in Section B, Part III, Introduction and with Figure 48). The well-myelinated axons descend through the white matter of the hemispheres, through the posterior limb of the internal capsule (see Figure 26, Figure 27, Figure 28A, and Figure 28B), continue through the midbrain and pons (see below) and are then found within the medullary pyramids (see Figure 6 and Figure 7). Hence, the cortico-spinal pathway is often called the pyramidal tract, and clinicians may sometimes refer to this pathway as the pyramidal system. At the lowermost part of the medulla, most (90 ) of the corticospinal fibers decussate (cross) in the pyramidal decussation (see Figure 7) and form the lateral cortico-spinal tract in...

Voluntarynonvoluntary motor control

Red Nucleus

The red nucleus is a prominent nucleus of the midbrain. It gets its name from a reddish color seen in fresh dissections of the brain, presumably due to its high vascularity. The nucleus (see Figure 48, Figure 51B, and Figure 65A) has two portions, a small-celled upper division and a portion with large neurons more ventrally located. The rubro-spinal pathway originates, at least in humans, from the larger cells. The red nucleus receives its input from the motor areas of the cerebral cortex and from the cerebellum (see Figure 53). The cortical input is directly onto the projecting cells, thus forming a potential two-step pathway from motor cortex to spinal cord. The rubro-spinal tract is also a crossed pathway, with the decussation occurring in the ventral part of the mid-brain (see also Figure 48 and Figure 51B). The tract descends within the central part of the brainstem (the tegmentum), and is not clearly distinguishable from other fiber systems. The fibers then course in the lateral...

Pain modulation system

Nucleus Cajal

We have a built-in system for dampening the influences of pain from the spinal cord level the descending pain modulation pathway. This system apparently functions in the following way The neurons of the periaque-ductal gray can be activated in a number of ways. It is known that many ascending fibers from the anterolateral system and trigeminal system activate neurons in this area (only the anterolateral fibers are being shown in this illustration), either as collaterals or direct endings of these fibers in the midbrain. This area is also known to be rich in opiate receptors, and it seems that neurons of this region can be activated by circulating endorphins. Experimentally, one can activate these neurons by direct stimulation or by a local injection of morphine. In addition, descending cortical fibers (cortico-bulbar) may activate these neurons (see Figure 46). The axons of some of the neurons of the periaqueduc-tal gray descend and terminate in one of the serotonin-containing raphe...

White matter medial dissected view corpus callosum photograph

Corpus Callosum

The structures that are found within the depths of the cerebral hemispheres include the white matter, the cerebral ventricles, and the basal ganglia (see Figure OA and Figure OL). The white matter consists of the myelinated axonal fibers connecting brain regions. In the spinal cord these were called tracts in the hemispheres these bundles are classified in the following way (also discussed with Figure 16) association bundles, projections fibers, and commissural connections.

Lower inset nerve roots

Need Images Cervical Nerve Root

The dorsal root (sensory) and ventral root (motor) unite within the intervertebral foramina to form the (mixed) spinal nerve (see also Figure 5). The nerve cell bodies for the dorsal root are located in the dorsal root ganglion (DRG). Both the roots and the dorsal root ganglion belong to the peripheral nervous system (PNS) (where the Schwann cell forms and maintains the myelin). During early development, the spinal cord is the same length as the vertebral canal and the entering exiting nerve roots correspond to the spinal cord vertebral levels. During the second part of fetal development, the body and the bony spine continue to grow, but the spinal cord does not. After birth, the spinal cord only fills the vertebral canal to the level of L2, the second lumbar vertebra (see also Figure 3). The space below the termination of the spinal cord is the lumbar cistern, filled with cere-brospinal fluid. Therefore, as the spinal cord segments do not correspond to the vertebral segments, the...

Autonomic Nervous Systemsym Path Etic Division

The sympathetic division controls the fight or flight response of the body, shutting down the digestive functions, inhibiting erections, shunting blood away from the kidneys, and dilating the pupils. The sympathetic division increases heart rate, dilates capillaries in the lungs, brain and muscle tissue, and stimulates the adrenal glands. This division is also known as the thoracolumbar division because the nerves exit the CNS in the thoracic and lumbar regions of the spinal cord. There are ganglia associated with the sympathetic division and these are located on either side of the ventral portion of the vertebral column. They are called the sympathetic chain ganglia and the neurons from the thoracolumbar division synapse with nerve cells in these ganglia.

Ventricles anterior view

CSF flows from the third ventricle into the aqueduct of the midbrain. This ventricular channel continues through the midbrain, and then CSF enters the fourth ventricle, which also straddles the midline. The ventricle widens into a diamond-shaped space, when seen from the anterior perspective. This ventricle separates the pons and medulla anteriorly from the cerebellum posteriorly. The lateral recesses carry CSF into the cisterna magna, the CSF cistern outside the brain (see Figure 21), through the foramina of Luschka, the lateral apertures, one on each side. The space then narrows again, becoming a narrow channel at the level of the lowermost medulla, which continues as the central canal of the spinal cord (see Figure 4). Sc Spinal cord

Nuclei of the brainstem

Wide areas of the cortex send fibers to the brainstem as projection fibers (see Figure 16). These axons course via the internal capsule and continue into the cerebral peduncles of the midbrain (see Figure 26). The fibers involved with motor control occupy the middle third of the cerebral peduncle along with the cortico-spinal tract (described with the previous illustration see Figure 48), supplying the motor cranial nerve nuclei of the brainstem (see Figure 8A and Figure 48), the reticular formation and other motor-associated nuclei of the brainstem.


Section A The Atlas starts with an Overview of the various parts of the central nervous system, the CNS. Then we embark on an Orientation to the structural components of the CNS, and this is presented from the spinal cord upward to the brain additional material on the spinal cord is added in other parts of the Atlas. Radiographic images have been included, because that is how the CNS will be viewed and investigated in the clinical setting. omy, includes a neurological orientation and detailed neu-roanatomical information, to allow the student to work through the neurological question Where is the disease process occurring (i.e., neurological localization) Because vascular lesions are still most common and relate closely to the functional neuroanatomy, the blood supply to the brain is presented in some detail, using photographs with overlays. The emphasis in this section is on the brain-stem, including a select series of histological cross-sections of the human brainstem. In addition,...


Muscular Organ System

The human body is either studied by regions or by organs systems. This book uses the organ system approach in which individual organs (such as bones) are grouped into the larger organ system (for example, the skeletal system). Typically eleven organ systems are described. The skeletal system consists of all of the bones of the body. Examples are the femur and the humerus. The nervous system consists of the nerves, spinal cord, and brain while the lymphatic system consists of lymph glands, conducting tubes called lymphatics, and organs such as the spleen. The term immune system is more of a functional classification Humerus Spinal cord Spleen Deltoid b. Femur, c. Skeletal, d. Brain, e. Spinal cord, f. Nerves,

Lumbar level l3

This cross-sectional level of the spinal cord has been used in the various illustrations of the pathways in Section B of this atlas. This cross-section is similar in appearance to the cervical section, because both are innervating the limbs. There is, however, proportionately less white matter at the lumbar level. The descending tracts are smaller because many of the fibers have terminated at higher levels. The ascending tracts are smaller because they are conveying information only from the lower regions of the body. The sacral region of the spinal cord is the smallest in size and is therefore easy to recognize (not shown). The white matter is quite reduced in size. There is still a fair amount of gray matter because of the innervation of the pelvic musculature. This region of the spinal cord, roughly the conus med-ullaris (see Figure 2A), also contains the preganglionic parasympathetic neurons of the autonomic nervous system. These neurons innervate the bowel and the bladder.

Upper figure

The dorsal horn of the spinal cord has a number of nuclei related to sensory afferents, particularly pain and temperature, as well as crude touch. The first nucleus encountered is the posteromarginal, where some sensory afferents terminate. The next and most prominent nucleus is the substantia gelatinosa, composed of small cells, where many of the pain afferents terminate. Medial to this is the proper sensory nucleus, which is a relay site for these fibers neurons in this nucleus project across the midline and give rise to a tract the anterolateral tract (see below and Figure 34). There is a small local tract that carries pain and temperature afferents up and down the spinal cord for a few segments, called the dorsolateral fasciulus (of Lissauer).

Lower illustration

In the spinal cord, the neurons that are located in the ventral or anterior horn, and are (histologically) the anterior horn cells, are usually called the lower motor neurons. Physiologists call these neurons the alpha motor neurons. In the brainstem, these neurons include the motor neurons of the cranial nerves (see Figure 8A). Since all of the descending influences converge upon the lower motor neurons, these neurons have also been called, in a functional sense, the final common pathway. The lower motor neuron and its axon and the muscle fibers that it activates are collectively called the motor unit. The intact-ness of the motor unit determines muscle strength and muscle function. All other reflexes, even a simple withdrawal reflex (e.g., touching a hot surface) involves some central processing (more than one synapse, multisynaptic) in the spinal cord, prior to the response (shown on the right side). All these reflexes involve hard-wired circuits of the spinal Recent studies...

Cervical level c8

This is a cross-section of the spinal cord through the cervical enlargement. This level has been used in many of the illustrations of the various pathways (in Section B). Since the cervical enlargement contributes to the formation of the brachial plexus to the upper limb, the gray matter ventrally is very large because of the number of neurons involved in the innervation of the upper limb, particularly the muscles of the hand. The dorsal horn is likewise large, because of the amount of afferents coming from the skin of the fingers and hand. All the descending tracts are fully represented, as many of the fibers will terminate in the cervical region of the spinal cord. In fact, some of them do not descend to lower levels.


Spinal Cord Sensation

Dermatomes are regions of the skin innervated by nerves. The nerves receive sensory inputs from the skin and take that information back to the spinal cord. The clinical importance of dermatomes is the role they play in assessing spinal cord damage. If there is a significant spinal cord

Label Frontal Lobe

Brain Areas Label

Gyrus receives sensory information from the body. On the lateral aspect of the brain is the lateral fissure and inferior to this is the temporal lobe of the brain. Hearing, taste, smell, and the formation of memories all have centers here. The most posterior part of the cerebrum is the occipital lobe, which has visual interpretation areas. Label the regions seen in a lateral view of the brain and the spinal cord. Color the precentral and postcentral gyri and then color the lobes of the brain. Shade in the cerebellum as well.

Scapula Labeling

Anatomy Labeled Subscapular Fossa

The pectoral girdle consists of the scapulae and the clavicles. Each scapula is a triangular bone and the three edges are known as the superior border, the lateral border, and the medial border. The scapular spine is on the posterior surface and it expands into a terminal process known as the acromion process. Above the spine is the supraspinous fossa. Below the spine is the infraspinous fossa and on the anterior side of the scapula is the subscapular fossa and the coracoid process. The inferior angle of the scapula is at the junction of the medial and lateral borders. Inferior to the acromion process is the glenoid fossa. This is a depression where the head of the humerus articulates with the scapula. Label the various features of the scapula and color in the regions of the bone with different colors. Locate as many of the features from the various angles presented. Answer Key a. Acromion process, b. Superior border, c. Coracoid process, d. Glenoid fossa, e. Subscapular fossa, f....

Spinocervical Tract

Spinocervical Tract

Figure 2.28 Spinal Reflex Pathways Summary of the spinal reflex pathways. Dorsal (posterior) spinal root ganglion Cervical part of spinal cord Lumbar part of spinal cord Dorsal (posterior) spinal root ganglion Cervical part of spinal cord Lumbar part of spinal cord oreticular tracts). The fasciculus gracilis and cuneatus of the spinal pathways). Ultimately, these fibers ascend as parallel pathways to lemniscal system convey proprioceptive, vibratory, and tactile sen- the thalamus, synapse, and ascend to the cortex. Spinal trigeminal tract Spinal Cervical part of spinal cord Sensory information below the head is localized to specific areas of the body, which reflect the distribution of peripheral sensory fibers that convey sensations to the spinal cord through the dorsal roots (sensory nerve cell bodies reside in the corresponding dorsal root ganglion). The area of skin subserved by afferent fibers of one

In Basis Pontis

Corticospinal Tract Topographic

Spinal cord Spinal cord Synapse occurs at spinal level Lateral corticospinal fibers synapse on ipsilateral anterior horn cells anterior corticospinal fibers synapse on contralateral anterior horn cells The corticospinal, or pyramidal, tract is the major motor tract that controls voluntary movement of the skeletal muscles, especially skilled movements of distal muscles of the limbs. All structures from the cerebral cortex to the anterior horn cells in the spinal

Blood Brain Barrier

Blood Brain Barrier

The blood-brain barrier (BBB) is the cellular interface between the blood and the central nervous system (CNS brain and spinal cord) It serves to maintain the interstitial fluid environment to ensure optimal functionality of the neurons. This barrier consists of the capillary endothelial cells with an elaborate network of tight junctions and astrocytic foot processes that abut the endothelium and its basement membrane. The movement of large molecules and

Blood supply

Spinal Cord Histology Picture

The anterior spinal artery, the main blood supply to the spinal cord, comes from branches from each of the vertebral arteries that join (see Figure 58) it descends in the midline (see Figure 2B) and supplies the ventral horn and the anterior and lateral group of tracts, including the lateral cortico-spinal pathway. The posterior spinal arteries supply the dorsal horn and the dorsal columns. The blood supply to the spinal cord was reviewed with Figure 2B it is known that this blood supply is marginal, particularly in the mid-thoracic region. The learner is encouraged to work out the clinical symptomatology following lesions of the spinal cord at various levels. FIGURE 69 Spinal Cord Histology Cross-Sections

Special tract

Dorsolateral Fasciculus

An acute injury to the cord, such as severing of the cord following an accident, will usually result in a complete shutdown of all spinal cord functions, called spinal shock (discussed with Figure 5). After a period of about 3-4 weeks, the spinal cord reflexes will return. In a matter of weeks, due to the loss of all the descending influences on the spinal cord, there is an increase in the reflex responsiveness (hyperreflexia) and a marked increase in tone (spasticity), along with the Babinski response (discussed with Figure 49B). A classic lesion of the spinal cord is the Brown-Sequard syndrome, which is a lesion of one-half of the spinal cord on one side. Although rare, this is a useful lesion for the learner to review the various deficits, sensory and motor, that would be found after such a lesion. In particular, it helps the learner understand which side of the body would be affected because of the various crossing of the pathways (sensory and motor) at different levels....