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Jenna Carlson

on 21 November 2014

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Transcript of Objectives

Basics Structure of the Spinal Cord
Recurrent Nerves
Ascending Tracts
Image References
Descending Tracts
The Spinal Cord and Meninges

By: Jenna Carlson, Kristi Edgar, Brent Ingelman, Christian Montoya, and Clarissa Prewitt
(Great Anterior Medullary Artery)
Sympathetic and Parasympathetic Nerves
Distinguish the structural components that make up the spinal cord
Identify the meninges and vasculature of the spinal cord.
Restate the functions of recurrent nerves.
Understand the structural organization of a spinal cord cross section
Describe the sensory and motor components of the spinal cord
Apply knowledge of the spinal cord to clinical presentations of spinal cord injury and spina bifida.

• Carry sensory information from the periphery to the brain
• 3 major ascending tracts
Dorsal column medial lemniscal tract
Touch, proprioception, pressure, vibration
Spinothalamic tracts (lateral and anterior)
Pain, temperature
Spinocerebellar tracts (posterior and anterior)

• Carry motor information from the brain to the periphery
Pyramidal tracts-voluntary, skilled movement
Lateral corticospinal tract
Carries motor information to muscles in the limbs
Anterior corticospinal tract
Carries motor information to axial muscles
Extrapyramidal tracts-subconscious body functions
Rubrospinal tract
Reticulospinal tracts
Tectospinal tract
Vestibulospinal tract

Spinal cord travels through Foramen magnum as continuation of
medulla oblongota
There are 4 parts with 31 pairs of spinal nerves
cervical enlargement
and the
lumbrosacral enlargement
Conus medullaris
- the tapered end of the spinal cord proper
Cauda equina
- formed by a loose bundle of nerves coming out of the end of the spinal cord
Filium terminale
- continuation of pia mater that anchors the spinal cord

• Any damage to the spinal cord or nerves at the end of the spinal canal
• Causes permanent changes in strength, sensation and other body functions below the site of the injury
• Types:
: all motor and sensory function below injury is lost
: some motor and sensory function below injury is preserved
Affects all or part of the trunk, legs and pelvic organs

Arms, hands, trunk, legs and pelvic organs affected

Spinal Cord Injury
Central Cord Syndrome

Most common incomplete spinal cord injury
Loss of sensation and motor
Motor impairment in the upper extremity
Hands and upper extremity are located "centrally" in corticospinal tract

Spinal Cord Injury Rehabilitation
Physical Therapy
Improves function and mobility
Utilizes the plasticity of the spinal cord
Focus on functional independence
Bed/wheelchair mobility
Gait training
Body Weight Supported Treadmill Training (BWSTT)
Robotic-Assisted BWSTT
Development of the spinal cord is a very complicated process
The human brain and spine begin as a flat plate of cells, which rolls into a tube, called the neural tube
In open neural tube defects, all or parts of the neural tube fails to close, leaving an opening that is left open or covered by bone and skin

Spina Bifida
- birth defect that causes vertebral arches to fail to normally develop and fuse posterior to the vertebral canal
- most severe form of spina bifida in that one or more vertebral arches may fail to develop completely and is associated with the herniation of the meninges or spinal cord

Spina Bifida and Physical Therapy

Balance and Coordination
Gait Training
Muscle Strengthening
Transition and Transfer Training
Equipment Evaluation
: membranes surrounding spinal cord
3 Separate Membranes
Dura Mater
Arachnoid Mater
Pia Mater
-Most superficial layer
-Middle layer, lines Dura Mater but not attached to it
-Deepest layer, follows contours of spinal cord
Functions of meninges:
Support & Protect
-Spinal cord
-Spinal nerve roots

Contain CSF
Runs from foramen magnum to coccyx creating the
spinal dural sac
Composition: mainly tough fibrous tissue with some elasticity
All layers are continuous with cranial meninges
Creates a
dural root

that blends with the epineurium at the intervertebral foramen
Dura-arachnoid interface
The space between the bone of vertebrae and the dura is called the
epidural space
-contains venous structures embedded in fat (epidural fat)
-Site of epidural anesthesia
Subarachnoid space
-Contains vasculature,
cerebrospinal fluid

-Site of
Lumbar puncture
aka spinal tap!, and
spinal anesthesia
Connected to Pia mater by
arachnoid trabeculae
connective tissue

Arachnoid Mater
Middle layer, fibrous/elastic, delicate, avascular
Pia Mater
-Closely follows all structures of spinal cord, including roots and blood vessels
Denticulate ligaments
– extend from lateral side of spinal cord to attach to dura mater
Innermost, 2 thin layers, transparent
Dura-arachnoid interface
Epidural space
Denticulate ligament
Dura mater
Pia mater
Arachnoid trabeculae
Epidural fat
Denticulate ligament
Arachnoid mater
Pia mater (covering spinal cord
Dura mater
Sub-arachnoid space
Turn your knowledge on!
Distinguish the structural components that make up the spinal cord
Identify the meninges and vasculature of the spinal cord.
Restate the functions of recurrent nerves.
Understand the structural organization of a spinal cord cross section
Describe the sensory and motor components of the spinal cord
Apply knowledge of the spinal cord to clinical presentations of spinal cord injury and spina bifida.

Turn up your knowledge!
Keep turning that knowledge up!
Crank your knowledge higher!
Is your knowledge maxed out already?
Know even more! That's one more!
Directly in between which 2 meningeal layers is most of the cerebro spinal fluid in the spinal cord found?

A) Pia and arachnoid mater
B) Dura and pia mater
C) Dura and arachnoid mater
D) Subarachnoid and pia mater
What type of spinal cord artery is responsible for supplying the nerve roots and can also supply the gray matter?

A) Spinal
B) Radicular
C) Medullary
D) Sulcul
Nerves to the anuli fibrosi and anterior and posterior longitudial ligaments contain what types of receptors?

A) Pain
B) Proprioception
C) Vasodilation
D) Both A&B


All of the following tracts are descending (sensory) tracts, EXCEPT...
A) Anterior Spinothalamic tract
B) Posterior Spinocerebellar tract
C) Anterior Corticospinal tract
D) Dorsal Column Medial Lemniscal tract
Which of the following is the tapered end of the spinal cord?
A) Filium Terminale
B) Pia Mater
C) Cauda Equina
D) Conus Medullaris
Brown, AG (1981). Organization in the Spinal Cord: The Anatomy and Physiology of Identified Neurones. Berlin: Springer-Verlag. http://en.wikipedia.org/wiki/Grey_column.
Dafney N. The University of Texas Health Science Center at Houston. Anatomy of the Spinal Cord. Available at http://nba.uth.tmc.edu/neuroscience/m/s2/chapter03.html. Accessed on 13 November 2014.
Finke A., Haines C., University of Rochester Medical Center. Spina Bifida. http://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p02415. Accessed 10 November 2014.
Friese, A; Kaltschmidt, J. A. Ladle, D. R. Sigrist, M. Jessell, T. M. Arber, S. (Aug 11, 2009). "Gamma and alpha motor neurons distinguished by expression of transcription factor Err3". Proceedings of the National Academy of Sciences of the United States of America 106 (32). http://en.wikipedia.org/wiki/Grey_column.
Intermountain Healthcare. Spina Bifida. Available at http://intermountainhealthcare.org/services/pediatricrehab/symptoms-conditions/pages/spina-bifida.aspx. Accessed 14 November 2014.
Liptak G S. Spina Bifida Association. What is Spina Bifida?. http://www.spinabifidaassociation.org/site/c.evKRI7OXIoJ8H/b.8277225/k.5A79/What_is_Spina_Bifida.htm. Accessed 9 November 2014.
McKinley W, Kulkarni U. Functional Outcomes per Level of Spinal Cord Injury. Medscape. http://emedicine.medscape.com/article/322604-overview#aw2aab6b3. Accessed November 23, 2013.
Moore, D. Incomplete Spinal Cord Injuries. Orthobullets. http://www.orthobullets.com/spine/2008/incomplete-spinal-cord-injuries. Accessed November 19, 2013.
Moore KL, Dalley AF, Agur AM. Clinically Oriented Anatomy. Lippincott Williams & Wilkins; 2013.
Saladin. Anatomy and Physiology, 5th Ed. http://en.wikipedia.org/wiki/Spinal_cord.
Yasui K, Hashizume Y, Yoshida M, Kameyama T, Sobue G (1999). "Age-related morphologic changes of the central canal of the human spinal cord". Acta Neuropathol. 97 (3): 253–9. http://en.wikipedia.org/wiki/Central_canal_of_spinal_cord.

Dorsal Median Sulcus
Ventral Median Fissure
Ependymal Canal
Dorsal Horn
Ventral Horn
Lateral Horn
Dorsal Laminae
I and II- Pain, Temp, and Itching
III and IV-Mechanical Pressure
V and VI- Proprioception

Ventral Laminae
IX- Alpha Motor Neurons

Lateral Horn
Sympathetic Nervous System
Input from Brain stem,
Organs, and Hypothalamus
What Function Does Lamina IX Serve?

A) Sense Pain and Tempurature
B) Generate Muscle Contraction
D) Sense Mechanical Pressure

hoot, I have to go to the
Afferent Neurons
Efferent Neurons
Afferent VS Efferent Neurons
Full transcript