Spinal cord function and dysfunction Flashcards
How many spinal cord segments are there?
31
Spinal nerve pairs (31)
- Cervical-> 8 pairs
- Thoracic-> 12 pairs
- Lumbar-> 5 pairs
- Sacral-> 5 pairs
- Coccygeal-> 1 pair
Enlargements of the spinal cord for innervation of the limbs
- Cervical enlargement (C3-T1)-> upper limb innervation
- Lumbar enlargement (L1-S3)-> lower limb innervation
Enlargements contain more neurons in that region-> responsible for limb innervation
Epidural anaesthesia
- Anaesthetic delivered into epidural space (access to space within vertebral column)
- dura mater not pierced
- performed below L2 (epidural space no longer filled with spinal cord which could be damaged by needle=low risk of spinal cord injury)
- used if not safe to put under anaesthetic= allows sedation(labour, hip replacements in elderly)
Dermatomes and myotomes
Dermatome=area of skin innervated by one single spinal nerve or spinal segment
Myotome=muscle innervated by one single spinal nerve or spinal segment
Major tracts of the spinal cord
- Fasciculus (posteromedial location)->divided into 2 tracts (fasciculus gracilis from ipsilateral lower limb and fasciculus cuneatus from ipsilateral upper limb) at the posterior column of the spinal cord carrying fine touch, vibration and proprioception information
- Spinocerebellar (posterolateral location)->proprioception from limbs to cerebellum
- Lateral corticospinal (lateral location)->motor to ipsilateral anterior horn
- Spinothalamic (anterolateral location)->pain and temperature from contralateral side of the body
- Anterior corticospinal tract (anterior location)->motor to ipsilateral and contralateral anterior horn
Factors affecting spinal lesion severity
- Loss of neural tissue
- Vertical level
- Transverse plane
Loss of neural tissue
- Small if due to trauma
- more extensive in degenerative disease/metastases
Vertical level
-Higher the spinal cord lesion, the greater the disability (closer to head->more of body is affected)
Transverse plane
-most lesions are not complete
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Brown-Sequard syndrome
-Spinal cord lesion results in weakness/paralysis on one side of body and sensation loss on opposite side
Main tracts affected by spinal injuries
- Lateral corticospinal (major movement loss->paralysis)
- Dorsal columns (loss of touch sensation)
- Spinothalamic (loss of ability to feel pain/temp)
Stages of lateral corticospinal tract injury
Stage 1: SPINAL SHOCK
-lots of inflammation with complete loss of reflex activity below lesion (flaccid paralysis)
-lasts for days/weeks
Stage 2: RETURN OF REFLEXES
-reflex pathway between sensory neuron and motor neuron is more excitable
-reflexes return more intense and more rapid
-hyperrflexia and/or spasticity (rigid paralysis)
Nerve emergence
- Pattern of nerve emergence changes between cervical and thoracic nerves
- C1-C7=nerves emerge above vertebrae
- C8=nerve emerges below vertebrae
- Onwards=nerves emerge below corresponding vertebrae
Spinal levels vs vertebral levels
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Meningeal covering of the spinal cord
THREE MEMBRANES SURROUNDING THE SPINAL CORD
- pia mater adheres tightly to the surface of the spinal cord
- subarachnoid space is filled with CSF and continuous with the cranial subarachnoid space (bathes brain surface and spinal cord)
- arachnoid mater is ballooned up against the dura mater
- epidural space is the space between the dura mater and the vertebral periosteum, filled with fat and venous plexus=EPIDURAL SPACE DOES NOT EXIST BETWEEN DURA MATER AND SKULL
- dura mater is hard and continuous with the inner sheet of cranial dura mater, forming a dural sac and extending to S2
-denticulate ligaments are longitudinally oriented pia mater sheets extending towards the arachnoid mater and dura mater (anchors spinal cord in centre of subarachnoid space and to dura), attachment separates anterior and posterior root origins
Spinal block
- Anaesthetic delivered between L3/L4 or between L4/L5 (cauda equina)
- dura mater and arachnoid mater pierced
- can assess CSF status with this method
Filum terminale
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Corticospinal tract
-Main voluntary movement pathway
Dorsal column pathways
-For discriminative touch, vibration and proprioception
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Nerve
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Ramus
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Grey matter
CONTAINS CELL BODIES
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White matter
CONTAINS AXONS AND ASCENDING/DESCENDING TRACTS
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Posterior median sulcus
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Anterior median fissure
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Posterolateral sulcus
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Anterolateral sulcus
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Spinothalamic tract
-For pain and temperature