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Anatomy of Spinal Cord,[object Object],                  Dr. E.THIRULOGACHANDAR ,[object Object],PROF.S.TITO’S UNIT  ,[object Object]
Anatomy of Spinal Cord
Anatomy of Spinal Cord
Anatomy of Spinal Cord
Anatomy of Spinal Cord
2. Structure: Grey matter,[object Object]
Anatomy of Spinal Cord
1.NUCLEUS POSTEROMARGINALIS,[object Object],2.SUBSTANTIA GELATINOSA,[object Object],3&4.NUCLEUS PROPRIUS DORSALIS,[object Object],5.LAMINA5,[object Object],6.BASE OF DORSAL HORN ,[object Object],7.INTERMEDIATE ZONE,[object Object],8&9 VENTRAL HORN,[object Object]
Anatomy of Spinal Cord
Anatomy of Spinal Cord
POSTERIOR COLUMN,[object Object],PYRAMIDAL,[object Object],TRACT,[object Object],SPINOTHALAMIC,[object Object],TRACT,[object Object]
POSTERIOR,[object Object],SENSATION CARRIED,[object Object],1.POSITION,[object Object],2.VIBRATION,[object Object],3.DISCRIMINATIVE TOUCH,[object Object],4.TWO POINT DISCRIMINATION,[object Object],5.STEROGNOSIS,[object Object],COLUMN,[object Object]
Anatomy of Spinal Cord
Anatomy of Spinal Cord
SPINOTHALAMIC,[object Object],TRACT,[object Object]
CORTIOCSPINAL,[object Object],TRACT,[object Object]
Anatomy of Spinal Cord
Posterior Spinocerebellar Tract,[object Object],Originates in thoracic and upper lumbar regions.,[object Object],Consists of uncrossed fibers that enter cerebellum through inferior cerebellar peduncles.,[object Object],Transmits ipsilateral proprioceptive information to cerebellum.,[object Object]
Anterior Spinocerebellar Tract,[object Object],Originates in lower trunk and lower limbs.,[object Object],Consists of crossed fibers that recross in pons and enter cerebellum through superior cerebellar peduncles.,[object Object],Transmits ipsilateral proprioceptive information to cerebellum.,[object Object]
Blood Supply of Spinal Cord,[object Object]
Anatomy of Spinal Cord
BLOOD SUPPLY OF SPINAL CORD,[object Object]
The spinal cord is supplied by,[object Object],	1. Anterior spinal artery 2. Posteriorspinalartery3. Spinal branch from the 1st intercostal artery4. Spinal branch from the 11th intercostal artery,[object Object],Branches of the vertebral, deepcervical, intercostal, and lumbararteries contribute to three arteries that run the length of the spinal cord; the anterior spinal and the two posterior spinal arteries.,[object Object],Anterior spinal artery,[object Object],The anterior spinal artery is the larger,[object Object],It is a midlineartery – lies on the anterior median fissure,[object Object],It is formed at the foramen magnum by union of two arteries onefromeachvertebralartery,[object Object],Supplies the spinal cord anterior part namely the lateral columns and the anterior grey and white columns,[object Object],The posterior spinal arteries,[object Object],One or two on each side – derived from the vertebralartery (or from inferior cerebellar artery) at the level of foramen magnum,[object Object],Both the anterior and the posterior spinal arteries descend from the level of the foramen magnum,[object Object]
21 pairs of segmental radicular arteries supply the nerve roots and about half of them contributeto the spinal arteries.,[object Object]
The arteries of Adamkiewicz,[object Object],Spinal branches (segmental radicular arteries) from the 1st and 11th  intercostal arteries are large (T1 & T11),[object Object],They pass along the nerve roots to the spinal cord and reinforce the anterior and posterior spinal arteries,[object Object],supplies the lower thoracic and upper lumbar parts of the cord.,[object Object],Spinal artery at T1 (Adamkiewicz),[object Object],supplies the cord only downwards,[object Object],Spinal artery at T11 (Adamkiewicz),[object Object],supplies the cord both above and below (radicularis magna),[object Object]
Anatomy of Spinal Cord
	Abnormal situation,[object Object],	e.g. high take off  – the iliac artery branch supplies the lower thoracolumbar region of the cord entering through intervertebral foramen of L4-5,[object Object]
Horizontal distribution,[object Object]
Generally the proportion of flow is greatest from the raducularis magna “feeder” artery to the thracolumbar region. In abnormal situations ( e.g. high take-off) the iliac artery branch may supply the lower thoracolumbar region of the cord entering by way of the intervertebral foramen in the vicinity of L4-5,[object Object]
Spinal Veins,[object Object],Spinal veins form plexuses anteriorly and posteriorly,[object Object],On each side the spinalveins are double, straddling the posterior nerve roots,[object Object],	All of them draininto,[object Object],vertebralveins in the neck, ,[object Object],azygos veins in the thorax,,[object Object],lumbar veins in the lumbar region, ,[object Object],lateral sacral veins in the sacral region,[object Object],	through intervertebral foramina,[object Object]
Venous Drainage of the Spinal Cord,[object Object],This is by 6 irregular, plexiform channels,[object Object],.,[object Object],There is one along the anterior and posterior midlines;,[object Object],Along the line of attachment of the dorsal roots of each side;,[object Object],Along the line of attachment of the ventral roots of each side.,[object Object],These are drained by the radicular veins.,[object Object],Each, in turn empty into the epidural venous plexus.,[object Object]
APPROACH TO SPINAL CORD DISEASES ,[object Object],Patient symptoms –motor, sensory ,autonomic,[object Object],Clinical examination –motor ,sensory and reflex level ,[object Object],Investigations-CSF analysis, CT ,MRI,MRA,CT myelogram,EMG &NCS,[object Object]
                          MOTOR SYSTEM,[object Object],    -stiffness of legs and tripping of toes –s/o UMN lesion ,[object Object],     -buckling of knees ,wasting or fasciculations –s/0 LMN lesion  ,[object Object],     -UMN signs will be below the level of lesion-hypertonia ,spasticity ,clonus ,brisk reflexes .pl.extensor,[object Object],     -LMN signs –muscle wasting ,fasciculations sensory loss ,tender muscles ,,[object Object]
UMN signs –early with extramedullarylesions,late with intramedullary lesions,[object Object],Both UMN,LMN signs –with intramedullarylesions,MND,,[object Object],Symmetrical upper and lower girdle muscle involvement with myalgia-inflm.myopathies,[object Object],Asymmetrical distal and proximal muscle  involvement –inlcusion body myositis,[object Object],Delayed relaxation of muscles,-myotonic disorders ,[object Object],Episodic attacks of flaccid weakness –hypokalemic periodic paralysis,[object Object]
                         SENSORY SYSTEM,[object Object],     --radicular pain-lancinatingdermatomal pain ,increased by cough, sneeze ,common with extradural lesions ,[object Object],     --vertebral pain ,aching  ,localised to spine involved –neoplastic or inflammatory extradural lesions ,[object Object],      --funicular pain-deep ,illdefineddysaesthesia,due to intra-medullary lesions ,[object Object]
Spinal cord-loss of pain&temp. over the opp.side,if AL funiculus involved ,[object Object],                     -loss of position ,vibration sense if dorsal funiculus involved ,[object Object],                     -sacral sparing if lesion is deep ,[object Object],Dorsal root-radicular pain &sensory loss over the dermatome,[object Object],Dorsal root ganglion –diffuse pansensoryloss,with sensory ataxia ,[object Object],Peripheral neuropathy-paresthesia,tingling sensation ,over the distribution without sensory loss ,[object Object],Polyneuropathy-distal symm.sensory loss,[object Object]
Descending progression of paresthesia –intramedullary lesion  ,[object Object],Ascending progression of paresthesia –extramedullary lesions,[object Object],Definite sensory level of pain and temp.- extramedullary lesions(Brown-sequard),[object Object],Dissociated sensory loss - intramedullary lesion ,[object Object]
FORAMEN MAGNUM,[object Object],Lhermitte sign ,[object Object],Spastic quadriparesis,[object Object],Long tract sensory signs,[object Object],Bladder disturbance ,[object Object],9-12 cranial nerve inovlvement,[object Object],Elsberg phenomenon,[object Object],Downbeat nystagmus ,papilledema ,cerebellar ataxia,[object Object],EXAMPLES-meningioma,NF,glioma,syrinx ,MS, ,[object Object]
LEVEL C7,[object Object],Diaphragm spared ,,[object Object],Biceps and supinator jerk preserved ,[object Object],Finger flexor reflex exagg.,[object Object],Paradoxical triceps reflex,[object Object],Sensory loss over C7 dermatome,[object Object]
THORACIC SEGMENTS ,[object Object],Paraplegia and sensory loss below the thoracic level;,[object Object],Bladder bowel and sexual dysfunction;,[object Object],If lesion above T6,supf.abdominal reflex(-),[object Object],Lesion at T10 –BEEVOR’S SIGN,[object Object]
LEVEL L2,[object Object],Spastic paraparesis,[object Object],No weakness of abdominal muscles ,[object Object],(--)cremasteric reflex,[object Object],Knee jerk depressed ,,[object Object],Ankle jerk exagg.,[object Object]
LEVEL S1,S2,[object Object],Ankle jerk (--),[object Object],Knee jerk present ,[object Object],Sensory loss over sole, heel &outer aspect of the foot,[object Object]
CONUS MEDULLARIS LESION ,[object Object],Paralysis of pelvic floor muscles ,[object Object],Symmetrical saddle anesthesia ,[object Object],Autonomous neurogenic bladder-loss of voluntary initiation ,inc.residual urine &,[object Object],    (-)bladder sensation ,[object Object],Constipation ,impaired erection and ejaculation ,[object Object]
CAUDA EQUINA LESION ,[object Object],Early radicular pain ,,[object Object],Asymmetrical sensory loss ,[object Object],Asymmetrical LMN type of paralysis,[object Object],Late bladder involvement,[object Object],(--)ankle jerk,[object Object]
THANK YOU ,[object Object]

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Anatomy of Spinal Cord

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