1. Presentation spinal cord

2. Origin: Termination Spinal cord in adult in child
foramen megnum continous with medulla oblongata of brain
Termination
in adult
at the lower boarder of L1
in child
at the upper boarder of L3

5. Menings 1 dura mater Function’ Protection
The spinal cord is surrounded by three membranes
1 dura mater
2 :arachnoid mater
3:pia mater :
Function’
Protection
Also by cerebrospinal fluid present in the subarachnoid space

7. In the cervical region inferiorly
it gives origin to the brachial plexus
lower thoracic region and lumber region
it gives origin to lumbosacral plexus .
superiorly
the spinal cord is fusiformly enlarge the enlargement is referred as the cervical and lumber enlargement
inferiorly
the spinal cord tapers off into the conus medullaris from the apex of which a prolongation of pia mater the filum terminale descend to be attached to the posterior surface of the coccyx.

8. location The cord lie in midline anterior median fissure
posterior median sulcus.
Along the entire length of the spinal cord are attached 31 no of spinal nerves by the
anterior or motor roots and
Posterior root or sensory
posterior root ganglion
cells which gives rise to peripheral and center nerve fibber

10. Structure of spinal cord
gray mater
inner
white mater
Outer
GRAY MATER
On croos section the gray mater is seen H-shaped pillar with
anterior column or horns
posterior column or horns
lateral gray column or horn (THORACIC AND LUMBER)
united by
gray commissure
With central canal

12. Nerves cell groups in the anterior gray column
Alpha efferent nerve
large
Multipolar
It innervates the skeletal muscle
Axon pass out in anterior roots of spinal nerves
Gamma efferent
Small
Multipolar
It innervates intrafusal muscle fibers of neuromuscular spindles
Axon may pass out in anterior roots of the spinal nerves

13. (2) CENTRAL GROUP (3) LATERAL GROUP
Nerve cell of the anterior gray column is divided into three basic groups
(1) MEDIAL GROUP
(2) CENTRAL GROUP
(3) LATERAL GROUP

14. Medial group EXTENTION innervate muscle of neck, trunk, intercostal
WHOLE SPINAL CORD
innervate
muscle of
neck,
trunk,
intercostal
abdominal

15. (2)Central group: (c) lumbosacral nucleus (L2 TO S1) EXTENTION
cervical, lumber, sacral segments
Three nuclei
(a) phrenic nucleus
(C3’4’5)
INERVATE
DIAGHPHRAM
(b)accessory nucleus)
(C5 OR 6)
INNERVATION
sternocliedomastoid and trapezius muscle
(c) lumbosacral nucleus
(L2 TO S1)
unknwon distribution

16. Lateral group Extention Innervation cervical and lumbosacral segment
Muscles
(1) upper limb
(2) lower limb

17. Nerve cells of the posterior gray column
four nerve cell group
1 substantia gelatinosa
2 nucleus propius
3 nucleus dorsalis (clarks column)
4 visceral afferent nucleus
First two
extention
through out the length of the cord
other two
lumber and thoracic segments

18. Substantia gelatinosa
location
apex of the posterior gray column
composed
Golgi type 2 neuron
function
receives afferent fiber associated with
pain ,
temperature
touch.
Furthermore it receive input from the descending fibers from the supraspinal level .

19. Nucleus propius Location Below s g Function senses of position
movement (proprioception)
two points discrimination
vibration

20. Nucleus dorsalis Location base of the posterior gray column extending
C8 to L3 4
FUNCTION
proprioceptive endings
neuromuscular spindles and tendon spindle

21. Visceral afferent nucleus
LOCATION
lateral to the nucleus dorsalis
EXTENTION
T1 to L2
FUNCTION
receiving visceral afferent information

22. Nerve cell group lateral gray column
Extend
T1 TO S4
Cells
T1 TO L3
preganglionic sympathetic nerve fiber
CELLS
S 2,3,4
preganglionic parasympathetic fiber

23. The gray commissure and central canal
LOCATION
the anterior and posterior gray columns on each side are connected by a transverse gray commissure so that the gray column r in the central of the gray commissure is situated central canal.
Superiorly
above this it open into the cavity of the fourth ventricle
continuous with the central canal of the caudal half of the medulla oblongata
Inferiorly
It is closed
conus medullaris it expend into the fusiform terminal ventricle
terminate below with in the root of the filum terminale
It is filled with cerebrospinal fluid and is lined with epithelium called the ependyma

24. Anterior gray commisure
IT resembles letter H
posterior gray commissure
The part of the gray commissure that is situated posterior gray canal
Anterior gray commisure
lie anterior to the canal

25. White mater lateral column posterior column anterior column
It is divided into
anterior lateral
posterior white columns or finiculi.
anterior column
location
lie on each side lie in between the midline and the point of emergence of the anterior nerve root .
lateral column
between the emergence of the anterior nerve root and the entry of the posterior nerve root the
posterior column
in between the entry of posterior nerve root and midline

27. Structure composition
in centrral nervous system the white mater of spinal cord consist of a mixture of
nerve fiber
neuroglia
blood vessel
it surrounds the gray mater
its white color is due to the high proportion of myelinated nerve fiber

28. Blood Supply of the Spinal Cord
The spinal cord receives its arterial supply from three small, longitudinally running arteries: the two posterior spinal arteries and one anterior spinal artery. The posterior spinal arteries, which arise either directly or indirectly from the vertebral arteries, run down the side of the spinal cord, close to the attachments of the posterior spinal nerve roots. The anterior spinal arteries, which arise from the vertebral arteries, unite to form a single artery, which runs down within the anterior median fissure.
The posterior and anterior spinal arteries are reinforced by radicular arteries, which enter the vertebral canal through the intervertebral foramina.
The veins of the spinal cord drain into the internal vertebral venous plexus.

29. INJURIES

30. Injuries in children
Children account for 1-10% of all spinal injuries.
Motor vehicle accidents account for most injuries, followed by falls and sports.
Most serious spinal injuries in children involve the cervical spine.

31. In children less than 8 years of age, most injuries are between the occiput and C2:
Fulcrum of movement located at C2-3 in children, C5-6 in adults
Significant ligamentous and joint capsule laxity
Relatively large head and weak neck muscles
Horizontal orientation of facet joints
Incomplete ossicification of odontoid process

32. Injuries in
adults

33. Terminology Plegia = complete lesion
Paresis = some muscle strength is preserved
Tetraplegia (or quadriplegia)
Injury of the cervical spinal cord
Patient can usually still move his arms using the segments above the injury (e.g., in a C7 injury, the patient can still flex his forearms, using the C5 segment)
Paraplegia
Injury of the thoracic or lumbo-sacral cord, or cauda equina
Hemiplegia
Paralysis of one half of the body
Usually in brain injuries (e.g., stroke)

34. What are the differences between UMN and LMN. (e. g. , cauda equina vs
What are the differences between UMN and LMN? (e.g., cauda equina vs. myelopathy)

35. Thoracic injuries (T2-L1)
Paraparesis or paraplegia
UMN (upper motor neuron) signs

36. Cauda equina injuries (L2 or below)
Paraparesis or paraplegia
LMN (lower motor neuron) signs
Thigh flexion is almost always preserved to some degree

37. What is the difference between cauda equina and conus medullaris syndrome?