Chapter 13! Chapter 13 Spinal Cord and Spinal Nerves! The Spinal Cord and Spinal Nerves!

Transcription

1 Chapter 13! The Spinal Cord and Spinal Nerves! SECTION 13-1! The brain and spinal cord make up the central nervous system, and the cranial nerves and spinal nerves constitute the peripheral nervous system! 2! Grouping of Neural Tissues (1 of 3)! White matter! Myelinated (and unmyelinated) neuron processes! Schwann cells in PNS! Oligodendrocytes in CNS! Gray matter! Nerve cell bodies and dendrites! Unmyelinated axons! Neuroglia (e.g. astrocytes)! Nerve! Bundle of nerve fibers (axons) outside the CNS! Has associated CT layers! 3! 1!

2 Grouping of Neural Tissue (2 of 3)! Ganglion! Collection of nerve cell bodies outside of the CNS! E.g. Dorsal root ganglion! Nucleus! Collection of nerve cell bodies with a common function found inside the CNS! In brain or spinal cord! Unmyelinated! E.g. Basal nuclei! 4! Grouping of Neural Tissue (3 of 3)! Columns are major regions of cord! E.g., posterior columns! Tracts are bundles of axons with common:! Structural characteristics (e.g. axon diameter, myelinated or not)! Function/direction! E.g., spinothalamic tract! Ascending tracts (in cord) = sensory! Descending tracts (in cord) = motor! Horns! Major areas of gray matter in spinal cord! 5! SECTION 13-2! The spinal cord is surrounded by three meninges and conveys sensory and motor information! 6! 2!

3 Gross Anatomy of the Spinal Cord Figure 13-2! 7! Spinal Cord Functions/Anatomy! Spinal cord functions:! Convey sensory information to brain! Convey motor information to PNS! Reflexively integrate sensory and motor info! Gross anatomical features:! Length! Extends from medulla to L1 L2 in adults! 16 to 18 in. long! About 0.5 in. diameter! 8! Spinal Cord Gross Anatomy (1 of 2)! Enlargements:! Regions where cord is thicker! Cervical enlargement! Fibers to and from arms! Lumbar enlargement! Fibers to and from legs! Conus medullaris! Tapered end of the cord! About L1 or L2! E E E 9! 3!

4 Spinal Cord Gross Anatomy (2 of 2)! Filum terminale! Fibrous extension of pia mater! Forms part of coccygeal ligament! Coccygeal ligament! Dura mater + filum terminale (pia)! Attaches conus medullaris to coccyx! Cauda equina ( horse s tail )! Nerves arising from lower portion of cord! Descend in spinal canal! Exit spinal canal as spinal nerves! 10! Conus Medullaris, Filum Terminale! 1st lumbar! Vertebra! Gray s anatomy! Subarachnoid! space! Conus medullaris! Dura mater! Filum terminale -! Intradural portion! 2nd sacral vertebra! 1st coccygeal! vertebra! Filum terminal -! extradural portion! (coccygeal ligament)! 11! Spinal Tap, Spinal Nerves! Spinal tap! Deliver anesthetics, sample CSF fluid or pressure, etc.! Done between L3 and L4 or L4 and L5! (Cord not present here)! Spinal nerves contain two roots! Spinal nerves are mixed nerves! Ventral root - motor! Dorsal root - sensory! Dorsal root ganglion! Sensory cell bodies (unipolar neurons)! 12! 4!

5 Gross Anatomy of the Spinal Cord Figure 13-2b! sensory! mixed! motor! 13! The Spinal Meninges Figure 13-3a! 14! Spinal Meninges and Associated Structures! Continuous with cranial meninges at F. magnum! Functions:! Provide support, stability, shock absorption!!! Epidural space:! Between dura mater and walls of vertebral canal! Contains areolar CT, blood vessels! Cushions cord! 15! 5!

6 Dura Mater! Dura mater = tough mother! Not firmly attached to bone (as in cranium)! Dense irregular CT! Inner lining of simple squamous EPI! Tubular portion runs from F. Magnum to S2! Fuses to form coccygeal ligament (with filum terminale) that extends to coccyx! Fuses with CT coverings of spinal nerves! Subdural space! Probably not present in life! 16! Arachnoid Membrane! Arachnoid = spider-like = refers to trabeculae! Avascular! Simple squamous EPI + CT trabeculae! Collagen + elastin fibers form trabeculae! EPI adheres to dura across subdural space! Extends with dura to end of intradural portion of filum terminale, so roots of nerves making up the cauda equina are in subarachnoid space! Subarachnoid space! Contains cerebrospinal fluid (CSF)! 17! Pia Mater! Pia mater = soft or delicate mother! Adheres to surface of brain and cord! Delicate collagen and elastin fibers! Highly vascular! Runs to coccyx as filum terminale (with dura, forms coccygeal ligament)! Denticulate (dentate) ligaments (Fig. 13-5)! Formed from pia mater! Extend through arachnoid to attach to dura! Suspend cord within subarachnoid space! 18! 6!

7 The Spinal Cord and Spinal Meninges! Figure 13-3b! Note orientation compared to that in Figure 13-5! 19! SECTION 13-3! Gray matter is the region of integration and command, and white matter carries information from place to place! 20! Sectional Organization of Cord Figure 13-5b! Note orientation compared to that in Figure 13-3! 21! 7!

8 Internal Anatomy of the Cord! Ventral (anterior) median fissure! (A fissure is larger than a sulcus.)! Dorsal (posterior) median sulcus! (smaller than fissure)! Gray commissures! Commissure = crossing from one side of the body to the other! Gray = gray matter! Central canal! Contains CSF! 22! Gray Matter in the Cord see Figure 13-5a! Nuclei - collections of cell bodies with a similar function! Ventral (anterior) gray horns! Somatic motor nuclei! Efferent information to skeletal muscles! Lateral gray horns! Visceral (autonomic) motor nuclei! Only in thoracic and lumbar segments! Dorsal (posterior) gray horns (see slide #63)! Sensory area! Somatic and autonomic (visceral) nuclei! 23! Sectional Organization of Cord Figure 13-5a! Note interneurons in dorsal horns! 24! 8!

9 White Matter Columns and Tracts! Columns:! Large collections of fibers conveying information to or from the brain! Have similar origin and similar destinations! Tracts:! Collections of fibers within a column! Carry same type of information in the same direction to the same destination! 25! Examples of Columns and Tracts! Posterior columns! Sensory (ascending)! Spinothalamic tracts! Sensory (ascending)! Corticospinal tracts! Motor (descending)! Voluntary movements! Vestibulospinal tracts! Motor (descending)! Automatic (involuntary) movements! Note that the name usually tells you the direction of information flow.! 26! Sensory Columns and Tracts Figure 15-4! Posterior column pathway Spinothalamic pathway Note organization and direction. Do not try to memorize locations.! 27! 9!

10 Motor Columns and Tracts Figure 15-8! Lateral corticospinal tract Note organization and direction. Do not try to memorize locations.! Anterior corticospinal tract Vestobulospinal tract 28! SECTION 13-4! Spinal nerves form plexuses that are named according to their level of emergence from the vertebral canal! 29! Spinal Nerves! Spinal nerves are mixed nerves! Contain both sensory and motor fibers! Exist in 31 pairs! Exit vertebral canal via intervertebral foramina! Named for where they exit vertebral column! Cord stops at level of L2! Nerves exiting below this level form the cauda equina! 30! 10!

11 Spinal Nerve Categories Figure 13-9! Pairs of spinal nerves:!! 8 cervical! (C1 exits between atlas and occipital bone)! 12 thoracic! 5 lumbar! 5 sacral! 1 coccygeal! 31 pairs! 31! Peripheral Nerve Anatomy Figure 13-6! Connective tissue coverings! 1. Epineurium! Surrounds entire nerve! 2. Perineurium! Delineates fascicles (bundles)! 3. Endoneurium! Surrounds individual nerve fibers! Does this terminology seem familiar?! 32! Rami (Branches) of Spinal Nerves! Ramus = branch ; plural = rami! 1. Dorsal ramus! Information to and from skin, skeletal muscles of back! Somatic and visceral, both motor and sensory!! 2. Ventral ramus! Information to and from ventrolateral body surface, body wall and limbs! Somatic and visceral, both motor and sensory! Form plexuses or thoracic (intercostal) nerves! 33! 11!

12 Nerve Roots and Rami modified from Fig. 13-3b! Dorsal! Dorsal root ganglion! Dorsal root! Dorsal ramus! Ventral ramus! Ventral root! Ventral! Denticulate ligament! Rami communicantes! Sympathetic chain ganglion! 34! Rami Communicantes (much more in Ch. 16)! 3. Rami communicantes! Communicate between ventral rami and sympathetic ganglia! Visceral sensory and visceral motor! Information to and from interoceptors, smooth muscle, visceral organs, glands! 3a. White ramus! Myelinated preganglionic fibers! 3b. Gray ramus! Unmyelinated postganglionic fibers! Gray and white rami unite at sympathetic ganglia! Form sympathetic nerves! 35! Thoracic (Intercostal) Nerves! Formed by ventral rami of T2 - T12 spinal nerves! Go directly to innervated structures.! Most axons from these segments do NOT join plexuses! Thoracic nerves 36! 12!

13 Distribution of Sensory Nerve Fibers Fig. 13-8a! Exteroceptors in skin are:! Ambient temperature! Pain! Light touch, pressure! 37! Distribution of Motor Nerve Fibers Fig. 13-8b! 38! Dermatomes Figure 13-7! Dermatome = specific region of skin innervated by a single pair of spinal nerves.!!! Clinically important for diagnoses of specific neuropathies.! 39! 13!

14 Nerve Plexuses! Plexus = network! Formed from ventral rami! T2 - T12 do not participate in plexuses! Plexuses are formed by nerve fibers from different spinal nerves. During development, small skeletal muscles innervated by different ventral rami fuse to form larger muscles with compound origins. The anatomical distinctions between the component muscles may disappear, but separate ventral rami continue to control each part of the compound muscle. p. 439! 40! Peripheral Nerves and Nerve Plexuses! Cervical plexus! Brachial plexus! Figure 13-9! Lumbar plexus! Sacral plexus! 41! Brachial Plexus 1 Figure 13-11a! 42! 14!

15 The Brachial Plexus 2 See your copy of Netter! Netter Plate ! Brachial Plexus 3 Figure 13-11b! 44! SECTION 13-5! Interneurons are organized into functional groups called neuronal pools! 45! 15!

16 ! Chapter 13 Spinal Cord and Spinal Nerves! The Organization of Neuronal Pools! Figure 13-13! 46! SECTION 13-6! Reflexes are rapid, automatic responses to stimuli! 47! Reflexes! Definition:! Unconscious, rapid, stereotyped responses to a stimulus.! Involve a reflex arc! Advantages of reflexes. Why important?! 1. Fast response! Don t have to think about it! 2. Predictable! Absence indicates damage to N.S.! 48! 16!

17 Reflex Arc 1! Spinal cord is the integrating center.! Components of a Reflex Arc:! 1. Sensory receptor! Responds to stimulus! Generates signal to be sent to integrator! 2. Sensory neuron! Cell body in dorsal root ganglion! Carries info to integrating center! Info enters via dorsal root! 49! Reflex Arc 2! 3. Integrating center = spinal cord! Usually involves interneurons! Polysynaptic reflex (most reflexes)! May not involve interneurons! Monosynaptic reflex! 4. Motor neuron! Transmits impulses to muscle or gland! 5. Effector! Muscle or gland that responds to motor neuron! Effects a change in controlled variable! 50! Events of a Reflex Arc Figure 13-14a! 51! 17!

18 Classification of Reflexes Figure 13-15! 52! Types of Spinal Reflexes! Wiring diagrams! Ipsilateral! Contralateral! Intersegmental! Reflex responses initiated by:! 1. Changes in muscle length! Stretch reflex - e.g. patellar reflex! 2. Changes in tendon tension! Golgi tendon reflex! 3. Pain! Flexor reflex, crossed extensor reflex! 53! 1. Muscle Spindle (Stretch) Reflex! Responds to changes in muscle length A.K.A. knee-jerk or patellar reflex! A monosynaptic reflex! Receptor (muscle spindle) located in muscle! Cord sends excitatory message to the muscle being stretched! Adjusts stretch of muscle! Adjust muscle tone at rest! Prevents overstretch! 54! 18!

19 The Patellar (Knee-jerk) Reflex Figure 13-17! + + = excitatory synapse! 55! Muscle Spindles 1! Intrafusal fibers! Specialized muscle cells! Surrounded by extrafusal ( normal ) muscle fibers! (Extrafusal fibers innervated by alpha motor neurons)! Innervated by both motor and sensory neurons! A. Gamma motor neurons (γ motor neurons)! Innervate ends of intrafusal fibers! Contraction adjusts sensitivity of spindle 56! Muscle Spindle Intrafusal Fibers 2! B. Sensory innervation of intrafusal fibers! Innervate center of intrafusal fibers! (no actin or myosin here)! Synapse in cord with motor neurons that innervate extrafusal fibers in the same muscle! Collaterals inform brain of degree of spindle stretch! Function to adjust muscle tone! 1. Stretch AP frequency stimulate extrafusal fibers muscle tone! 2. Compress AP frequency stimulation of extrafusal fibers muscle tone! 57! 19!

20 Intrafusal Fibers From 7 th edition! Note that gamma afferent fires! to some degree even at normal length.! 58! 2. (Golgi) Tendon Reflex! Function:! Senses changes in muscle tension (via tendon tension)! Receptor located in tendon (Golgi tendon organ)! Prevents injury to tendons! Ipsilateral reflex! Sends inhibitory message to muscle under tension! 59! Golgi Tendon Organ! 60! 20!

21 3. Flexor Reflex a.k.a. Withdrawal Reflex! Characteristics responds to PAIN 1. Polysynaptic! 2. Ipsilateral! 3. Intersegmental! Synapses occur within multiple cord segments! Activates several muscle groups! (i.e. stimulates more than one effector)! 4. Reciprocal innervation! (i.e. flexors and extensors)! 61! Flexor Reflex a.k.a. Withdrawal Reflex 2! Mechanism:! 1. Stimulate pain-sensitive sensory neuron! 2. Message sent to cord! 3. Activate interneurons! 4. Relay to several segments! 5. Several flexors activated, extensors inhibited! 62! Flexor Reflex 3 Figure 13-14! Be able to draw this!! See study guide.! + + _ + Back to #23! + _ indicates excitatory synapse indicates inhibitory synapse 63! 21!

22 Crossed Extensor Reflex! Characteristics:! 1. Polysynaptic! 2. Contralateral! 3. Reciprocal innervation! Activates flexors on one side! Inhibits extensors on this side! Activates extensors on the other side! Inhibits flexors on this side! 4. Intersegmental! 64! Crossed Extensor Reflex 2 Figure 13-18! Mechanism:! 1. Pain! 2. Sensory info to cord! 3. Contract flexors on one side, extensors on other side! ! Flexor and Crossed Extensor Reflexes! Comparison Figures 13-19, -20 from 9 th edition! 66! 22!

23 SECTION 13-8! The brain can affect spinal cord-based reflexes! 67! Integration and Control of Spinal Reflexes! Higher centers can modify spinal reflexes! Inhibit or facilitate reflex patterns! Continuous inputs (IPSP, EPSP) to neurons! involved in reflexes! Allows a few neurons from brain to control complex motor functions! e.g. Walking, running based on spinal reflexes! Modified by higher centers! Example: decerebrate cat! 68! 23!