Nerve Pathways:

Functions, Lesions and Adhesions

 Spinal cord

• The spinal cord is a cylinder of CNS. The spinal cord exhibits subtle cervical
and lumbar (lumbosacral) enlargements produced by extra neurons in
segments that innervate limbs. The region of spinal cord caudal to the
lumbar enlargement is conus medullaris. Caudal to this, a terminal filament
of glial tissue extends into the tail.

• A spinal cord segment = a portion of spinal cord that gives rise to a pair
(right & left) of spinal nerves. Each spinal nerve is attached to the spinal
cord by means of dorsal and ventral roots composed of rootlets. Spinal
segments, spinal roots, and spinal nerves are all identified numerically by
region, e.g., 6th cervical (C6) spinal segment.
 Nerve roots
• Both the spinal cord (CNS) and spinal roots
(PNS) are enveloped by meninges within
the vertebral canal. Spinal nerves (which are
formed in intervertebral foramina) are
covered by connective tissue (epineurium,
perineurium, & endoneurium) rather than
meninges.

• Sacral and caudal spinal roots (surrounding

the conus medullaris and terminal filament
and streaming caudally to reach Image taken from
corresponding intervertebral foramina) wikipedia
collectively constitute the cauda equina.
MORE SUITABLE IMAGE NEEDED
 Afferent Nerves
Primary Afferent Neuron = the first neuron in a spinal reflex or ascending spinal pathway.

Primary afferent neurons have their unipolar Collateral branches from the cranial and
cell bodies in spinal ganglia. caudal branches enter the gray matter to
synapse on interneurons and projection
neurons (or directly on efferent neurons
for the myotatic reflex).
Their axons traverse dorsal roots, penetrate
the spinal cord (at the dorsolateral sulcus)
and bifurcate into cranial and caudal In some cases (discriminative touch), the
branches which extend over several cranial branches of incoming axons
segments within white matter of the dorsal ascend directly to the brainstem where
funiculus. they synapse on projection neurons of
the pathway.
 Spinal Cord Cross Section

Image taken from: http://cas.bellarmine.edu/tietjen/HumanBioogy/SpinalCord01.gif

 Ascending Pathways:
In general, pathways may be categorised into three broad
functional types:
1) Conscious discrimination/localisation (e.g., pricking pain, warmth, cold,
discriminative touch, kinesthesia) requires a specific ascending spinal pathway to
the contralateral thalamus which, in turn, sends an axonal projection to the cerebral
cortex. Generally there are three neurons in the conscious pathway and the axon of
the projection neuron decussates and joins a contralateral tract.

2) Affective related (emotional & alerting behavior) information involves ascending

spinal pathways to the brainstem. Projection neurons are non-specific. They receive
synaptic input of different modalities and signal an ongoing magnitude of sensory
activity, but they cannot signal where or what activity.

3) Subconscious sensory feedback for posture/movement control involves ascending

spinal pathways principally to the cerebellum or brainstem nuclei that project to the
cerebellum. Generally there are only two neurons in a subconscious pathway and
the axon of the projection neuron joins an ipsilateral tract.
 Nerve pathways
Ascending Tracts
Tract Signal function
Vibration, tactile sensation, conscious
Dorsal columns proprioception
Spinocerebeller Proprioception

Spinothalamic (lateral and Pain, temperature, itch (lateral), crude

anterior) touch (anterior)

Spinoreticular Pain

Spinomesencephalic Pain

Spino-cervico-thalamic Pain (touch?)

Spinohypothalamic Pain
Dorsal Column and Spinocerebellar
Pathways
• Dorsal column pathway carries
info on tactile sensation, pressure
and proprioception.

• In the dorsal tract, the sensory

neurons synapse in an area
Thalamus known as Clarke's nucleus or
Z "Clarke's column".
G
C
• This is a column of relay neuron
cell bodies within the medial gray
matter within the spinal cord in
layer VII (just beneath the dorsal
horn), specifically between T1-L1.
Clarkes These neurons then send axons
Column (L1-T1) up the spinal cord and form
synapses in the accessory (lateral)
cuneate nucleus, lateral to the
cuneate nucleus in the medulla.

• Spinocerebellar pathway carries

info on proprioception

N.B . cerebellar feedback actually occurs posteriorly not laterally,

however in a 2D diagram its easier to represent it this way.
Spinoreticular and Spinothalimic
pathways
• The Spinothalamic Tract, like the
Dorsal Column-Medial Lemniscus
Tract, use three neurons to convey
sensory information from the
periphery to conscious level at the
cerebral cortex.
Thalamus Thalamus

• The Spinothalamic tract carries

M
information on pain, temperature and
P
crude touch.

• The Spinoreticular pathway carries

info on pain, temperature and crude
touch.

N.B. cerebellar feedback actually occurs posteriorly not laterally,

however in a 2D diagram its easier to represent it this way.
Descending Spinal Pathways:
Axons of brain projection neurons travel in descending tracts in spinal white
matter. They arise from various locations in the brain and synapse primarily
on interneurons within the spinal cord.

By synapsing on interneurons, descending tracts regulate:

1) spinal reflexes;

2) excitability of efferent neurons (for posture and movement); and

3) excitability of spinal projection neurons, i.e., the brain is able to regulate

sensory input to itself. In some cases, descending tracts affect axon
terminals of primary afferent neurons, blocking release of neurotransmitter
(presynaptic inhibition).
 Nerve pathways
Descending Tracts
Tract Signal function
Fine voluntary motor control of the limbs. The
Corticospinal (pyramidal) pathway also controls voluntary body posture
adjustments.
Involved in involuntary adjustment of arm position in
Rubrospinal response to balance information; support of the body.
Regulates various involuntary motor activities and
Reticulospinal (1) Pontine assists in balance (leg extensors). Some pattern
movements e.g. stepping
(2) Medullary Inhibits firing of spinal and cranial motor neurons,
control of antigravity muscles.
It is responsible for adjusting posture to maintain
Vestibulospinal (1) Medial balance (neck muscles).
(2) Lateral It is responsible for adjusting posture to maintain
balance (body/lower limb).
Controls head and eye movements, Involved in
Tectospinal involuntary adjustment of head position in response to
visual information.
 Corticospinal tract
Travels from the cerebral cortex down to
the spinal cord.

CST actually consists of two separate

tracts in the spinal cord: the lateral
corticospinal tract and the anterior
corticospinal tract. Contains mostly
motor axons.

Referred to as a pyramidal tract as

when the tract passes the medulla, it
forms a dense bundle of nerve fibres
that is shaped somewhat like a pyramid
Lateral Anterior
CST CST
Rubrospinal tract

• Travels from the cerebral cortex down to

the spinal cord via the red nucleus. An
extra-pyramidal motor tract.

• Its main role is the mediation of voluntary

movement. It is responsible for large
muscle movement such as the arms and
the legs as well as for fine motor control. It
facilitates the flexion and inhibits the
extension in the upper extremities
Reticulospinal Tract
• An extra-pyramidal motor tract
which travels from the reticular
formation.

• The tract is divided into two parts, the

M medial (or pontine) and lateral (or
P
medullary) reticulospinal tracts (MRST
and LRST).

• 1. Integrates information from the

motor systems to coordinate automatic
movements of locomotion and posture.

• 2. Facilitates and inhibits voluntary

movement, influences muscle tone.
Vestibulospinal Tract
• Inputs originate from the labyrinthine
system via the vestibular nerve and
from the cerebellum.

• The medial part of the

vestibulospinal tract project
V bilaterally down the spinal cord and
triggers the cervical spinal circuits,
controlling a correct position of the
head and neck.

• The lateral part of the

vestibulospinal tract projects
ipsilateral down to the lumbar
region. There it helps to maintain an
upright and balanced posture by
stimulating extensor motor neurons
in the legs.
 Descending Pathways

Pathway Upper limb Lower limb

This Tract functions to modulate the activity of Alpha

Cortico/-pyramidal or Gamma Motor Neurons as directed by the Motor
Cortex.

Rubro-spinal Stimulates flexors

Medullary inhibits extensors and excites flexors

Reticulo-spinal Pontine excites extensors and inhibits flexors
(Generally upper limb)
Doesn’t affect upper limbs Stimulates extensors
but helps position head and (lateral)
Vestibulo-spinal neck in response to body
tilting (medial)

Tecto-spinal Control of head, neck and eye movements.

 Spinal Cord Cross Section

Image taken from; http://img.medscape.com/pi/emed/ckb/clinical_procedures/1134815-1148570-1177.jpg

 Gray matter organisation

• Posterior/Dorsal
I-VI: Two schemes have hornevolved for organizing neuron
Laminacell bodies within gray
I: Posterormarginal matter. Either may be used
nucleus
according
Laminae to which
II/III: Substansia works best for a particular
gelatinosa
Laminae III/IV/V: Nucleus propius
circumstance.
Lamina VI: Nucleus dorsalis
VII-IX: Anterior/Ventral horn
• 1) VII:
Lamina Spinal Laminae—spinal
Intermediolateral nucleus gray matter is divided
Lamina VIII:
into tenMotor interneurons
laminae (originally based on observations of
Lamina IX: Motor
thick neurons
sections in a which also cat).
neonatal contain theadvantage
The Onuf’s nucleus in
is that
the sacral region
all neurons are included. The disadvantage is that
Lamina X: Neurons bordering central canal
laminae are difficult to distinguish.
 Spinal Nuclei
2) Spinal Nuclei—recognizable clusters of cells are identified as nuclei [a
nucleus is a profile of a cell column]. The advantage is that distinct nuclei are
generally detectable; the disadvantage is that the numerous neurons outside of
distinct nuclei are not included
Image taken from: http://images3.wikia.nocookie.net/psychology/images/thumb/c/c0/Medulla_spinalis_-_Substantia_grisea_-
_English.svg/400px-Medulla_spinalis_-_Substantia_grisea_-_English.svg.png
 Motor Neurons
• Motor neurons are split into two groups: Upper and Lower
motor neurons.

• Upper motor neurons originate in the motor region of the cerebral

cortex of the brain stem and carry motor information down to the
final common pathway, that is, any motor neurons that are not
directly responsible for stimulating the target muscle.

• The cell bodies of these neurons are some of the largest in the
brain, approaching nearly 100μm in diameter.

• These neurons connect the brain to the appropriate level in the

spinal cord, from which point nerve signals continue to the muscles
by means of the lower motor neurons.
 Motor neurons
• Lower motor neurons (LMNs) are the motor neurons connecting
the brainstem and spinal cord to muscle fibers, transmitting nerve
impulses from the upper motor neurons to the muscles. A lower
motor neuron's axon terminates on an effector (muscle).

• Lower motor neurons are classified based on the type of muscle

fibre they innervate:

– Alpha motor neurons (α-MNs) innervate extrafusal muscle fibers, the most
numerous type of muscle fibre and the one involved in muscle contraction.

– Gamma motor neurons (γ-MNs) innervate intrafusal muscle fibers, which

together with sensory afferents compose muscle spindles. These are part of
the system for sensing body position (proprioception).
Descending Pathway Lesions
• An upper motor neuron lesion is a lesion of the neural pathway
above the anterior horn cell or motor nuclei of the cranial nerves.

• This is in contrast to a lower motor neuron lesion, which affects

nerve fibers travelling from the anterior horn of the spinal cord to the
relevant muscle(s).

• Upper motor neuron lesions are indicated by:

– Spasticity, increase in tone in the extensor muscles (lower limbs) or flexor muscles (upper
limbs)
– Clasp-knife response where initial resistance to movement is followed by relaxation
– Weakness in the flexors (lower limbs) or extensors (upper limbs), but no muscle wasting
– Increase Deep tendon reflex (DTR)
– Presence of Babinski sign
 Descending Lesions cont.
• Damage to lower motor neurons, lower motor neurone lesions (LMNL)
causes:
– Decreased tone
– Decreased strength
And:
– Decreased reflexes in affected areas.

• These findings are in contrast to findings in upper motor neurone lesions.

– LMNL is indicated by:
– Abnormal EMG potentials, fasciculations, paralysis, weakening of muscles, and
neurogenic atrophy of skeletal muscle.
 Ascending Pathway Lesions
• Loss of sensory input from relevant pathway
– E.g. Spinothalamic tract
• Unilateral lesion usually causes contralateral anaesthesia (loss of sensation (pain and
temperature)). Anaesthesia will normally begin 1-2 segments below the level of lesion,
affecting all caudal body areas. This is clinically tested by using pin pricks.

– If lesion is hemisection (halfway across the spinal cord) (causing hemiplegia)) it

is known as Brown-Séquard syndrome.
• Brown-Séquard syndrome may be caused by a spinal cord tumour, trauma (such as a
gunshot wound or puncture wound to the neck or back), ischemia (obstruction of a
blood vessel), or infectious or inflammatory diseases such as tuberculosis, or multiple
sclerosis.

– Any presentation of spinal injury which is an incomplete lesion can be called a

partial Brown-Séquard or incomplete Brown-Séquard syndrome, so long as it has
characterized by features of a motor loss on the same side of the spinal injury
and loss of sensation on the opposite side.
 Lesion signs

• Lesions have positive or negative signs.

– Positive (also called release phenomena) = abnormal and stereotyped

responses that are explained are explained by the withdrawal of tonic
inhibition (e.g. decerebrate rigidity).

– Negative signs reflect the loss of particular capacities normally

controlled by the damaged systems.
Difference between positive and
negative signs of lesion
• 1.) Diseases affecting the descending pathways give rise to
spasticity whereas diseases of motor neurons do not.

• 2.) Diseases affecting motor neurons directly result in denervation

atrophy and reduced muscle volume, whereas this does not occur
with damage to the descending pathway.

• 3.) Damage to the descending systems tend to be distributed more

diffusely in limb or face muscles and often affects large groups of
muscles e.g. the flexors. In contrast, degeneration in the local
groups of motor neurons tends to affect muscles in a patchy way
and may even be limited to single muscles.
 Adhesions
The following information and images were all taken from: Biomechanics of the Nervous System: Breig Revisited
(http://www.neurodynamicsolutions.com/breig-revisited.php)

A.) Anteriorly located D.) Fracture of the

foramnum magnum odontoid process.
tumour.

E.) Compression
B.) Spondylotic fracture of thoracic
protrusions into the process, with
cervical canal. kyphtoic
angulation.

C.) Intramedullary
glial tissue scar or F & G.) Pedicles
circumscribed deformed by
oedema, as in osteophytic spurs.
multiple sclerosis
and spinal cord
injury.
 Fissure Formation
A.) A transverse tear in
the posterior side results
from an anterior
compression combined
with cervical extension.
Sites of tearing in the
B.) A transverse tear in
cervical cord resulting
the anterior side of the
from compression by a
cord occurs from a
body impinging on it
posterior compression
from (A) anterior and
irrespective of whether
(B) posterior directions.
the cervical canal is
flexed or extended.
 Effects of scar tissue

Scar tissue occurs in normal

tissue after damage and
forms with higher
collagenous content than that
of the original tissues.
This results in a stiffer
structure that adapts
differently to pressure in
either tension or
compression that the original
tissues.
Formation of vortices in cord pulp

Extrusion of cord substance by

fractured or displaced bone usually
continues for some time after a
transverse fissure has appeared.

Viscous tissue elements are therefore

forced into the pial sheath and flow in
cranial and caudal directions.

The flow is augmented by the elastic

retraction of the membranes of the
severed nerve fibres. The resistance to
flow can set up vortices.
 Influence of posture on adhesions
Impingement e.g.
margin of petrous
bone, calcified tissue,
tumour.
Clivus tumour, or
anterior located Flexion
foramen magnum exacerbates all
tumour. stresses in the
Intramedullary firm spinal cord – no
body setting up matter what the
bending tensile level!!
stresses.

Herniated lumbar disc

creating stress in
nerve roots.
Thanks for listening

Questions?