Professional Documents
Culture Documents
Lecture Outline
Basic Anatomy
Embryology
Vascular Supply
Grey Matter
White Matter
Clinical Cases & Neuroimaging
Spinal Cord
The Basics
40-50 cm in length
1 1.5 cm in diameter
31 paired roots
Ends at the L1-L2 as the
conus medullaris
Cauda equina continues as
collection of lumbosacral
nerves
Filum terminale
C1-C7= Above vertebrae
C8 & below= Below vertebrae
Spinal Cord
Embryology
Spinal Cord
Embryology
Spinal Cord
Meninges
-Skin
-Subcutaneous Fat
-Supraspinous ligament
-Intraspinous ligament
-Ligamentum flavum
-Epidural fat
-Dura
-Arachnoid
Spinal Cord
Blood supply
Spinal Cord
Blood Supply
Spinal Cord
Grey Matter
Spinal Cord
Defined by cellular
structure & location
I-VI Dorsal horn
VII & X - Intermediate
zone
VIII & IX Ventral
horn
Spinal Cord
Spinal Cord
Spinal Cord
Spinal Cord
Grey matter
Spinal Cord
Spinal Cord
Spinal Cord
Spinal Cord
Dorsal columns
Spinothalamic tract
Spinocerebellar tracts
Spinal Cord
Spinal Cord
Also:
Spinal Cord
From (peripheral
process)
Region
Dorsal spinocerebellar
Muscle spindles
(primary)
Ventral spinocerebellar
Cuneocerebellar
Muscle spindle
(primary)
Ipsilateral arm
Rostral spinocerebellar
Ipsilateral arm
Spinal Cord
Motor pathways
Spinal Cord
Spinal Cord
Vestibulospinal:
Tectospinal:
Brown-sequard syndrome
Syringomyelia and
Chiari malformation.
Loss of pain / temp in a
cape-like distribution.
Preserved vibration /
posterior column
sensation and motor
systems until late in
disease course.
Spondylolysis
Spondylolisthesis
Cord contusion is the best response because there is gross traumatic injury to the
spinal column with disruption of the C4-C5 ligamenta flava, interspinous ligaments,
and posterior longitudinal ligament. There is fracture deformity of C5 vertebra
consistent with a flexion teardrop fracture and fracture of C6. There is prevertebral
soft tissue edema, and the cord has T2 hyperintense signal at the C5 and C6 level
consistent with traumatic cord contusion with some intramedullary hemorrhagic
component. Neuromyelitis optica, ependymoma, abscess, and sarcoid myelitis are not
the best choices because the extensive vertebral column injuries are not consistent with
the typical presentation of any of these entities.
The spinal lesion is multisegmental, elongated, and is in the lower cervical and thoracic levels.
The pattern and extent of this lesion is atypical for multiple sclerosis in its size and extent and
most characteristic of a form of transverse myelitis. The presence anti aquaporin antibodies (NMO
antibodies) is a diagnostic marker of neuromyelitis optica (also known as Devic disease) which is
a distinct form of demyelinating disease. The other choices would be highly unlikely to have these
auto-antibodies.
The arrows on the two images point to a semilunar nodule along the right anterior margin of
the right facet joint. This structure results in right lateral recess stenosis and is a frequent
etiology of radicular pain in the elderly. This structure arises continuous with the right facet
joint and is typical of a synovial cyst, likely partially calcified. A neurofibroma would be more
likely seen within the right neuroforamen arising along the nerve root. A large free fragment
with that dimension and that location is unlikely. The structure is adjacent to, but does not
appear to be continuous with the adjacent disc.
The figures demonstrate a diffuse heterogeneous appearance of the vertebrae, "salt and
pepper pattern". There is also a larger focal enhancing lesion extending into the pedicle
of L2 along with compression fractures. This pattern of diffuse osseus invasion can be
seen due to hematologic diseases and is most typical of multiple myeloma. Thalassemia
is associated with marrow reconversion with the repopulating of yellow marrow by
hematopoietic cells, but that would not be expected to show this salt and pepper pattern
or a focal lesion as in L2, nor would metastatic carcinoma. There are pathologic
compression fractures and some kyphotic posturing, but these would not be the best
answers.