Clinical Anatomy Of The Spine, Spinal Cord, And...

Your spinal cord is a cylindrical structure that runs through the center of your spine, from your brainstem to your low back. It's a delicate structure that contains nerve bundles and cells that carry messages from your brain to the rest of your body. Your spinal cord is one of the main parts of your nervous system.

Clinical Anatomy of the Spine, Spinal Cord, and...

With its unique clinical perspective and evidence-based coverage, Clinical Anatomy of the Spine, Spinal Cord, and ANS is the definitive reference for applying anatomic considerations to the evaluation and management of conditions of the spine and associated neural structures, including spinal impingement and subluxation. High-quality color illustrations and photographs, as well as abundant radiographs, CT, and MRI images, visually demonstrate specific anatomic and neuromusculoskeletal relationships and highlight structures that may be affected by manual and surgical spinal techniques or other diagnostic and therapeutic procedures.

With its unique clinical perspective and evidence-based coverage, Clinical Anatomy of the Spine, Spinal Cord, and ANS is the definitive reference for applying anatomic considerations to the evaluation and management of conditions of the spine and associated neural structures, including spinal impingement and subluxation. High-quality color illustrations and photographs, as well as abundant radiographs, CT, and MRI images, visually demonstrate specific anatomic and neuromusculoskeletal relationships and highlight structures that may be affected by manual and surgical spinal techniques or other diagnostic and therapeutic procedures.

"Embryological, gross anatomical, histological, and physiological aspects of the spine, spinal cord, and ANS are comprehensively discussed and related to the pathophysiology encountered in clinical practice. Extensive use of illustrations, clinical vignettes, photographs, radiologic images, and well-organized tables enhances the presentation and eases the aforementioned application of current anatomical knowledge in the clinical setting. The text is well-written and organized in short paragraphs separated by a logic sequence of headings and subheadings to maintain oversight to the reader.

The spinal cord is a tubular structure composed of nervous tissue that extends from the brainstem and continues distally before tapering at the lower thoracic/upper lumbar region as the conus medullaris. The spinal cord is anchored distally by the filum terminale, a fibrous extension of the pia mater anchoring the spinal cord to the coccyx.[1] Protecting the spinal cord is the surrounding cerebrospinal fluid (CSF), supportive soft tissue membranes and meninges, and the osseous vertebral column.[2] Basic knowledge of the spinal cord and spinal column structure and function is essential for healthcare providers as the recognition of characteristic clinical signs and symptoms is imperative for the appropriate treatment of patients presenting with a wide range of clinical symptoms.

Anatomical dissections of the back and neck, thoracic and abdominal cavities, and spinal cord, Chapters 3,4,6,7, and 13. From Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS by Cramer, G. and Darby, S., 1995 Mosby Year Book, St. Louis.

Anatomical dissections of the back and neck, thoracic and abdominal cavities, and spinal cord, Chapters 3,4,6,7, and 13. From Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS - Second Edition by Cramer, G. and Darby, S., 2005 Mosby Year Book, St. Louis.Anatomical dissections of the back and neck, thoracic and abdominal cavities, and spinal cord, Chapters 3,4,6,7, and 13. From Basic and Clinical Anatomy of the Spine, Spinal Cord and ANS - Third Edition by Cramer, G. and Darby, S., 2014 Mosby Year Book, St. Louis.Published Abstracts:Cramer, G.; Cantu, J.; Greenstein, J.; Dorsett, R.; Gongaware, K.; and Frank, P. 1993. The Accuracy of Magnetic Resonance Imaging In Determining the Vertical Dimensions of the Cervical Intervertebral Foramina. Proceedings of the 1993 International Conference of Spinal Manipulation, pp. 38-40.

Development continues with new features, such as mobile-friendly functionality, course lecture videos, clinical correlate lecture videos and in 2015, we launched Neuroanatomy Online, an open-access electronic laboratory to complement Neuroscience Online as a resource for the study of neuroanatomy.

Although the spinal cord constitutes only about 2% of the central nervous system (CNS), its functions are vital. Knowledge of spinal cord functional anatomy makes it possible to diagnose the nature and location of cord damage and many cord diseases.

Each spinal nerve is composed of nerve fibers that are related to the region of the muscles and skin that develops from one body somite (segment). A spinal segment is defined by dorsal roots entering and ventral roots exiting the cord, (i.e., a spinal cord section that gives rise to one spinal nerve is considered as a segment.) (Figure 3.4).

A dermatome is an area of skin supplied by peripheral nerve fibers originating from a single dorsal root ganglion. If a nerve is cut, one loses sensation from that dermatome. Because each segment of the cord innervates a different region of the body, dermatomes can be precisely mapped on the body surface, and loss of sensation in a dermatome can indicate the exact level of spinal cord damage in clinical assessment of injury (Figure 3.5). It is important to consider that there is some overlap between neighboring dermatomes. Because sensory information from the body is relayed to the CNS through the dorsal roots, the axons originating from dorsal root ganglion cells are classified as primary sensory afferents, and the dorsal root's neurons are the first order (1) sensory neuron. Most axons in the ventral roots arise from motor neurons in the ventral horn of the spinal cord and innervate skeletal muscle. Others arise from the lateral horn and synapse on autonomic ganglia that innervate visceral organs. The ventral root axons join with the peripheral processes of the dorsal root ganglion cells to form mixed afferent and efferent spinal nerves, which merge to form peripheral nerves. Knowledge of the segmental innervation of the cutaneous area and the muscles is essential to diagnose the site of an injury.

At all the levels of the spinal cord, nerve cells in the gray substance are multipolar, varying much in their morphology. Many of them are Golgi type I and Golgi type II nerve cells. The axons of Golgi type I are long and pass out of the gray matter into the ventral spinal roots or the fiber tracts of the white matter. The axons and dendrites of the Golgi type II cells are largely confined to the neighboring neurons in the gray matter.

Surrounding the gray matter is white matter containing myelinated and unmyelinated nerve fibers. These fibers conduct information up (ascending) or down (descending) the cord. The white matter is divided into the dorsal (or posterior) column (or funiculus), lateral column and ventral (or anterior) column (Figure 3.8). The anterior white commissure resides in the center of the spinal cord, and it contains crossing nerve fibers that belong to the spinothalamic tracts, spinocerebellar tracts, and anterior corticospinal tracts. Three general nerve fiber types can be distinguished in the spinal cord white matter: 1) long ascending nerve fibers originally from the column cells, which make synaptic connections to neurons in various brainstem nuclei, cerebellum and dorsal thalamus, 2) long descending nerve fibers originating from the cerebral cortex and various brainstem nuclei to synapse within the different Rexed layers in the spinal cord gray matter, and 3) shorter nerve fibers interconnecting various spinal cord levels such as the fibers responsible for the coordination of flexor reflexes. Ascending tracts are found in all columns whereas descending tracts are found only in the lateral and the anterior columns.

Four different terms are often used to describe bundles of axons such as those found in the white matter: funiculus, fasciculus, tract, and pathway. Funiculus is a morphological term to describe a large group of nerve fibers which are located in a given area (e.g., posterior funiculus). Within a funiculus, groups of fibers from diverse origins, which share common features, are sometimes arranged in smaller bundles of axons called fasciculus, (e.g., fasciculus proprius [Figure 3.8]). Fasciculus is primarily a morphological term whereas tracts and pathways are also terms applied to nerve fiber bundles which have a functional connotation. A tract is a group of nerve fibers which usually has the same origin, destination, and course and also has similar functions. The tract name is derived from their origin and their termination (i.e., corticospinal tract - a tract that originates in the cortex and terminates in the spinal cord; lateral spinothalamic tract - a tract originated in the lateral spinal cord and ends in the thalamus). A pathway usually refers to the entire neuronal circuit responsible for a specific function, and it includes all the nuclei and tracts which are associated with that function. For example, the spinothalamic pathway includes the cell bodies of origin (in the dorsal root ganglia), their axons as they project through the dorsal roots, synapses in the spinal cord, and projections of second and third order neurons across the white commissure, which ascend to the thalamus in the spinothalamic tracts.

Information from the skin, skeletal muscle and joints is relayed to the spinal cord by sensory cells located in the dorsal root ganglia. The dorsal root fibers are the axons originated from the primary sensory dorsal root ganglion cells. Each ascending dorsal root axon, before reaching the spinal cord, bifurcates into ascending and descending branches entering several segments below and above their own segment. The ascending dorsal root fibers and the descending ventral root fibers from and to discrete body areas form a spinal nerve (Figure 3.10). There are 31 paired spinal nerves. The dorsal root fibers segregate into lateral and medial divisions. The lateral division contains most of the unmyelinated and small myelinated axons carrying pain and temperature information to be terminated in the Rexed laminae I, II, and IV of the gray matter. The medial division of dorsal root fibers consists mainly of myelinated axons conducting sensory fibers from skin, muscles and joints; it enters the dorsal/posterior column/funiculus and ascend in the dorsal column to be terminated in the ipsilateral nucleus gracilis or nucleus cuneatus at the medulla oblongata region, i.e., the axons of the first-order (1) sensory neurons synapse in the medulla oblongata on the second order (2) neurons (in nucleus gracilis or nucleus cuneatus). In entering the spinal cord, all fibers send collaterals to different Rexed lamina. 041b061a72