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Home , Central canal, Dura mater, Grey column, Lateral grey column, Meninges, Rexed laminae

of the , The Spinal Cord spinal and If all the nerves exited directly from the , autonomous the brain would be bigger. God created the spinal cord below the brain. The spinal cord is like a channel coming out of a Majda M Thurnher1 fountain in the way that nerves emerge from Johan van Goethem2 both sides and go down, thus putting the organs closer to the brain. 1Medical University of Vienna | University Hospital Vienna | Department of Biomedical Imaging and Image- That is why God placed the spinal cord into a Guided Therapy Vienna | Austria CEO of the European Board of (EBNR) hard bony channel called the spine to protect it Past President of the European Society of Neuroradiology (ESNR) from injury. 2 University of Antwerp | Belgium President of the European Society of Neuroradiology (ESNR) Ibn Sina (Avicenna) 980-1037

SPINAL CORD SPINAL CORD

• The spinal cord is part of the (CNS)

• It is situated inside the vertebral canal of the .

• During development, there’s a disproportion between spinal cord growth and vertebral column growth. The spinal cord finishes growing at the age of 4, while the vertebral column finishes growing at age 14-18. 35 / 38 mm

• Cervical, thoracic, , pelvic 13 mm thick in the cervical and lumbar regions 6.4 mm thick on the thoracic area 43 / 45 cm

SPINAL CORD Posterior median

• The spinal cord is made of Dorsal horns gray and just like other parts of the CNS.

• It shows four SURFACES: anterior, posterior, and Blasius G: Anatome Medullae Spinalis Nervorum 1666 White matter two lateral. • They feature FISSURES (anterior) and sulci (anterolateral, posterolateral, and posterior). Ventral horns

Courtesy of Eric Schwartz Ventral median fissure

1 Gray matter Gray matter posterior • anterior grey column The dorsal horn (posterior horn) contains that receive somatosensory information from the body

• The ventral horn (anterior horn) largely contains motor neurons that exit the spinal cord to innervate

No lateral gray matter in the cervical region! • The intermediate column and lateral horn contains neurons that innervate visceral and pelvic organs

Gray matter The “Lamination” of the gray matter

Anterior Cell Columns • The distribution of cells – Ventromedial (Vm) and fibers within the gray – Ventrolateral (Vl) matter of the spinal cord exhibits a pattern – Dorsomedial (Dm) of lamination. – Dorsolateral (Dl) • The cellular pattern of – Accessory (A) each lamina is composed Intermediate Gray Matter of various sizes or shapes – Intermediolateral (Iml) of neurons which led – Intermediomedial (Imm) Rexed to propose a new Posterior Cell Columns classification based on 10 layers (laminae). – Substantia gelatinosa (Sg) – Nucleus proprius (Np)80 – Nucleus dorsalis (Nd) A cytoarchitectonic of the spinal cord in the . J Comp Neurol 1954; 100:297-351

High Resolution MR Microscopy of the Spinal Cord at 9.4 T 3T Spatial Resolution Postmortem Anatomy & DTI

Courtesy of Thomas Naidich, New York, USA

2 Courtesy of Thomas Naidich, New York, USA

Rexed Laminae I -X

Dorsal Root Entry Zone Nucleus Proprius Dorsal Column of Clarke

Intermediolateral Column of Terni Courtesy of Thomas Naidich, New York, USA

MR Microscopy of the Human Spinal Cord at 7 T

3 White matter

Coloured scanning electron micrograph (SEM)

Ascending tracts convey information from the periphery to the brain (sensory information)

Descending tracts carry information from the brain to the periphery (motor information).

Spinal Pathways Pathway for sensation of and reaction to pain

• Sensory neurons finger • Ascending pathway • • Sensory cortex • • Thalamus • Descending pathway • Muscles

4 Ascending tracts (sensory) Fasciculus gracilis and cuneatus

Pain • Fine touch Temperature • Coarse touch • Vibration

Fine touch Fasciculus cuneatus – upper limbs Vibration Faciculus gracilis – lower limbs Proprioception

Conscious sensory information cortex Subconsciousinformation

Spinothalamic tract (anterolateral tracts)

• Crude touch • Pain • Temperature • Proprioception

Descending tracts (motor) Corticospinal tracts (pyramidal) (pyramidal and extra-pyramidal)

Movement Muscle tone Spinal

• Voluntary movements

5 Extrapyramidal tracts

• rubrospinalis • reticulospinalis anterior • tectospinalis • vestibulospinalis

Fasciculus gracilis • Fine touch Fasciculus cuneatus • Fine touch • Proprioception • Proprioception • Vibration • Vibration

Spinothalamic tract • Pain Spinocerebellar tract • Proprioception • Temperature (subsconscious) • Crude touch

6 Corticospinal tracts (lateral and anterior) (extra-pyramidal) • Skilled voluntary movements

Tectospinal tract (extra-pyramidal) (extra-pyramidal)

Reticulospinal tract (extra-pyramidal) • a component of the peripheral nervous system that rate regulates involuntary physiologic processes Blood pressure Respiration • It contains three anatomically distinct divisions: sympathetic, Sexual arousal parasympathetic and enteric.

7 Autonomic nervous system

COVERINGS

Spinal

• Three layers of meninges envelop the spinal cord and the roots of spinal nerves

Dura mater

Arachnoid

Pia mater

Leptomeninges

The spinal The spinal arachnoid The spinal pia • Around the margin of the cranial dura mater is closely adherent to the , and is continuous • Thin (avascular) layer lining the • Directly covering the spinal cord and spinal roots with the spinal dura mater dural sac and nerves root sheaths

• Separated form the dura • Continuous with the lig. • The Spinal Dura Mater (dura mater denticulatum spinalis) forms a loose sheath around the medulla spinalis

• represents only the meningeal layer of the cranial dura mater (the endosteal layer ceases at the foramen magnum)

• its place is taken by the lining the vertebral canal

8 Spinal spaces Epidural Subarachnoid • Space between the dura and the • Space between the arachnoid periosteum and pia • Content: fat, venous plexus, • Continuous with cerebral roots below S2 subarachnoid space • Content: CSF, , ,

Internal vertebral venous plexus Internal vertebral venous plexus • It sits within the within a layer of fat containing the internal vertebral venous plexus. • The vertebral venous plexus is a highly anastomotic network of valveless veins running along the entire length of the spinal canal.

Spinal epidural extramedullary hematopoiesis

• sudden stabbing back pain that Spontaneous spinal epidural progressed toward paraparesis

9 Tuberculous Radiculitis

How much anatomy do you need to report?

Spinal cord lesion

Long T2 lesion Short T2 lesion

Anterior Posterior Lateral Central

Enhancement pattern Bilat ventral Marginal Central Anterior Posterior

Compression Infarct B12 deficiency

CASE #1

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Sagittal Short T2 lesions

Axial Posterior/Lateral anterior

Enhancement YES NO Nodular or ring

Other clues Brain lesions

Diagnosis Multiple Sclerosis

CASE #2

11 Spinal cord lesion

Sagittal Short T2 lesion

Axial Central

Enhancement YES

Other clues DTI: central with spreading fibers lateral

Diagnosis

Myelopathy Myelopathy

Long T2 lesion Sagittal Short T2 lesion Sagittal

Axial lateral central Posterior/Lateral Anterior/lateral/ Anterior/lateral/ Central Anterior gray Symmetrical Central Axial posterior posterior matter dorsal columns

Enhancement NO YES YES YES YES YES + leptomeningeal Nodular or ring Enhancement „Pancake-like“ Nodular or ring NO YES NO YES NO YES YES YES Black butterfly „Missing piece „Shaggy ring“ “Trident sign“ sign“

Other clues Degenerative Degenerative disease disease Brain lesions Brain lesions Eccentric , syrinx Bright spotty Subpial Other clues + edema Dilated vessels lesions enhancement

Diagnosis Chronic Acute MS Vasculitis Tumor spondylotic spondylotic Mets myelopathy myelopathy Ischemia SCD Paraneoplastic ATM sDAVF NMO Sarcoidosis Diagnosis HIV ADEM

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