Normal Anatomy and Function of the Spinal Cord Frederick Frost MD APS Intensive SCI Medicine Review Course Denver 2017 33 vertebrae 7 12 5 5 4 Spinal nerves Cervical nerves Thoracic nerves 31 nerve pairs 8-12-5-5-1 Lumbar nerves Sacral nerves Coccygeal nerve Brown Sequard Injury Side of lesion Spastic paralysis and loss of vibration/ proprioception, and fine touch Loss of pain and temperature sensation Anterior spinal artery Posterior spinal arteries Spinal Cord Vasculature Posterior spinal v. Posterolateral spinal vein Posterior spinal a. Sulcal artery vein Arterial vasocorona Anterior spinal Radicular aa. artery anterior vein posterior Pia mater Spinal ganglion Arachnoid Spinal aa. Dura mater Dorsal root sleeve Internal vertebral venous plexus Figure 5-63. Drawing showing the blood supply and venous draninage of the spinal cord. Circulation continued… Dorsal nerve ramus Dorsal branch of posterior intercostal a. Ventral nerve ramus or intercostal nerve Posterior intercostal artery Internal intercostal membrane External intercostal Lateral cutaneous branch Innermost intercostal Lateral cutaneous branch membrane Anterior intercostal artery Internal intercostal Transversus thoracis Internal thoracic artery External intercostal membrane Anterior cutaneous branch Perforating (cutaneous) branch Collateral arteries of the spinal cord Posterior spinal aa. Anterior spinal a. Anterior radicular a. Posterior radicular aa. Spinal (segmental) artery Branch to vertebral body and dura mater Dorsal branch of posterior intercostal a. Posterior intercostal aa. Artery of Adamkiewicz From L intercostal artery Mellisano G 2008 Venous system: a plexus. Drains into cervical, azygous vv, and dural sinuses Satellite topics Neuroprotection The NASCIS studies Spinal Cord Pathophysiology • Substances that support nerve growth – Inosine – BDNF – NT3 - 4 – BFGF • Substances that cause damage or inhibit nerve repair – glutamate – chondroitin NASCIS Studies • Bracken MB et al. Efficacy of methylprednisolone in acute SCI. JAMA 1984 251: 45-52. • Bracken MB et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405–1411. • Bracken MB, et al., for the National Acute Spinal Cord Injury Study. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277: 1597–1604. • Bracken MB et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second national acute spinal cord injury study. J Neurosurg 1992; 76: 23–31. • Coleman WP, Benzel E, Cahill DW et al. 'A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury.' J Spinal Disord. 2000;13:185-99 Thank you! [email protected].