Anatomy of the Spinal Cord

2021 ◽  
pp. 60-67
Author(s):  
Jennifer A. Tracy
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Cervical Cord ◽  
Filum Terminale ◽  
Upper Limbs ◽  
Descending Pathways ◽  
Lumbar Vertebral Body

The spinal cord begins as the cervical cord immediately below the medulla and extends through the spinal canal, where it becomes the thoracic, lumbar, sacral, and coccygeal parts of the cord. In most persons, the spinal cord proper ends at the lower portion of the first lumbar vertebral body, where it forms the conus medullaris and, finally, the filum terminale. A cervical enlargement contains the innervation pathways of the upper limbs; a lumbar enlargement contains the pathways of the lower limbs. This chapter reviews ascending and descending pathways in the spinal cord.

scholarly journals Can compressive thoracic cord lesions cause a pure lower motor neurone syndrome?

2018 ◽  
Vol 19 (1) ◽  
pp. 72-74
Author(s):  
Chin Yong Kok ◽  
Hoskote Chandrashekar ◽  
Christopher Turner ◽  
Hadi Manji ◽  
Alexander M Rossor
Keyword(s):  
Spinal Cord ◽  
Motor Neurone ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Cervical Cord ◽  
Upper Limbs ◽  
Cervical Spondylotic Amyotrophy ◽  
Thoracic Cord ◽  
Cord Lesion

Compressive lesions of the spinal cord usually cause a syndrome of upper motor neurone weakness, spasticity and sensory loss below the level of the lesion. It has long been recognised that compressive cervical cord lesions may present as isolated lower motor neurone weakness of the upper limbs, a syndrome termed cervical spondylotic amyotrophy. We describe two patients presenting with isolated lower motor neurone weakness of the lower limbs in association with a compressive cord lesion at T11/12, a condition we have termed thoracic spondylotic amyotrophy.

Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures

2007 ◽  
Vol 6 (1) ◽  
pp. 92-95 ◽  
Author(s):  
Peter C. Gerszten ◽  
William C. Welch
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Spinal Canal ◽  
Cauda Equina ◽  
Clinical Effectiveness ◽  
Balloon Kyphoplasty ◽  
Balloon Inflation ◽  
Compression Fractures ◽  
Percutaneous Balloon ◽  
Tumor Debulking

✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.

scholarly journals Cervical Cord Compression With Lower Limbs Sensory Disturbance Presentation: Three Case Reports and Literature Review

2021 ◽  
Author(s):  
Yafei Cao ◽  
Yihong Wu ◽  
Weiji Yu ◽  
Weidong Liu ◽  
Shufen Sun ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Lower Limb ◽  
Cord Compression ◽  
Lower Limbs ◽  
Anterior Cervical Discectomy ◽  
Cervical Cord ◽  
Sensory Disturbance ◽  
Cervical Discectomy ◽  
Sensory Disturbances

Abstract Background: Lower limb sensory disturbance presentation can be a false localizing cervical cord compressive myelopathy (CSM). It may lead to delayed or missed diagnosis, resulting in the wrong management plan, especially in the presence of concurrent lumbar lesions.Case presentation:Three Asian patients with lower limb sensory disturbances presentation were treated ineffectively in the lumbar. Magnetic resonance imaging (MRI) showed cervical disc herniation and cervical level spinal cord compression. Anterior cervical discectomy surgery and zero-p interbody fusion were performed. After operations, imagings showed that the spinal cord compression were relieved, and the lower limbs sensory disturbances were also relieved. Three-months follow-up after operation showed good recovery.Conclusions:These three cervical cord compression cases of lower limb sensory disturbance presentation were easily misdiagnosed with lumbar spondylosis. Anterior cervical discectomy and fusion operation had a good therapeutic effect. Therefore, cases that present with lower limb sensory disturbance, but in a non-radicular classical pattern, should always alert a suspicion of a possible cord compression cause at a higher level.

scholarly journals The Analysis of the Preventive Nursing of Infection after Orthopedic Operation

2015 ◽  
Vol 4 (1) ◽  
pp. 9
Author(s):  
Min Ai
Keyword(s):  
Spinal Cord ◽  
Lower Limbs ◽  
Upper Limbs ◽  
Isolation System ◽  
Clinical Nursing ◽  
Factors Influencing ◽  
Orthopedic Operation

<p><strong>Objective:</strong> To explore the preventive nursing methods of infection after orthopedic operation and provide some basis for clinical nursing. <strong>Method: </strong>1000 patients who have received orthopedic operations are selected randomly from our hospital from September 2009 to September 2014, then we make follow-up and survey, analyze the factors influencing infection and implement corresponding nursing measures. <strong>Result:</strong> Among the 1000 patients, 26 patients have incision infection of sterile operation and the infected positions are on spinal cord, upper limbs and lower limbs. Surveys find that after orthopedic operation, infection patients are mostly infected 3-4 weeks after being hospitalized with the earliest infection occurring after one week after being hospitalized. We can find that the longer patients are hospitalized for, the higher the occurrence of infection is. <strong>Conclusion: </strong>In the preventive nursing of infection after orthopedic operation, sterile operation and preoperative, intraoperative and postoperative nursing should be remembered. And the most important one is to adopt sterilization and isolation system after orthopedic operation to lower the occurrence of infection to the lowest.</p>

Significant clinical and radiological resolution of a spinal cord syrinx following the release of a tethered cord in a patient with an anatomically normal conus medullaris

2008 ◽  
Vol 1 (5) ◽  
pp. 396-398 ◽  
Author(s):  
John Caird ◽  
Peter Flynn ◽  
Robert S. McConnell
Keyword(s):  
Spinal Cord ◽  
Neurological Deficit ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Current Understanding ◽  
Filum Terminale ◽  
Ongoing Debate ◽  
Progressive Neurological Deficit

✓The authors describe a case of progressive neurological deficit caused by syringomyelia in a 7-year-old boy with a normally positioned conus medullaris. This deficit responded favorably to surgical untethering of the filum terminale, with subsequent clinical and radiological improvement. The authors discuss the implications of their findings in the context of the current understanding of the pathophysiology of tethered cord syndrome, particularly in relation to the ongoing debate in the neurosurgical literature.

scholarly journals Spinal cord anomalies in patients with anorectal malformations without severe sacral abnormalities or meningomyelocele: outcomes after expectant, conservative management

2016 ◽  
Vol 25 (6) ◽  
pp. 782-789 ◽  
Author(s):  
Kristiina Kyrklund ◽  
Mikko P. Pakarinen ◽  
Seppo Taskinen ◽  
Reetta Kivisaari ◽  
Risto J. Rintala
Keyword(s):  
Spinal Cord ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Neurological Abnormalities ◽  
Urinary Tract Symptoms ◽  
Male Patients

OBJECTIVE The goal of this study was to determine the significance of spinal cord anomalies (SCAs) in patients with anorectal malformations (ARMs) by comparing the outcomes for bowel function, lower urinary tract symptoms (LUTS), and lower-limb neurological abnormalities to these outcomes in patients with similar ARMs and a normal spinal cord. METHODS The spinal cord MRI records of female patients treated for vestibular and perineal fistula (VF/PF) and male patients with rectourethral fistula (RUF) at a single center between 1983 and 2006 were reviewed. Bowel function and LUTS were assessed by questionnaire. Patients with extensive sacral anomalies or meningomyelocele were excluded. RESULTS Of 89 patients (median age 15 years, range 5–29 years), MRI was available in 90% (n = 80; 40 male patients with RUF), and 80% of patients returned the questionnaire (n = 64; 31 male patients with RUF). Spinal cord anomalies were found in 34%, comprising a filum terminale lipoma in 30%, low conus medullaris in 10%, and thoracolumbar syrinx in 6%. Bowel functional outcomes between patients with SCAs (n = 23) and those with a normal spinal cord (n = 41) were not significantly different for soiling (70% vs 63%), fecal accidents (43% vs 34%), and constipation (57% vs 39%; p = not significant for all). The LUTS, including urge (65% vs 54%), urge incontinence (39% vs 24%), stress incontinence (17% vs 22%), and straining (32% vs 29%) were also comparable between groups (p = not significant for all). No patients developed lower-limb neurological abnormalities. CONCLUSIONS The results suggest that the long-term functional outcomes for patients with SCAs who had VF/PF and RUF may not differ significantly from patients with the same type of ARMs and a normal spinal cord. The results favor a conservative approach to their management in the absence of abnormal neurological findings in the lower limbs.

Spinal cord traction, vascular compromise, hypoxia, and metabolic derangements in the pathophysiology of tethered cord syndrome

2010 ◽  
Vol 29 (1) ◽  
pp. E9 ◽  
Author(s):  
Aristotelis S. Filippidis ◽  
M. Yashar Kalani ◽  
Nicholas Theodore ◽  
Harold L. Rekate
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Clinical Picture ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Structural Abnormality ◽  
Filum Terminale ◽  
Radiological Criteria ◽  
Definition Of

Object The definition of tethered cord syndrome (TCS) relies mainly on radiological criteria and clinical picture. The presence of a thickened filum terminale and a low-lying conus medullaris in symptomatic patients is indicative of TCS. The radiological definition of TCS does not take into account cases that involve a normal-lying conus medullaris exhibiting symptoms of the disease. Methods The authors performed a MEDLINE search using the terms “tethered cord” and “pathophysiology.” The search returned a total of 134 studies. The studies were further filtered to identify mostly basic research studies in animal models or studies related to the biomechanics of the filum terminale and spinal cord. Results Spinal cord traction and the loss of filum terminale elasticity are the triggers that start a cascade of events occurring at the metabolic and vascular levels leading to symptoms of the disease. Traction on the caudal cord results in decreased blood flow causing metabolic derangements that culminate in motor, sensory, and urinary neurological deficits. The untethering operation restores blood flow and reverses the clinical picture in most symptomatic cases. Conclusions Although classically defined as a disease of a low-lying conus medullaris, the pathophysiology of TCS is much more complex and is dependent on a structural abnormality, with concomitant altered metabolic and vascular sequelae. Given the complex mechanisms underlying TCS, it is not surprising that the radiological criteria do not adequately address all presentations of the disease.

scholarly journals Clinical implications morphometric study of the cervical spine on MRI

2019 ◽  
Vol 10 (2) ◽  
Author(s):  
Swati S.More ◽  
Anita R. Gune ◽  
Jeetendra K. Patil
Keyword(s):  
Spinal Cord ◽  
Vertebral Body ◽  
Spinal Cord Compression ◽  
Spinal Canal ◽  
Cord Compression ◽  
Cervical Region ◽  
Canal Stenosis ◽  
Cervical Spinal Canal ◽  
Canal Diameter ◽  
Increased Risk

Degenerative changes, history of trauma or inflammation usually progressed to cervical spinal canal stenosis.  This condition leads to cervical spondylosis neuropraxia and cervical spondylotic myelopathy (CSM). SAC (space available for the cord) value is important to understand the symptoms of spinal cord compression in cervical canal stenosis. The aim of our study is to establish cervical spinal canal morphometry in Western Maharashtra population observed by MRI of cervical region.70 subjects aged between 18-70 years. The sagittal vertebral body diameter, the sagittal spinal canal diameter and the sagittal spinal-cord diameter were measured at the C3 - C7 level. The SAC was determined. For each variable a two-way ANOVA was performed, sagittal canal diameter, sagittal spinal cord diameter and SAC were significant with p-value P< 0.0001**. Mean vertebral body diameters observed were 1.49-1.51. Values of SAC observed were C3-1.5 cm, C4- 1.51cm, C5- 1.49cm, C6- 1.5cm, C7- 1.49cm. Average sagittal spinal canal diameter from C3-C7 was 14.1± 1.3 mm. The range of SAC was between 6.4-9.5mm, least at the C5 level. We conclude that subjects in our study do not have an increased risk of spinal cord compression.

scholarly journals Conus medullaris syndrome caused by spinal cord schistosomiasis: case report

2021 ◽  
Author(s):  
Mariana de Souza Dias ◽  
Matheus Felipe de Souza Vasconcelos
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Urinary Retention ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Cns Involvement ◽  
Hyperintense Signal ◽  
Mri Study ◽  
The Brain ◽  
Loss Of Strength

Background: Neuroschistosomiasis is a rare but severe complication of schistosomiasis that is often underdiagnosed and can affect both the brain and the spinal cord. CNS involvement occurs during hepato-intestinal or intestinal phase of the disease, when the Schistosoma eggs or adult worms reach the vertebral venous plexuses via Batson plexuses. Objective: To report a case of a patient with conus medullaris syndrome caused by spinal cord schistosomiasis whose symptoms had great improvement after undergoing treatment with praziquantel and prednisone. Case report: A 45-year-old woman, from Bahia, Brazil, with no significant medical history, presented with intense pain in her legs from knees below, associated with progressive loss of strength, tingling and dysesthesias in both lower limbs, causing gait impairment followed by urinary retention. At physical examination, grade III paraparesis in proximal limbs and grade IV in distal limbs and unsteady dysbasic gait were observed, no meningeal signs were found. MRI study revealed hyperintense signal in medulla at the level of T12-L1 to conus medullaris in T2 sequences, mainly on central portions and medulla, also slight impregnation with gadolinium showing dotted pattern was observed, suggestive findings of inflammatory myelitis. KatoKatz test was performed evidencing Schistosoma eggs. After diagnosis, patient was treated with prednisone and praziquantel for 5 weeks. At the end the of treatment, she has showed progressive improvement of her symptoms. In our last evaluation, the patient showed a great recovery of movement and strength, now grade IV in proximal limbs and grade V in distal limbs as well as a steadier gait. Urinary retention is still present, and she still needs intermittent catheterization for the time being Conclusion: Neuroschistosomiasis, when symptomatic, is a severe disorder in which can cause significant incapacity and morbidity. It is an underdiagnosed disorder but has been increasingly reported in populations in endemic areas and in tourists. Prognosis depends largely on early diagnosis and treatment.

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