Saladin Outline Ch.13 Page
Saladin 5e Extended Outline
The Spinal Cord, Spinal Nerves, and Somatic Reflexes
I. The Spinal Cord (pp. 482–490)
A. The spinal cord serves three principle functions. (p. 482)
1. Conduction. The spinal cord contains bundles of nerve fibers that conduct information up and down the cord.
2. Locomotion. Motor neurons in the brain initiate walking, but continued walking is coordinated by groups of neurons called central patterns generators in the cord.
3. Reflexes. Involuntary stereotyped responses to stimuli involve the brain, spinal cord, and peripheral nerves.
C. In terms of surface anatomy, the spinal cord is a cylinder of nervous tissue that arises from the brainstem at the foramen magnum, and then passes through the vertebral canal as far as the inferior margin of the first lumbar vertebra or slightly beyond. (pp. 482–483) (Fig. 13.1)
1. Early in fetal development, the spinal cord extends the full length of the vertebral column; the vertebral column grows faster, however, so by birth the spinal cord extends only to L3.
2. The cord gives rise to 31 pairs of spinal nerves.
a. The first pair passes between the skull and vertebra C1; the rest pass through the intervertebral foramina.
b. Although the cord is not visibly segmented, the part supplied by each pair of spinal nerves is called a segment.
c. The cord exhibits the anterior median fissure anteriorly, and the posterior median sulcus posteriorly. (Fig. 13.2b)
3. The spinal cord is divided into cervical, thoracic, lumbar, and sacral regions, which are named for the level of the vertebral column from which the spinal nerves emerge, not the vertebrae that contain the cord.
4. In the inferior cervical region, the cervical enlargement of the cord gives rise to nerves of the upper limbs.
5. In the lumbosacral region, the lumbar enlargement gives rise to nerves to the pelvic region and lower limbs.
6. Inferior to the lumbar enlargement, the cord tapers to a point called the medullary cone.
7. The lumbar enlargement and medullary cone give rise to a bundle of nerve roots called the cauda equine that occupy the vertebral canal from L2 to S5.
D. The spinal cord and brain are enclosed in three fibrous connective tissue membranes called meninges (sing. meninx). (pp. 483–485) (Fig. 13.2)
1. The dura mater forms a loose-fitting sleeve called the dural sheath around the spinal cord.
a. The space between the sheath and the vertebral bones, called the epidural space, is occupied by blood vessels, adipose tissue, and loose connective tissue.
b. Anesthetics are sometimes introduced to this space to block pain signals.
2. The arachnoid mater consist of a simple squamous epithelium adhering to the inside of the dura and a loose mesh of fibers spanning the gap between the arachnoid membrane and the pia mater.
a. This space is called the subarachnoid space and is filled with cerebrospinal fluid (CSF).
b. Inferior to the medullary cone, the subarachnoid space is called the lumbar cistern and is occuplied by the cauda equine and CSF.
3. The pia mater is a delicate, translucent membrane that closely follows the contours of the spinal cord.
a. The pia mater continues beyond the medullary cone as a fibrus strand, the terminal filum, within the lumbar cistern.
b. At the level of S2 it exits the cistern and fuses with the dura mater; they form the coccygeal ligament that anchors the cord and meninges to vertebra Co1.
c. At regular intervals, extensions of the pia called denticulate ligaments extend through the arachnoid to the dura, helping to anchor and stabilize it.
Insight 13.1 Spina Bifida (Fig. 13.3)
E. Viewing the cross-sectional anatomy of the spinal region reveals the relationship of the spinal cord to individual vertebra and the spinal nerves. (Figs. 13.2a, 13.2b)
1. Like the brain, the spinal cord consists of gray and white matter.
a. The gray matter has a relatively dull color because it contains little myelin; it consists of somas, dendrites, and proximal parts of the axons of neurons.
b. White matter has a bright, pearly white appearance due to the abundance of myelin; it consists of bundles of axons, called tracts.
2. Gray matter makes up the central core of the spinal cord, which looks butterfly- or H-shaped in cross sections.
a. The core consists of two posterior (dorsal) horns and two thicker anterior (ventral) horns.
i. The right and left sides are connected by a gray commissure.
ii. In the middle of the commissure is the central canal, which in some places in adults remains open, lined with ependymal cells, and filled with CNS.
b. A spinal nerve branches into a posterior (dorsal) root and an anterior (ventral) root near its attachment to the spinal cord.
i. The posterior root carries sensory nerve fibers that enter the posterior horn of the cord and sometimes synapse with an interneuron.
ii. The anterior horn contains the large somas of the somatic motor neurons, the axons of which exit and lead to the skeletal muscles.
c. An additional lateral horn is visible in cross sections from the second thoracic throught he first lumbar segments of the cord; it contains neurons of the sympathetic nervous system.
3. The white matter of the spinal cord surrounds the gray matter.
a. It consists of bundles of axons that course up and down the cord, arranged in three pairs called columns, or funiculi.
b. The three columns are posterior (dorsal), lateral, and anterior (ventral), and each consists of subdivisions called tracts, or fasciculi.
F. The spinal tracts consist of ascending tracts and descending tracts. (Fig. 13.4) (Table 13.1)
1. Ascending tracts carry sensory information up the cord.
2. Descending tracts conduct motor impulses down to targets.
3. All nerve fibers in a particular tract have similar origin, destination, and function.
a. Many of these fibers have their origin in a region called the brainstem, a vertical stalk that supports the large cerebellum and the two even larger cerebral hemispheres.
b. Several of these tracts undergo decussation, meaning that they cross over from one side of the body to the other side.
i. A stroke that damages motor centers of the right side of the brain can cause paralysis of the left limbs, and vice versa.
ii. When the origin and destination of a tract are on opposite sides of the body, they are said to be contralateral.
iii. When a tract does not decussate, its fibers are said to be ipsilateral.
4. In the ascending tract, sensory signals typically travel across three neurons from origin in receptors to destinations in sensory areas of the brain.
a. A first-order neuron detects a stimulus and transmits a signal to the spinal cord or brainstem.
b. A second-order neuron continues as far as the thalamus, a “gateway” at the upper end of the brain stem.
c. A third-order neuron carries the signal the rest of the way to the cerebral cortex.
d. The axons of these neurons are called the first- through third-order nerve fibers. (Fig. 13.5)
e. There are five major ascending tracts: The gracile fasciculus, the cuneate fasciculus, the spinothalamic tract, the spinoreticular tract, and two spinocerebral tracts.
f. The gracile fasciculus carries signals from the midthoracic and lower parts of the body; it composes the entire posterior column below T6, and is joined at T6 by the cuneate fasciculus. (Fig. 13.5a)
i. It consists of first-order nerve fibers that travel ipsilaterally and terminate at the gracile nucleus in the medulla oblongata.
ii. Its fibers carry signals for vibration, visceral pain, deep and discriminative touch, and proprioception from the lower limbs.
g. The cuneate fasciculus joins the gracile fasciculus at T6 and occupies the lateral portion of the posterior column. (Fig. 13.5a)
i. It carries the same type of sensory signals originating from the upper limb and chest.
ii. Its fibers end in the cuneate nucleus on the ipsilateral side of the medulla oblongata.
iii. In the medulla, second-order fibers of the gracile and cuneate systems decussate and form the medial lemniscus; third-order fibers run from the thalamus to the cerebral cortex and have contralateral effect.
h. The spinothalamic tract and some smaller tracts form the anterolateral system that passes up the anterior and lateral columns of the spinal cord. (Fig. 13.5b)
i. It carries signals for pain, temperature, pressure, tickle, itch, and light or crude touch.
ii. First-order neurons end in the posterior horn of the spinal cord, where they synapse with second-order neurons that decussate and form the ascending spinothalamic tract which proceeds contralaterally.
iii. In the thalamus, third-order neurons continue to the cerebral cortex.
i. The spinoreticular tract carries pain signals resulting from tissue injury.
i. First order sensory neurons synapse with second-order neurons in the posterior horn.
ii. They decussate and ascend the cord to a loosely organized core of gray matter called the reticular formation in the medulla and pons.
iii. From there, third-order neurons continue from the pons to the thalamus.
iv. Fourth-order neurons complete the path from the thalamus to the cerebral cortex.
j. The posterior (dorsal) and anterior (ventral) spinocerebellar tracts travel through the lateral column.
i. They carry proprioceptive signals from the limbs and trunk to the cerebellum.
ii. The first-order neurons originate in muscles and tendons and end in the posterior horn of the spinal cord.
iii. Second-order neurons send fibers up the spinocerebellar tracts and end in the cerebellum.
iv. Fibers of the posterior tract travel up the ipsilateral side of the spinal cord.
v. Fibers of the anterior tract cross over and travel up the contralateral side, but then cross back in the brainstem to enter the ipsilateral side of the cerebellum.
5. In the descending tracts, motor signals are carried from the brainstem in a pathway typically involving two neurons, upper and lower motor neurons.
a. The upper motor neuron begins with a soma in the cerebral cortex of brain stem.
b. The axon of the upper motor neuron terminates on a lower motor neuron in the brain stem or spinal cord.
c. The axon of the lower motor neuron then innervates the muscle or other targe organ.
d. There are four descending tracts: the corticospinal; the textospinal; the lateral and medial reticulospinal; and the lateral and medial vestibulospinal tracts.
e. The corticospinal tracts carry motor signals from the cerebral cortex for precise, finely coordinated movement.
i. The fibers form ridges called pyramids on the anterior surface of the medulla oblongata and so were once called pyramidal tracts.
ii. Most of these fibers decussate in the lower medulla and form the lateral corticospinal tract on the contralateral side of the spinal cord.
iii. A few fibers remain uncrossed and for the anterior (ventral) corticospinal tract on the ipsilateral side; however, these fibers have decussated lower and still control contralateral muscles. (Fig. 13.6)
f. The tectospinal tract begins in the tectum region of the midbrain and descends through the brainstem to the upper spinal cord on the same side, going only as far as the neck.
i. It is involved in reflex turning of the head in response to sights and sounds.
g. The lateral and medial reticulospinal tracts originate in the reticular formation of the brainstem.
i. They control muscles of the upper and lower limbs, especially to maintain posture and balance.
ii. They also contain descending analgesic pathways that reduce pain signals.
h. The lateral and medial vestibulospinal tracts begin in the brainstem vestibular nuclei.
i. The vestibular nuclei receive impulses for balance from the inner ear.
ii. The tract passes down the anterior column of the spinal cord and facilitates control of the extensor muscles of the limbs, helping one to keep balance.
iii. The medial vestibulospinal tract splits into ipsilateral and contralateral fibers; it plays a role in the control of head position.
i. Rubrospinal tracts are prominent in other mammals but are almost nonexistent in humans.
II. The Spinal Nerves (pp. 490–503)
A. Understanding the role of spinal nerves requires an understanding of the general structure of nerves and ganglia. (pp. 491–493)
1. A nerve is a cordlike organ composed of numerous nerve fibers (axons) bound together by connective tissue. (Fig. 13.8)
a. A nerve may contain a few nerve fibers or more than a million.
b. Nerve fibers of the PNS are ensheathed in Schwann cells that form a neurilemma and often a myelin sheath around the axon.
i. External to the neurilemma, each fiber is surrounded by a basal lamina and then a sleeve of loose connective tissue called the endoneurium.
c. Nerve fibers are gathered into bundles called fascicles, each wrapped in a multilayered sheath called the perineurium, which contains up to 20 layers of squamous epithelium–like cells.
d. Several fascicles are then bundled together in an outer epineurium.
i. The epineurium is composed of dense irregular connective tissue and protects the nerve from stretching and injury.
e. Nerves have a high metabolic rate and need a plentiful blood supply, which is furnished by blood vessels that penetrate the connective tissue coverings.
Insight 13.2 Poliomyelitis and Amyotrophic Lateral Sclerosis (Fig. 13.7)
f. PNS nerve fibers are of two kinds: sensory (afferent) fibers and motor (efferent) nerve fibers; both can also be described as somatic or visceral, and as general or special. (Table 13.2)
g. Nerves can be classified as sensory, motor, or mixed.
i. Sensory nerves, composed only of afferent fibers, are rare and include olfactory and optic nerves.
ii. Motor nerves carry only efferent fibers.
iii. Most nerves are mixed nerves, consisting of both afferent and efferent fibers that each conduct only one way.
2. A ganglion is a cluster of neurosomas outside the CNS. (Fig. 13.9)
a. A ganglion is enveloped in an epineurium continuous with that of the nerve.
b. Among the neurosomas are bundles of nerve fibers leading into and out of the ganglion.
B. There are 31 pairs of spinal nerves: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. (pp. 493–496) (Fig. 13.10)
C. The first cervical spinal nerve emerges between the skull and atlas (C1); therefore, the numbering of a cervical spinal nerve corresponds to the number of the vertebra inferior to them (nerve C5 emerges above vertebra C5).
D. Below the cervical vertebrae, the pattern changes: The remaining spinal nerves emerge inferiorly to the corresponding numbered vertebrae (nerve L3 emerges inferior to vertebra L3).
1. The proximal branches of each spinal nerve occur as it passes through the intervertebral foramen.
a. Each spinal nerve branches to form two points of attachment to the spinal cord; as it passes through the foramen toward the cord, it divides into a posterior (dorsal) root and an anterior (ventral) root. (Fig. 13.11)
b. Shortly after the branch point, the posterior root expands into a posterior (dorsal) root ganglion and then divides into six to eight rootlets that enter the posterior horn of the cord. (Figs. 13.1b, 13.12).
c. Anteriorly, another six to eight rootlets connect the anterior root to the spinal cord.
d. The anterior and posterior roots merge at the intervertebral foramen to form the spinal nerve proper, which is thus a mixed nerve.
i. The anterior and posterior roots are shortest in the cervical region and become longer inferiorly.
ii. The roots of segments L2 to Co of the cord form the cauda equina.
e. Some viruses invade the CNS via these roots.
2. The distal branches of a spinal nerve are more complex. (Fig. 13.13)
a. Immediately after emerging from the intervertebral foramen, the nerve divides into an anterior ramus, and posterior ramus, and a small meningeal branch.
i. Each spinal nerve branches on both ends: anterior and posterior roots approach the spinal cord, and anterior and posterior rami lead away from the vertebral column.
b. The meningeal branch reenters the vertebral canal and innervates the meninges, vertebrae, and spinal ligaments. (Fig. 13.11)
c. The posterior ramus innervates the muscles and joints in the region of the spine and skin of the back.
d. The anterior ramus innervates the anterior and lateral skin and muscles of the back and gives rise to nerves of the limbs.
i. The anterior rami vary from one region to another; in the thoracic region it forms an intercostal nerve, and in all other regions form the nerve plexuses.
ii. The anterior ramus also gives off a pair of communicating rami that connect with a string of sympathetic chain glanglia in spinal nerves T1 through L2. (Fig. 13.13)
E. Except in the thoracic region, the anterior rami branch and merge to form five weblike nerve plexuses: the cervical plexus, brachial plexus, lumbar plexus, sacral plexus, and coccygeal plexus. (pp. 496–502) (Fig. 13.10) (Tables 13.3, 13.4, 13.5, 13.6)
1. Spinal nerve roots give rise to each plexus and may also include smaller branches called trunks, anterior divisions, posterior divisions, and cords.
2. These nerves have somatosensory and motor functions.
a. One of the most important somatosensory functions is that of proprioception, information about body position and movement.
b. The motor function is primarily to stimulate contraction of skeletal muscles.
Insight 13.3 Shingles
F. Each spinal nerve except C1 receives sensory input from a specific skin area called a dermatome. (p. 500) (Fig. 13.19)
1. Dermatomes may overlap at their edges by as much as 50%.
2. Three successive spinal nerves must be anesthetized or severed to produce total loss of sensation from one dermatome.
Insight 13.4 Spinal Nerve Injuries
III. Somatic Reflexes (pp. 503–510)
A. Reflexes are quick, involuntary, stereotypic reactions of glands or muscles to stimulation. (pp. 503–504)
1. Reflexes have four characteristics.
a. They require stimulation—they are responses to sensory input.
b. They are quick—they involve few if any interneurons and minimum synaptic delay.
c. They are involuntary—they occur without intent and often without awareness.
d. They are stereotyped—they occur the same way every time.
2. Reflexes include glandular secretion and contractions of all three types of muscle, and also some learned responses termed conditioned reflexes.
3. Somatic reflexes are unlearned skeletal muscle reflexes mediated by the brainstem and spinal cord; they involve the somatic nervous system.
4. A somatic reflex employs a reflex arc that involves the following pathway.
a. Somatic receptors in the skin, a muscle, or a tendon.
b. Afferent nerve fibers.
c. An integrating center in the gray matter of the spinal cord or brainstem comsisting of one or more interneurons.
d. Efferent nerve fibers.
e. Skeletal muscles.
B. Many somatic reflexes involve stretch receptors called muscles spindles. (p. 504–506)
1. Muscle spindles are among the body’s proprioceptors; they inform the brain of muscle length and body movements.
2. They are especially abundant in muscles that require fine control, such as the hands.
3. Muscles spindles are named for their fusiform shape. (Fig. 13.20)
a. They are scattered through the perimysium of a muscle with their long axes parallel to the fibers.
b. They are especially concentrated at the ends, near the tendons.
4. A spindle contains 3 to 12 modified muscle fibers and a few nerve fibers wrapped in a fibrous capsule.
a. The muscle fibers within the spindle are called intrafusal fibers, while those that make up the rest of the muscle are called extrafusal fibers.
b. Intrafusal fibers are modified muscle fibers that have contractile ability only at the two ends; there are two classes of fibers:
i. Nuclear chain fibers, with a single file of nuclei in the noncontractile region; there are typically five in the spindle.
ii. Nuclear bag fibers, with nuclei clustered in the baglike middle region; there are typically two or three in a spindle.
c. Muscle spindles have three principle classes of nerve fibers, two sensory classes and one motor class:
i. A primary afferent (group Ia) fiber arises from anulospiral endings; it is a large, fast nerve.
ii. Up to 8 secondary afferent (group II) fibers wind primarily around the nuclear chain fibers adjacent to the anulospiral endings; they are intermediate-size fibers.
iii. Gamma motor neurons originate in the anterior horn of the spinal cord and lead to the contractile ends of the intrafusal fibers; these serve to adjust the sensitivity of the muscle spindle.
5. Fundamentally, when a muscle is at rest, relaxed, and stretched, the muscle spindle itself is stretched, and when the muscle contracts, the spindle shortens.
a. Both sensory nerve fibers send a stream of signals to the brain about the length of the muscle; this is the steady-state or tonic response.
b. As the spindle shortens, the secondary fiber fires and a lower frequency and the primary fiber ceases firing; this is the dynamic or phasic response.
c. When the muscle is fully contracted and stable, the primary fiber resumes firing at a slow rate.
c. Both types of fiber send signals regarding length, but the primary fiber’s signals indicate how fast length is changing.
C. When a muscle is stretched, it contracts to compensate, an action called the stretch (myotatic) reflex. (pp. 506–507)
1. Stretch reflexes often feed back to a set of synergists and antagonists; the flexion of a joint creates a stretch reflex in the extensors, and vice versa.
2. Stretch reflexes smooth out movements and are important in coordinating vigorous and precise movements.
3. A stretch reflex is mediated primarily by the brain and is not strictly a spinal reflex, but a component of it is spinal and can be more pronounced in very sudden stretches.
a. An example is the tendon reflex, of which one example is the knee-jerk (patellar) reflex. (Fig. 13.21)
4. In the spinal cord, the primary afferent fibers synapse directly with alpha motor neurons that return to the muscle, forming monosynaptic reflex arcs that have very little synaptic delay.
5. Testing somatic reflexes is valuable in diagnosing many diseases that cause exaggeration, inhibition, or absence of reflexes.
6. Stretch reflexes and other muscle contractions often depend on reciprocal inhibition in which prevents muscles from working against each other.
a. Some branches of the sensory fibers from muscles spindles in one muscle stimulate spinal cord interneurons that inhibit the alpha motor neurons of its antagonist. (Fig. 13.21)
D. A flexor (withdrawal) reflex is the quick contraction of flexor muscles to withdraw a limb from an injurious stimulus. (pp. 507–508) (Fig. 13.22)
1. The flexor reflex involves more complex neural pathways.
2. It involves contraction of the flexors and relaxation of the extensors in the limb.
a. Sustained contraction is produced by a parallel after-discharge circuit that is part of a polysynaptic reflex arc—a pathway with many synapses.
b. Some signals reach the muscles quickly and others a little later, providing prolonged output from the spinal cord.
E. The crossed extension reflex is the contraction of extensor muscles in the limb opposite the one affected by the flexor reflex. (p. 508) (Fig. 13.22)
1. This reflex allows one to keep balance when a limb is withdrawn.
2. Branches of the afferent nerve fibers cross contralaterally and synapse with interneurons to excite motor neurons to the muscles of the contralateral limb.
a. The flexor reflex employs an ipsilateral reflex arc while the crossed extension reflex employs a contralateral reflex arc.
b. An intersegmental reflex arc has input and output that occur at different segments of the spinal cord and thus affect muscles in different locations.
F. The Golgi tendon reflex is a response to excessive tension on a tendon. (pp. 508–509)
1. Golgi tendon organs are proprioceptors located in a tendon near its junction with a muscle. (Fig. 13.23)
a. A tendon organ consists of a tangle of knobby nerve endings entwined in the collagen fibers of the tendon.
b. When muscle contraction pulls on the tendon, the nerve endings are squeezed and send signals to the spinal cord giving the CNS feedback on muscle tension.
2. The Golgi tendon reflex inhibits alpha motor neurons to the muscle so that it does not contract as strongly, protecting the tendon from damage.
a. Strong muscles and quick movements can sometimes damage a tendon before the reflex can occur.
b. The tendon reflex also functions when some parts of a muscle contract more than others, so that a workload is spread more evenly over the muscle.
G. Table 13.7 lists some disorders of the spinal cord and spinal nerves. (p. 509)
Insight 13.5 Spinal Cord Trauma
Additional information on topics mentioned in Chapter 13 can be found in the chapters listed below.
Chapter 10: Muscles each nerve supplies (tables)
Chapter 14: Cerebrospinal fluid (CSF)
Chapter 14: Brainstem
Chapter 14: Reticular formation
Chapter 14: Coordination of muscle action
Chapter 14: Olfactory and optic nerves
Chapter 15: Sympathetic chain ganglia
Chapter 15: Visceral reflexes
Chapter 15: Steady-state or tonic muscle response
Chapter 16: Pain and the spinoreticular tract
Chapter 16: Different modes of sensory function