Spinal Cord: Anatomical Overview and Selected Pathologies

Abstract

The brain and the spinal cord work together to provide sensory perception and motor function to the body. These processes are accomplished by connections that occur between the brain and the peripheral nervous system through the spinal cord. Injury to the spinal cord can lead to significant deficits. Traumatic events can lead to compression, ischaemia or destruction of the spinal cord with consequential weakness, paralysis, sensory disturbances or urinary incontinence. Traumatic spinal cord injuries are classified as either complete (complete loss of motor and sensory function) or incomplete injuries (preservation of some motor or sensory function distal to the site of injury). The spinal cord can also be the site of aberrant neoplastic growth (spinal cord tumours) or immune‐modulated pathologies that lead to destruction and damage to the spinal cord (multiple sclerosis (MS)). Tumours, vascular diseases, infections, inflammatory diseases, demyelinating diseases and nutritional diseases can all result in damage to the spinal cord.

Key Concepts:

  • The vertebrae are specifically arranged to allow protection to the spinal cord as well as supporting and permitting movement of the trunk and limbs. The spinal cord is divided into distinct regions that provide innervation to different regions of the body.

  • There are ascending sensory tracts and descending motor tracts connecting the spinal cord to the brain. These tracts are located regionally in the spinal cord according to their function, and injury to a particular region leads to symptoms that correlate with the respective function of the damaged area.

  • Spinal cord tumours can be primary (arise from the spinal cord or its surrounding meninges) or secondary to metastatic spread. Tumours are classified according to their location relative to the dura mater, which surrounds the spinal cord.

  • Vascular malformations result in abnormal flow of blood within the spinal cord. They often shunt blood directly between arteries and veins, bypassing the capillary network. These malformations have a propensity to bleed.

  • If an artery providing blood to the spinal cord is blocked or occluded, spinal cord infarct or stroke ensues.

  • Pathogens in the blood can enter the central nervous system (CNS; brain and spinal cord) and lead to infection, inflammatory response and damage to the spinal cord.

  • Inflammatory diseases often arise idiopathically (cause unknown); some association exists between viral infections and autoimmune diseases. Demyelination of nerves and destruction of spinal cord tracts typically result and is seen in conditions such as sarcoidosis, transverse myelitis and Guillain–Barré.

  • Autoimmune diseases result when a maladaptive immune system recognises the host tissue as foreign material and mounts an inappropriate immune response. Multiple sclerosis and acute disseminated encephalomyelitis are two disorders in which one's immune system mounts an attack against normal white matter of the CNS.

  • Vitamin B12 is obtained through diet and is important for the formation and maintenance of the myelin sheath that surrounds neurons.

  • Traumatic injury to the spinal cord most commonly occurs due to motor vehicle accidents and can lead to paraplegia (lower extremity paralysis) or quadriplegia (upper and lower extremity paralysis). An incomplete spinal cord injury is one in which some motor or sensory function is preserved distal to the level of injury. Treatment consists of realignment and stabilisation of the vertebral column, decompression of mass lesions and prevention of hypoxia and hypotension (preventing the spinal cord from being deprived of oxygen and blood nutrients).

Keywords: spinal cord injury; spinal cord tumours vertebral column; spinal cord; spinal cord infection

Figure 1.

Bony anatomy. Reproduced with permission from Colorado Comprehensive Spine Institute. © Colorado Comprehensive Spine Institute.

Figure 2.

Sensory tracts. Reproduced with permission from Jeffrey Mann. © Jeffrey Mann.

Figure 3.

Vascular anatomy illustration. Reproduced from Nadeau et al. (). © Elsevier.

Figure 4.

Magnetic Resonance Image of a patient with an intradural, extramedullary tumour. MR images are grey‐scaled images that provide greater detail of soft tissues and neural structures. The image on the left shows a preoperative image of the upper thoracic spine, looked at sideways, showing a large lesion (tumour) inside the spinal canal but outside the spinal cord (arrow). The patient presented with leg weakness, balance problems and gait instability. The image on the right shows postoperative image showing decompression of the spinal cord, which was achieved via a laminectomy. The patient's symptoms resolved and he made an excellent recovery.

Figure 5.

Brown–Sequard syndrome. Reproduced with permission from Janet Stewart. © Janet Stewart.

close

References

Adams H, Avendano J, Raza SM et al. (2012) Prognostic factors and survival in primary malignant astrocytomas of the spinal cord: a population‐based analysis from 1973 to 2007. Spine 37(12): E727–E735.

Bizaare M, Dawood H and Moodley A (2008) Vacuolar myelopathy: a case report of functional, clinical, and radiological improvement after highly active antiretroviral therapy. International Journal of Infectious Diseases 12(4): 442–444.

Bournia VK, Dania V, Lachanis S, Konsta M and Iliopoulos A (2012) B12 deficiency myelopathy in a patient with long‐standing rheumatoid arthritis. Journal of Clinical Rheumatology 18(7): 372–374.

Boyaci B, Hornicek F, Rosenthal D et al. (2012) Sarcoidosis of the spine: a report of five cases and a review of the literature. Journal of Bone and Joint Surgery 94(7): e42 American volume.

Dimitrijevic MR, Gerasimenko Y and Pinter MM (1998) Evidence for a spinal central pattern generator in humans. Annals of the New York Academy of Sciences 860: 360–376.

Espinosa PS, Pettigrew LC and Berger JR (2008) Hereditary hemorrhagic telangectasia and spinal cord infarct: case report with a review of the neurological complications of HHT. Clinical Neurology and Neurosurgery 110(5): 484–491.

Leven D, Sadr A and Aibinder WR (2013) Brown–Sequard syndrome after a gun shot wound to the cervical spine: a case report. Spine Journal 13(12): e1–e5.

Liu X, Sun B, Xu Q et al. (2013) Outcomes in treatment for primary spinal anaplastic ependymomas: a retrospective series of 20 patients. Journal of Neurosurgery. Spine 19(1): 3–11.

Munoz‐Culla M, Irizar H and Otaegui D (2013) The genetics of multiple sclerosis: review of current and emerging candidates. Application of Clinical Genetics 6: 63–73.

Nadeau SE, Ferguson TS, Valenstein E et al. (2004) Medical Neuroscience. Philadelphia, PA: Saunders.

Ogden AT, Schwartz TH and McCormick PC (2011) Spinal cord tumors in adults. In: Winn HR (ed.) Youmans Neurological Surgery, pp. 3131–3143. Philadelphia, PA: Saunders.

Onifer SM, Smith GM and Fouad K (2011) Plasticity after spinal cord injury: relevance to recovery and approaches to facilitate it. Neurotherapeutics 8(2): 283–293.

Pandey S (2011) Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis. Journal of Spinal Cord Medicine 34(6): 609–611.

Piltti KM, Salazar DL, Uchida N, Cummings BJ and Anderson AJ (2013) Safety of human neural stem cell transplantation in chronic spinal cord injury. Stem Cells Translational Medicine 2(12): 961–974.

Schimmer RC, Jeanneret C, Nunley PD and Jeanneret B (2002) Osteomyelitis of the cervical spine: a potentially dramatic disease. Journal of Spinal Disorders & Techniques 15(2): 110–117.

Schoenfeld AJ, Laughlin MD, McCriskin BJ et al. (2013) Spinal injuries in United States military personnel deployed to iraq and afghanistan: an epidemiological investigation involving 7,877 combat casualties from 2005–2009. Spine 38(20): 1770–1778.

Topcu Y, Bayram E, Karaoglu P et al. (2013) Coexistence of myositis, transverse myelitis, and Guillain Barre syndrome following Mycoplasma pneumoniae infection in an adolescent. Journal of Pediatric Neurosciences 8(1): 59–63.

Verma R, Patil TB, Lalla R and Kumar M (2013) Extensive acute disseminated encephalomyelitis in a young girl responding to intravenous methylprednisolone. BMJ Case Reports. [Epub ahead of print].

Wilder MJ, Ng PP and Dailey AT (2012) Delayed onset of anterior spinal artery syndrome after repair of aortic coarctation. Spine 37(23): E1476–E1478.

Yoshihara H and Yoneoka D (2013) Trends in the treatment for traumatic central cord syndrome without bone injury in the United States from 2000 to 2009. Journal of Trauma and Acute Care Surgery 75(3): 453–458.

Further Reading

Drake RL, Vogl W and Adam WMM (2005) Gray's Anatomy for Students. Philadelphia, PA: Elsevier/Churchill Livingstone.

Green R and Kinsella LJ (1995) Current concepts in the diagnosis of cobalamin deficiency. Neurology 45: 1435–1440.

Kerr DA and Aytey H (2002) Immunopathogenesis of acute transverse myelitis. Current Opinion in Neurology 15(3): 339–347.

Kwon BK, Tetzlaff W, Grauer JN, Beiner J and Vaccaro AR (2004) Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine Journal 4(4): 451–464.

O'Donnel JA and Emery CL (2005) Neurosyphilis: a current review. Current Infectious Disease Report 7(4): 277–284.

Quinones‐Hinojosa A, Jun P, Jacobs R, Rosenberg WS and Weinstein PR (2004) General principles in the medical and surgical management of spinal infections: a multidisciplinary approach. Neurosurgical Focus 17(6): E1.

Rodesch E and Lasjaunias P (2003) Spinal cord arteriovenous shunts: from imaging to management. European Journal of Radiology 46(3): 221–232.

Sharma OP and Sharma AM (1991) Sarcoidosis of the nervous system. A clinical approach. Archives of Internal Medicine 151(7): 1317–1321.

Traul DE, Shaffrey ME and Schiff D (2007) Part I: spinal‐cord neoplasms‐intradural neoplasms. Lancet Oncology 8(2): 137–147.

Wegnar C (2005) Pathological differences in acute inflammatory demyelinating diseases of the central nervous system. International MS Journal 12(1): 13–19.

Contact Editor close
Submit a note to the editor about this article by filling in the form below.

* Required Field

How to Cite close
Stewart, Arielle A, Bydon, Mohamad, McGirt, Matthew, De la Garza‐Ramos, Rafael, Gokaslan, Aaron K, and Bydon, Ali(Feb 2014) Spinal Cord: Anatomical Overview and Selected Pathologies. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0021402.pub2]