Blood Supply of the Spinal Cord
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The spinal cord is blood is supplied by ?
- 1. Anterior spinal artery
- 2. Posterior spinal artery
- 3. Spinal branch from the 1st intercostal artery 4. Spinal branch from the 11th intercostal artery
Branches of the vertebral, deep cervical, intercostal, and lumbar arteries contribute to three arteries that run the length of the spinal cord , which are ?
Anterior spinal and the two posterior spinal arteries.
Which artery is larger , the anterior artery or the posterior arteries ?
Label the diagram ?
how many pairs of segmental radicular arteries supply the nerve roots and about half of them contribute to the spinal arteries ?
What are the arteries of Adamkiewicz ? What do they supply ?
-1st and 11th intercostal arteries are large
-supplies the lower thoracic and upper lumbar parts of the cord.
Which Adamkiewicz between 1st and 11th intercostal arteries only supplies downward ?
Where do these veins drain ?
vertebral veins -
azygos veins -
lumbar veins -
- vertebral veins in the neck
- azygos veins in the thorax
- lumbar veins in the lumbar region
- lateral sacral veins in the sacral region
Spinal veins form ______ anteriorly and posteriorly ?On each side the spinal veins are ______, straddling the posterior nerve roots ?
Explain the high take off of the iliac artery ?
- The iliac artery will enter through the L4-L5
Generally , where is the proportion of blood flow greatest in the spinal area ?
raducularis magna “feeder” artery to the thracolumbar region.
Where does the spinal cord extend from and how far does it go down the spinal column ?
Medulla oblongata to L1
Match them ?
Grey matter =
White matter =
ascending and descending tracts
sensory and motor nerve cells
- Grey matter – sensory and motor nerve cells
- White matter – ascending and descending tracts
What are the Dermatomes ? How can they be useful for a Physician ?
Area of skin innervated by sensory axons within a particular segmental nerve root
Knowledge is essential in determining level of injury
Useful in assessing improvement or deterioration
What are Myotomes ?
Area of innervated muscle
Where is the injury located if the person is a Quadriplegic ? how about paraplegic ?
It is in the cervical region
It is in the thoracic, lumbar , or sacral region
Explain the ASIA injury Scale ?
- A – Complete: no sensory or motor function preserved in sacral segments S4 – S5
- B – Incomplete: sensory, but no motor function in sacral segments
- C – Incomplete: motor function preserved below level and power graded < 3
- D – Incomplete: motor function preserved below level and power graded 3 or more
- E – Normal: sensory and motor function normal
Give some symptoms of Spinal Shock ?
- •Transient reflex depression of cord function below level of injury
- •Initially hypertension due to release of catecholamines
- •Followed by hypotension
- •Flaccid paralysis
- •Bowel and bladder involved
- •Sometimes priaprism develops
- •Symptoms last several hours to days
Give some symptoms of Neurogenic Shock ?
- •Triad of
- i) hypotension
- ii) bradycardia
- iii) hypothermia
- •More commonly in injuries above T6
- •Secondary to disruption of sympathetic outflow from T1 – L2
- •Loss of vasomotor tone – pooling of blood
- •Loss of cardiac sympathetic tone – bradycardia
- •Blood pressure will not be restored by fluid infusion alone
- •Massive fluid administration may lead to overload and pulmonary edema
- •Vasopressors may be indicated
- •Atropine used to treat bradycardia
What are some symptoms and signs of Central Cord Syndrome ?
- •Typically in older patients
- •Hyperextension injury
- •Compression of the cord anteriorly by osteophytes and posteriorly by ligamentum flavum
- •Also associated with fracture dislocation and compression fractures
- •More centrally situated cervical tracts tend to be more involved hence flaccid weakness of arms > legs
- •Perianal sensation & some lower extremity movement and sensation may be preserved
What are some symptoms and signs of Anterior cord Syndrome ?
- •Due to flexion / rotation
- •Anterior dislocation / compression fracture of a vertebral body encroaching the ventral canal
- •Corticospinal and spinothalamic tracts are damaged either by direct trauma or ischemia of blood supply (anterior spinal arteries)
- •Loss of power
- •Decrease in pain and sensation below lesion
- •Dorsal columns remain intact
What are some signs and symptoms of the Posterior Cord Syndrome ?
- Hyperextension injuries with fractures of the posterior elements of the vertebrae Clinically:
- • Proprioception affected – ataxia and faltering gait
- • Usually good power and sensation
Wgat are some signs and symptoms of Brown – Sequard Syndrome?
- •Hemi-section of the cord
- •Either due to penetrating injuries:i) stab woundsii) gunshot wounds
- •Fractures of lateral mass of vertebrae
- •Paralysis on affected side (corticospinal)
- •Loss of proprioception and fine discrimination (dorsal columns)
- •Pain and temperature loss on the opposite side below the lesion (spinothalamic)
What is the Cauda Equina Syndrome ?
-Due to bony compression or disc protrusions in lumbar or sacral region Clinically
•Non specific symptoms – back pain- bowel and bladder dysfunction- leg numbness and weakness- saddle parasthesia
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