PHYSIOLOGY OF SPINAL CORD

DERMATOMES

SPINAL CORD REFLEXES

TYPES OFREFLEXES SOMATIC VEGETATIVE

STRETCHING FLEXION EXTENTION RHYTMIC MOVEMENTS VASO- URINA- DEFAЕ- OTHERS MOTOR TION CATION

TENDON REFLEXES: WALKING SCRATCHING АХИЛЛОВ, КОЛЕННЫЙ, с m. BICEPS с m. TRICEPS

EFFECT MUSCLE PROTECTIVE STANDING WALKING REMOVAL EFFECTIVE ELIMINATION OF TONES REACTION POSTURE OF EXCITA- BLOOD TOXIC FORMATION TORY STIMULI SUBSTANCES

DESCENDING TRACTS

ASCENDING TRACTS

Tracts of tactile & proprio- sensitivity

Direct tracts (don’t cross)Fasciculus gracilus & fasciculus cuneatus

(tr.bulbo-thalamo-corticalis)Tr. Spino-cerebellaris ventralis (Flexig)

Crossed tractsTr. Spino-thalamo-corticalis anteriorTr. Spino-cerebellaris dorsalis (Govers)

SPINAL CORD REFLEXES

TYPES OFREFLEXES SOMATIC VEGETATIVE

STRETCHING FLEXION EXTENTION RHYTMIC MOVEMENTS VASO- URINA- DEFAЕ- OTHERS MOTOR TION CATION

TENDON REFLEXES: WALKING SCRATCHING АХИЛЛОВ, КОЛЕННЫЙ, с m. BICEPS с m. TRICEPS

EFFECT MUSCLE PROTECTIVE STANDING WALKING REMOVAL EFFECTIVE ELIMINATION OF TONES REACTION POSTURE OF EXCITA- BLOOD TOXIC FORMATION TORY STIMULI SUBSTANCES

STRETCH REFLEX

Antigravitational- helps to maintain erect posture regardless of the influence of the force of gravityReceptors – muscle spindelsNo contact neurons, monosynaptic reflex arch, short reflex timeTendon reflexes are clinical variant of stretch reflex

KNEE-JERK REFLEX

AHILLES REFLEX

SPINAL SHOCKDecreased excitability of spinal cord nervous centers below the level of trauma due to the absence of impulses from higher nervous centers

SPINAL SHOCK MANIFESTATIONS

Absence of spinal cord proper reflexesLoss of sensitivity (astesia)Decrease of muscle tone (atonia)Inability to perform voluntarily movements

RULES OF TOPICAL DIAGNOSTICS :

1.     Physician has to take into consideration all the patient’s feelings (sensations).2.     Each question asked by physician should get diagnostically valuable answer.3.     There should be a certain scheme of questions given to the patient.4.     Each question should be targeted at a certain anatomical structure.5.     If you don’t know what you are looking for don’t approach the patient!!!

PRINCIPLES OF TOPICAL DIAGNOSTICS OF SPINAL CORD DISEASES

Spinal cord

Patient’s complains Symptoms found at examination

Posterior horn •Pain in segment projection on the side of lesion•Paresthesias•Disturbed sensitivity

•Disturbed sensitivity •Perverted sensations•Decrease in tendon & periostal reflexes

Anterior horn •Decreased volume of movements in a certain segment on the side of lesion•Decreased muscle power in a certain segment•Sensation of smth creeping under the skin•Loss of muscle weight

•Muscle atrophy•Fibrillar contractions•Decreased muscle tone•Decrease in tendon & periostal reflexes or absence of reflexes

Spinal cord

Patient’s complains Symptoms found at examination

Grey commi-ssurae

Bilateral sensations:Pain in the segment

projection ParaesthesiasDisturbed sensitivityUrination disorders

Dissociated sensory loss of coat, pants, gloves, socks type(decreased pain & temperature sensations, preserved tactile)

Decrease or absence of reflexes in certain segments

Trophics disorders (scars after burns)

Spinal cord

Patient’s complains Symptoms found at examination

Lateral funiculus

•Decreased volume of movement on the side of lesion below the level of lesion•Decreased muscle power on the side of lesion below the level of lesion•Tetanic contractions below the level of lesion•Disturbed sensitivity on the opposite side (cold feet, feeling of heat, paraesthesias)

•Increased muscle tone•Increased reflexes•Pathological reflexes•Ascending type of sensitivity disturbances: pain & temperature on the opposite side

Anterior funiculus

Same as at pyramidal tract lesions

Same as at pyramidal tract lesions

Spinal cord

Patient’s complains Symptoms found at examination

Posterior funiculi

Positive Romberg symptomDisturbed finger-nose & heel-

knee probesDisturbances in

proprioreceptionDisturbances of vibration

sensationsIncreased reflexesInability to recognize objects by

touchComplex types sensitivity

disturbances (discrimination in dimerical space sensations, sensation of weight, pressure, kinesthesia)

Positive Romberg symptomDisturbed finger-nose & heel-

knee probesDisturbances in

proprioreception чувстваDisturbances of vibration

sensationsIncreased reflexesInability to recognize objects by

touchComplex types sensitivity

disturbances (discrimination in dimerical space sensations, sensation of weight, pressure, kinesthesia)