Anatomy of spinal cord

1. Big picture

The spinal cord is not only an anatomical structure; for the neurology exam it is a localization machine. If you understand the spinal cord anatomy, you can explain why one lesion gives ipsilateral pyramidal signs, another gives contralateral pain and temperature loss, another causes dissociated sensory loss, and why cauda equina syndrome is not pyramidal.

The examiner mainly wants you to know:

• the segments and roots of the spinal cord,

• the difference between cord lesion, root lesion, peripheral nerve lesion, and brainstem lesion,

• the position of the main ascending and descending tracts,

• the function of the anterior horn, posterior horn, lateral horn, posterior columns, lateral columns, and anterior columns,

• how spinal cord anatomy explains classic syndromes such as complete transverse lesion, Brown-Séquard syndrome, syringomyelia, anterior cord syndrome, conus lesion, and cauda equina syndrome.