4d. Composition and Central Connections of the Spinal Nerves

The typical spinal nerve consists of at least four types of fibers, the somatic sensory, sympathetic afferent or sensory, somatic motor and sympathetic efferent or preganglionic. The somatic sensory fibers, afferent fibers, arise from cells in the spinal ganglia and are found in all the spinal nerves, except occasionally the first cervical, and conduct impulses of pain, touch and temperature from the surface of the body through the posterior roots to the spinal cord and impulses of muscle sense, tendon sense and joint sense from the deeper structures. The sympathetic afferent fibers, conduct sensory impulses from the viscera through the rami communicantes and posterior roots to the spinal cord. They are probably limited to the white rami connected with the spinal nerves in two groups, viz., the first thoracic to the second lumbar and the second sacral to the fourth sacral nerves. The somatic motor fibers, efferent fibers, arise from cells in the anterior column of the spinal cord and pass out through the anterior roots to the voluntary muscles. The sympathetic efferent fibers, probably arise from cells in the lateral column or the base of the anterior column and emerge through the anterior roots and white rami communicantes. These are preganglionic fibers which end in various sympathetic ganglia from which postganglionic fibers conduct the motor impulses to the smooth muscles of the viscera and vessels and secretory impulses to the glands. These fibers are also limited to two regions, the first thoracic to the second lumbar and the second sacral to the fourth sacral nerves. 1 The afferent fibers which pass into the spinal cord establish various types of connections, some within the cord itself for spinal reflexes, others for reflexes connected with higher centers in the brain, while still others conduct impulses of conscious sensation by a series of neurons to the cerebral cortex. 2

FIG. 758– Diagram of the spinal cord reflex apparatus. Some of the connections of a single afferent neuron from the skin (d.r.2) are indicated: d.r.2, dorsal root from second spinal ganglion; m, muscles; sp.g.1 to sp.g.4, spinal ganglia; v.r.1′ to v.r.4, ventral roots. (After Herrick.) (See enlarged image) The Intrinsic Spinal Reflex Paths.—The collaterals and terminals of the ascending and descending branches of the posterior root fibers which leave the fasciculus cuneatus to enter the gray matter of the spinal cord end in various ways. Many end in the dorsal column, some near its apex, others in the substance of Rolando, others in the intermediate region between the dorsal and ventral columns, others traverse the whole thickness of the gray matter to reach the ventral column, others end in the dorsal nucleus, and others pass through the gray commissure to the dorsal column of the opposite side. All of these collaterals and terminals end in connection with cells or dendrites of cells in the gray columns. The axons of these cells have various destinations, some pass out into the lateral and ventral funiculi and turn upward to reach the brain. Those concerned with the intrinsic spinal reflexes come into relation either directly or indirectly with motor cells in the anterior column. It is very unlikely that either the terminals or collaterals of the dorsal root fibers effect simple direct connections with the motor cells of the ventral column, there is at least one if not several intercalated neurons in the path. These intercalated or correlation neurons may have short axons that do not pass out of the gray matter or the axons may pass out into the proper fasciculi and extend for varying distances up and down or in both directions giving off collaterals and finally terminating in the gray matter of the same or the opposite side. The shortest fibers of the proper fasciculi lie close to the gray matter, the longest ones are nearer the periphery of the proper fasciculi and are more or less intermingled with the long ascending and descending fasciculi which occupy the more marginal regions of the spinal cord. 3 Each sensory neuron, with its ascending and descending branches, giving off as it does many collaterals into the gray matter, each one of which may form a synapse with one or several correlation neurons, is thus brought into relation with many correlation neurons and each one of these in turn, with its ascending and descending branches and their numerous collaterals, is brought into relation, either directly or through the intercalation of additional correlation neurons, with great numbers of motor cells in the anterior column. The great complexity of these so-called simple reflex mechanisms, in the least complex portion of the nervous system the spinal cord, renders them extremely difficult of exact analysis. 4 The association or correlation neurons are concerned not only with the reflex mechanisms of the spinal cord but play an equally important role in the transmission of impulses from the higher centers in the brain to the motor neurons of the spinal cord. 5 The complex mechanisms just described are probably concerned not so much in the contraction of individual muscles as in the complicated action of groups of muscles concerned in the enormous number of movements, which the limbs and trunk exhibit in the course of our daily life. 6 Sensory Pathways from the Spinal Cord to the Brain.—The posterior root fibers conducting the impulses of conscious muscle sense, tendon sense and joint sense, those impulses which have to do with the coördination and adjustment of muscular movements, ascend in the fasciculus gracilis and fasciculus cuneatus to the nucleus gracilis and nucleus cuneatus in the medulla oblongata (Fig. 759). 7 In the nucleus gracilis and nucleus cuneatus synaptic relations are found with neurons whose cell bodies are located in these nuclei and whose axons pass by way of the internal arcuate fibers, cross in the raphé to the opposite side in the region between the olives and turn abruptly upward to form the medial lemniscus or medial fillet. The medial fillet passes upward in the ventral part of the formatio reticularis through the medulla oblongata, pons and mid-brain to the principal sensory nucleus of the ventro-lateral region of the thalamus. Here the terminals form synapses with neurons of the third order whose axons pass through the internal capsule and corona radiata to the somatic sensory area of the cortex in the post-central gyrus. 8 Fibers conducting the impulses of unconscious muscle sense pass to the cerebellum partly by way of the fasciculus gracilis and fasciculus cuneatus to the nucleus gracilis and nucleus cuneatus, thence neurons of the second order convey the impulses either via the dorsal external arcuate fibers directly into the inferior peduncle of the cerebellum or via the ventral external arcuate fibers which are continued from the internal arcuate fibers through the ventral part of the raphé and after crossing the midline emerge on the surface of the medulla in the ventral sulcus between the pyramids or in the groove between the pyramid and the olive. They pass over the lateral surface of the medulla and olive to reach the inferior peduncle through which they pass to the cerebellum. 9 Other fibers conducting impulses of unconscious muscle sense pass upward in the dorsal spinocerebellar fasciculus, which arises from cells in the nucleus dorsalis. The posterior root fibers conducting these impulses pass into the fasciculus cuneatus and the collaterals from them to the nucleus dorsalis are said to come almost exclusively from the middle area of the fasciculus cuneatus. They form by their multiple division baskets about the individual cells of the nucleus dorsalis, each fiber coming in relation with the bodies and dendrites of several cells. The axons of the second order pass into the dorsal spinocerebellar fasciculus of the same side and ascend along the lateral surface of the spinal cord and medulla oblongata until they arrive at the level of the olive, they then curve backward beneath the external arcuate fibers into the inferior peduncle and pass into the cerebellum. Here they give off collaterals to the dentate nucleus and finally terminate in the cortex of the dorsal and superior portion of the vermis, partly on the same side, but to a great extent by way of a large commissure to the opposite side. The fibers lose their myelin sheaths as they enter the gray substance and terminate by end ramifications among the nerve cells and their processes. Some of the fibers are said to end in the nucleus dentatus and the roof nuclei of the cerebellum (the nucleus globosus, nucleus emboliformis and nucleus fastigius) and others pass through them to terminate in the inferior vermis. A few fibers of the dorsal spinocerebellar fasciculus are said not to enter the inferior peduncle but to pass with the ventral spinocerebellar fasciculus. The cerebellar reflex are is supposed to be completed by the fibers of the superior peduncle which pass from the cerebellum to the red nucleus of the mid-brain where some of their terminals and collaterals form synapses with neurons whose axons descend to the spinal cord in the rubrospinal fasciculus. The terminal and collaterals of this fasciculus end either directly or indirectly about the motor cells in the anterior column. 10

FIG. 759– The sensory tract. (Modified from Poirier.) (See enlarged image) The ventral spinocerebellar fasciculus, since most of its fibers pass to the cerebellum, is also supposed to be concerned in the conduction of unconscious muscle sense. The location of its cells of origin is uncertain. They are probably in or near the dorsal nucleus of the same and the opposite side; various other locations are given, the dorsal column, the intermediate zone of the gray matter and the central portion of the anterior column. The neurons of the first order whose central fibers enter the fasciculus cuneatus from the dorsal roots send collaterals and terminals to form synapses with these cells. The fibers which come from the opposite gray columns cross some in the white and some in the gray commissure and pass with fibers from the same side through the lateral funiculus to the marginal region ventral to the dorsal spinocerebellar fasciculus. The fasciculus begins about the level of the third lumbar nerve and continues upward on the lateral surface of the spinal cord and medulla oblongata until it passes under cover of the external arcuate fibers. It passes just dorsal to the olive and above this joins the lateral edge of the lateral lemniscus along which it runs, ventral to the roots of the trigeminal nerve, almost to the level of the superior colliculus, it then crosses over the superior peduncle, turns abruptly backward along its medial border, enters the cerebellum with it and ends in the vermis of the same and the opposite side. Some of its fibers are said to join the dorsal spinocerebellar fasciculus in the medulla oblongata and enter the cerebellum through the inferior peduncle. A number of fibers are said to continue upward in the dorsolateral part of the tegmentum as far as the superior colliculus and a few pass to the thalamus. They probably form part of the sensory or higher reflex path. 11 The posterior root fibers conducting impulses of pain and temperature probably terminate in the posterior column or the intermediate region of the gray matter soon after they enter the spinal cord. The neurons of the second order are supposed to pass through the anterior commissure to the superficial antero-lateral fasciculus (tract of Gowers) and pass upward in that portion of it known as the lateral spinothalamic fasciculus. This fasciculus lies along the medial side of the ventral spinocerebellar fasciculus. It is stated by some authors that the pain fibers pass upward in the antero-lateral ground bundles. In some of the lower mammals this pathway carries the pain fibers upward by a series of neurons some of which cross to the opposite side, so that in part there is a double path. In man, however, the lateral spinothalamic fasciculus is probably the most important pathway. On reaching the medulla these fibers continue upward through the formatio reticularis in the neighborhood of the median fillet to the thalamus, probably its ventro-lateral region. Whether higher neurons convey the pain impulses to the cortex through the internal capsule is uncertain. The pathway is probably more complex and Head is of the opinion that our sensations of pain are essentially thalamic. The pain and temperature pathways in the lateral spinothalamic fasciculus are not so closely intermingled but that one can be destroyed without injury to the other. 12 Ransom suggests that the non-medullated fibers of the posterior roots, which turn into Lissauer’s tract and ascend or descend for short distances not exceeding one or two segments and finally end in the substantia gelatinosa, are in part at least pain fibers and that the fasciculus of Lissauer and the substantia gelatinosa represent part of the mechanism for reflexes associated with pain conduction and reception while the fibers to the higher centers pass up in the spinothalamic tract. 13 The fibers of tactile discrimination, according to Head and Thompson, pass up in the fasciculus cuneatus and fasciculus gracilis of the same side and follow the path of the muscle-sense fibers. The axons of the second order arising in the nucleus cuneatus and gracilis cross with the internal arcuate fibers and ascend to the thalamus with the medial lemniscus, thence by neurons of higher order the impulses are carried to the somatic sensory area of the cortex through the internal capsule. The other touch fibers, shortly after entering the spinal cord, terminate in the dorsal column or intermediate gray matter. Neurons of the second order send their axons through the anterior commissure to pass upward in the antero-lateral funiculus probably in the ventral spinothalamic fasciculus. In the medulla they join or pass upward in the neighborhood of the medial lemniscus to the thalamus and thence by neurons of higher order to the somatic sensory area of the cortex. 14 The remaining ascending fasciculi form a part of the complex known as the superficial antero-lateral fasciculus (tract of Gowers). The spinotectal fasciculus, as its name indicates, is supposed to have its origin in the gray matter of the cord and terminations in the superior and inferior (?) colliculi of the mid-brain serving for reflexes between the cord and the visceral and auditory centers of the mid-brain. 15 The spino-olivary fasciculus (olivospinal; bulbospinal, Helweg’s bundle) is likewise of unknown constitution and function; there is uncertainty even in regard to the direction of its fibers. 16 Sympathetic afferent fibers (visceral afferent; viscero-sensory; splanchnic afferent) enter the spinal cord by the posterior roots of the thoracic and first two or three lumbar nerves and the second to the fourth sacral nerves. The fibers pass to these nerves from the peripheral sympathetic system through the white rami communicantes. Some of the cell bodies of these afferent fibers are located in the spinal ganglia and others are in the sympathetic ganglia. Some of the afferent sympathetic fibers end about the cell bodies of somatic sensory neurons and visceral impulses are thus transmitted to these neurons which conduct them as well as their own special impulses to the spinal cord. Other sympathetic afferent neurons whose cell bodies are located in the spinal ganglia send collaterals to neighboring cells of somatic sensory neurons and thus have a double path of transmission to the spinal cord. Such an arrangement provides a mechanism for some of the referred pains. 17 These sympathetic afferent fibers presumably divide on entering the spinal cord into ascending and descending branches. Their distribution and termination within the spinal cord are unknown. Some of them probably eventually come into relation with the sympathetic efferent fibers whose cell bodies are located in the lateral column. Our knowledge concerning both the termination and origin of these fibers is very unsatisfactory. 18 The sympathetic efferent fibers (splanchnic motor; viscero-motor; preganglionic fibers) are supposed to arise from cells in the intermediate zone between the dorsal and ventral gray columns and in the intermedio-lateral column at the margin of the lateral column. These preganglionic sympathetic fibers are not distributed throughout the entire series of spinal nerves but are confined to two groups, the thoraco-lumbar from the first thoracic to the second or third lumbar nerves and the sacral group from the second to the fourth sacral nerves. They pass out with the anterior root fibers and through the rami communicantes to end in sympathetic ganglia. The impulses are distributed from cells in these ganglia through postganglionic fibers to the smooth muscles and glands. The thoraco-lumbar outflow and the sacral outflow form two distinct functional groups which are considered more fully under the sympathetic system. 19

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