Spinal Cord Anatomy & Syndromes
Introduction
The spinal cord transmits motor, sensory and autonomic signals between brain and body.
For emergency clinicians, concise knowledge of cord anatomy, vascular supply and major tract organisation underpins rapid bedside localisation, recognition of red flags (respiratory compromise, sphincter disturbance, progressive neurological deficit), imaging decisions and timely escalation.
This section summarises relevant anatomy and vascular vulnerability, links physiology to the classical cord syndromes, and gives focused ED assessment, imaging and early‑management priorities aligned with UK guidance (NICE NG41, RCEM, GOV.UK MESCC measures, NICE IPG/HTG).
Anatomy primer
Gross organisation
The cord has central grey matter (neuronal cell bodies, dorsal/ventral/intermediate horns) surrounded by white matter (ascending and descending myelinated tracts organised into dorsal, lateral and ventral funiculi). Clinical deficits follow tract and horn locations.
Major tracts and clinical relevance
- Corticospinal (lateral corticospinal): principal descending motor pathway; fibres decussate in the medulla; cord lesions produce ipsilateral upper motor neuron (UMN) signs below the level.
- Dorsal columns (fasciculi gracilis/cuneatus): carry vibration, proprioception and fine touch; ascend ipsilaterally and decussate in the lower medulla; cord lesions cause ipsilateral loss of these modalities below the lesion.
- Spinothalamic (anterolateral system): transmits pain and temperature; second‑order fibres cross within 1-2 spinal segments after entering the cord, so cord lesions produce contralateral pain/temperature loss beginning a few segments below the lesion.