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Topic

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Upper cervical spinal cord

The upper cervical spinal cord refers to the segment of the spinal cord located within the cervical region, typically spanning the C1 to C3 vertebral levels. This area is critical for the relay of neural signals between the brain and the rest of the body, especially for motor, sensory, and autonomic functions. The upper cervical cord contains essential pathways, including the corticospinal tracts and ascending sensory fibers, as well as the origins of the phrenic nerve which is vital for diaphragmatic control. Its integrity is crucial for basic life functions, and lesions in this region may lead to severe neurologic deficits or even life-threatening conditions.

Function

  • Transmits motor and sensory signals between the brain and body.

  • Houses upper motor neurons and ascending sensory tracts.

  • Contains descending autonomic fibers.

  • Gives rise to spinal nerves (notably C3–C5 contribute to the phrenic nerve for diaphragm control).

  • Plays a key role in respiratory, cardiovascular, and autonomic regulation.

Arterial Supply

  • Anterior spinal artery: Supplies the anterior two-thirds of the spinal cord.

  • Paired posterior spinal arteries: Supply the posterior one-third.

  • Radicular arteries: Contribute from vertebral and deep cervical arteries.

  • Segmental medullary arteries: Support the vascular network at cervical levels.

Venous Drainage

  • Anterior and posterior spinal veins.

  • Internal vertebral venous plexus (Batson’s plexus): Drains blood from the spinal cord to systemic circulation.

  • Radicular veins: Drain into vertebral and deep cervical veins.

MRI Appearance

T2-weighted MRI

  • Spinal cord: Intermediate to slightly hypointense compared to bright CSF.

  • Gray-white matter differentiation: Subtle but can sometimes be visualized.

  • Pathological lesions (edema, demyelination, tumor): Appear as high signal (bright) areas.

T1-weighted MRI

  • Spinal cord: Appears relatively hyperintense (brighter) compared to dark/hypointense CSF.

  • Gray-white matter differentiation: Less obvious than T2.

  • Lesions: Most pathological processes appear as hypointense (dark) regions compared to normal cord.

FLAIR MRI

  • Cord visualization: Poor, as FLAIR is not optimized for cord imaging.

  • Usefulness: Can help detect adjacent pathology (e.g., edema, syrinx), but less sensitive for subtle intramedullary changes than T2.

Post-contrast T1-weighted MRI

  • Normal cord: No enhancement.

  • Pathology: Abnormal enhancement seen in inflammation, tumors, demyelinating disease, or infection. Enhancement patterns assist in differential diagnosis.

CT Appearance

  • Cord visualization: Poor on non-contrast CT, seen as a soft tissue density within the spinal canal.

  • Best use: For bony detail, trauma, and detection of compressive lesions.

MRI images

Spinal cord mri 3t sagittal image