Article ; Online: A critical reappraisal of corticospinal tract somatotopy and its role in traumatic cervical spinal cord syndromes.
Journal of neurosurgery. Spine
2021 Volume 36, Issue 4, Page(s) 653–659
Abstract: The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function ... ...
| Abstract | The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function. |
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| MeSH term(s) | Animals ; Central Cord Syndrome/diagnostic imaging ; Central Cord Syndrome/pathology ; Cervical Cord/pathology ; Humans ; Mammals ; Pyramidal Tracts/diagnostic imaging ; Spinal Cord/pathology ; Spinal Cord Injuries |
| Language | English |
| Publishing date | 2021-11-12 |
| Publishing country | United States |
| Document type | Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural |
| ZDB-ID | 2158643-3 |
| ISSN | 1547-5646 ; 1547-5654 |
| ISSN (online) | 1547-5646 |
| ISSN | 1547-5654 |
| DOI | 10.3171/2021.7.SPINE21546 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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