SPINAL CORD REFLEXES

Today, we will talk about the spinal cord in general and spinal cord reflexes, and a few
points about what happens if you get complete transection of the spinal cord and also some points
about consequences of cutting a nerve; What happen to that nerve and so on.

This is a cross section of the spinal cord.

In the spinal cord, we have many types of neurons such as sensory, motor and interneurons.
In the dorsal aspect; we have sensory fibers coming from the periphery with different types of
sensation. And we have a lot of interneurons. And if you remember from first year lectures, when
we talk about the Central Nervous System (CNS), most of neurons inside our CNS are actually
interneurons, and few sensory ganglia.

And you can see here that the interneurons are performing a very important function
because they are part of the neuronal circuits which serve many functions. And we have this motor
neuron ,its cell body is found in the anterior aspect (gray matter) of spinal cord. And we have one
of interneuron which is called Renshaw inhibitory cell, this neuron is excited by certain neurons
and it inhibits other neurons.

Just to give you an idea about this Renshaw inhibitory cell. Let’s take this circuit. This is
sensory neuron, this is interneuron and this is motor neuron, and from this motor neuron, we can
see an impulse going through Renshaw inhibitory cell to inhibit either the same interneuron or
other interneurons.

So by this way, the excitation will go on this neuron as if we are concentrating the excitation
only in one neuron or group of neurons.
SPINAL REFLEXES

The spinal cord is the central part of what we call spinal reflexes. There are many types of
spinal reflexes.

Reflex: Automatic rapid response to different stimuli of whatever type such as pain, mechanical,
and so on.

And these are the components of a reflex:

1. Receptor
2. Sensory fiber
3. Integrating center (spinal cord)
4. Motor fiber
5. Effector (mostly skeletal and smooth muscle)

And we have 2 types of reflexes depending on how many synapses are involved.

1. Monosynaptic (e.g. stretch reflex)

2. Polysynaptic (e.g. Golgi tendon reflex, withdraw reflex, and cross-extensor reflex)

By the way, all reflexes are polysynaptic except the stretch reflex.

There is a question from a student, but I can’t hear it (I suppose it was something like if
monosynaptic is stronger than polysynaptic or not?). So, the doctor asnwered:

“It is not stronger or not, but depends on strength of stimulus, if the stimulus is strong, the impulse
will be strong. So doesn’t mean it is strong, but definitely it is faster. It takes short time to finish
because you have only one delay. If you have two delays, definitely the time will be more.”

STRETCH REFLEX

It is the only spinal reflex that has 1 synapse, and because of that, the time for reflex to be
excited and finish is short if you compare it with other polysynaptic spinal reflexes.

This reflex is very important. Just to remind you about this reflex, very simple and used all
the time as we will see in just few minutes.

As we said, reflexes consist of a receptor, sensory fiber, integrating center, motor fiber, and
an effector. So let’s apply this equation together here. This is skeletal muscle, and the receptor here
is called muscle spindle. The stimulus here is stretching, so in order to excite or start this reflex
you have to stretch the muscle.
 So this is muscle spindle that responds to stretching. The sensory fiber going to spinal cord,
and as you can see there is only one synapse. Then, the motor fiber will go to the same muscle that
has been stretched. About the response, because it is excitation, there will be contraction.

Stretching > stimulation > response > contraction.

There are 2 (sensory and motor) neurons and 1 synapse. Then, the sideway or collateral of
this reflex, of course we have inhibition of the antagonist muscle. For instance if you are stretching
the biceps, you have to inhibit the triceps.

So if you apply it here there is a collateral neuron (inhibitory) going to the triceps. If
we assume this is biceps. So we have what we call collateral but the basic components of
this reflex are two neurons, one synapse “and so on”. The fiber going to excite the muscle is
alpha motor neuron (thickest nerve fiber).

MUSCLE SPINDLE

Where are the muscle spindle fibers?. This is a diagram of a skeletal muscle. These dark
lines are muscle fibers, responsible for contraction. And you can see the muscle spindle
here*. They are between the muscle fibers.
 Now the muscle spindle has some contraction fibers, so we have to differentiate
these fibers from the muscle fibers (responsible for muscle contraction). So we have 1)
Extrafusal muscle fibers > responsible for whole muscle contraction , and 2) Intrafusal
muscle fibers > responsible for the contraction of the muscle spindle fibers.

Another important point is the arrangement of these receptors (muscle spindles), it

is parallel to the long fibers (extrafusal). And we will see why it is parallel.

Two types of nerve fibers coming to the muscle spindle receptors –sensory and
motor-. So in addition to being a sensory receptor, muscle spindle is also a contractile
element(motor).

The motor fiber going to Intrafusal is gamma. The nerve fiber going the Extrafusal is
alpha. The other point from this diagram, you can see that the gamma motor fiber is going
to the peripheral part (the two ends) of the receptor.

So we can say -from this picture- that the contractile element (actin and myosin) is
actually found in the periphery. So muscle spindles are sensory receptors and they have a
contractile element(actin and myosin) which is found in the periphery or at the edge.

So what is the function of this contraction (referring to muscle spindle)?

The muscle spindles are the stretch receptors (excited by stretching). So if there is
excitation of the motor fiber to the two ends, we are pulling the central part of the receptor.
Of course this stretching is not enough to excite but because it leads to elongation of muscle
spindle, it means the sensitivity is increased.

So the contraction of the both ends will increase the sensitivity. In other words, if
you want to increase the sensitivity of the muscle spindle to stretching, you can stretch the
two ends.
 The central part is sensitive to stretching. If you stretch it too much, you may excite
the sensory fiber. This central part sensitivity can be increased if you stretch it a little bit.
This stretching is done by the contractile element here. As if you are pulling this central
part in opposite direction. So if this central part is a little bit stretched, you need less
strong stimulus to excite it.

Again. The central part is the sensory-sensitive to stretching-, while the peripheral
part is the contractile element. Contracting the muscle from opposite direction will
stimulate the stretch receptor at the center.

So the idea of this gamma motor fiber is to increase the sensitivity of the muscle
spindle. Consequently, you are increasing the contraction of the skeletal muscle because at
the end, the aim of stretching is to cause contraction of the skeletal muscle and these motor
fibers (gamma) are so important.

30% of the motor nerve fiber in the anterior aspect of the spinal cord are of gamma
fiber. This gives you an idea about how important this stretch receptor is.

Muscle spindle is working all the time to keep the muscle in certain strength/tone.

Sensory nerve fibers for the muscle spindle are of two types: 1. Primary ending (Ia)
2. Secondary ending (II). There are different sensory fibers, providing certain functions.

Let us see the slide.

This is again the muscle spindle showing a little bit more detail. We have two types of
muscle spindles; 1. Nuclear bag, 2. Nuclear chain.

The central part resembles a ‘bag’ and a ‘chain’ respectively. So just to differentiate
between two points. These are the contractile elements*.

Also notice the two types of sensory fibers, and the gamma motor fibers.
 So if you contract the two contractile ends, the center will be stretched. 30% of
fibers in ventral roots are gamma fibers. It means that these muscle spindles are very very
important for function of motor activities and so on.

By the way, there are two types of stretching; 1. Static, 2. Dynamic

1. Static
If you are stretching muscle once and stop. [hold it stretched]
2. Dynamic
If you are stretching -during the process of stretching.

Dynamic and static stretching will excite certain types. Both primary and secondary
are excited when muscle spindle is elongated. It means that if the muscle fiber is still
elongated, both fibers (primary and secondary) will be stimulated. But during the process
of excitation the primary is responsible (dynamic response).

So we have two response; 1. During stretching 2. When the muscle is stretched.

Muscle contraction can result form 1) direct excitation of alpha motor. For instance,
impulses from motor area going down to the alpha motor supplying the skeletal muscle.
2) indirect through excitation of muscle spindle. If you excite the sensory nerve fiber, this
will go through the spinal cord and to reflex going directly again to the muscle to cause
excitation.

ACTIVATION OF MUSCLE SPINDLE SERVES MANY FUNCTIONS

So what is the function of this muscle spindle?

First of all these muscle spindles actually they are making our motor activity more
smooth. To explain this, normally if there is excitation to the alpha motor fiber it makes
excitation, then we will have relaxation. If this happens, you get like this response
(excitation-relaxation-excitation-relaxation). This leads to oscillation (jerky movements).

If you want to move, your motor activity will be fragmented (left figure). But because of
this stretch reflex, during stretching and relaxation there is a little bit more excitation to
muscle spindle leading to partial contraction. So the contraction will be like smooth
course (Right figure).
 Second is stabilization of body position (joints). Usually during movement there is
stretching-relaxation. Stretching will lead to excitation and so on. In general we will get
the stabilization of the joint. So muscle spindle is very important for this thing.

Third is maintaining muscle length. Follow the above figure. For example: If you
stretch skeletal muscle this will lead to stretching of muscle spindle. This will lead to
excitation of stretch reflex and leads to contraction of skeletal muscle.
Stretching/elongation, in order to retain the normal muscle length through excitation of
stretch reflex the muscle will be shortened by contraction.

If there is a decrease in muscle length during contraction, it means less stretching to

muscle spindle, and there is less excitation to this reflex. In other words, there is muscle
relaxation. So we can see both during contraction and relaxation there is some sort of
inhibition or excitation of muscle spindle reflex and this will make our movement and the
tone of the muscle almost kept constant.

Sometimes, in certain position we need to increase it or decrease it. If we want to

increase it simply you stimulate the gamma fiber and this is from the higher centers (e.g.:
vestibular nuclei/reticular formation/red nucleus). All these sending impulses down to the
gamma motor fiber.

If it is excitation, it means the muscle tone will be increased. Sometimes we increase

it and sometime we decrease it.

GOLGI TENDON REFLEX

Golgi is the person who describes this reflex. Actually I can say this reflex is exactly
opposite to stretch reflex.

So let us see first of all the circuit of this reflex. This is the receptor and you can see
it is found in the tendon or at the junction between the tendon and the muscle fiber and it is
called Golgi according to the first describer.
 This receptor is in series with the muscle fiber. If you remember the muscle fiber
and the muscle spindle are arranged in parallel. Muscle spindle is excited when there is
stretching, while Golgi tendon is excited when there is contraction (Increase in tension).

So during contraction of muscle, there will be excitation of this one and will be
conveyed by sensory fibers to the center and then through this motor fiber (it is
inhibitory). It inhibits that muscle.

So let us say it again. Contraction of the muscle leading to excitation of the tendon
receptor and this will lead to relaxation or inhibition of contraction. So as if it is increasing
the tension leads to relaxation of that muscle. So this is exactly opposite to the stretch
reflex. The difference is obvious here.

Both stretch reflex and Golgi tendon are necessary to keep muscle tone. And this is
very important and sometimes confusing.

What is muscle tone?

It is the partial/basal contraction of skeletal muscle. It means all muscles have some
contraction in it. This tone is due to the activity of muscle spindle and Golgi tendon.

If you cut the sensory fiber, the muscle tone will be decreased. This is called
hypotonia. It is not paralysis because you are decreasing the tone- especially the muscle
spindle-. Muscle tone is increased when there is impulses coming from the brainstem (eg:
reticular formation) through the gamma, increasing the sensitivity of stretch receptor
hence increasing the muscle tone.

A student asked: why sensory destruction leads to hypotonia?

 Answer: a muscle tone actually depends on these reflexes which work all the time.
Put it in this way. Just imagine this is stretch reflex. Always there is muscle contraction
even you are not using your muscle due to some sort of excitation of this stretch reflex. If
you cut this one, there is no stretch reflex which leads to less contraction of muscle. That is
why muscle becomes hypotonic/flaccid. But this is not paralysis. Paralysis is due to
cutting of the motor neuron.

Another response from the student which I couldn’t here it well.

But the doctor responded: mostly stretch reflex is responsible for muscle tone. They
are helping each other in order to maintain certain muscle tone. Muscle tone is mainly due
to gamma which is belonging to stretch reflex. This (Golgi) is helping but not essential.

WITHDRAWAL REFLEX

I think you can figure out what is meant by this. The response is flexion when the
stimulus is painful. So let us see what this reflex is made of. Stimulus (painful), sensory
through the dorsal root of spinal cord and you can see through series of interneurons you
will get certain response. The response is flexion.

In addition to that, you can see that we have collateral. One of them is this one which
goes to the antagonist muscle. If we stimulate this (the flexor), we have to inhibit that (the
extensor).

In addition to that, at the same time, this reflex will excite the other side of the body
in the opposite manner. Here (side of pain) the flexion is stimulated, there (opposite side)
the flexion is inhibited. While here the extensor is inhibited and there the extensor is
stimulated. That is why it is called “cross extensor reflex”.
 Actually every time when we withdraw something (e.g.: leg), the other side will be
extended in order to keep the balance. So this is called “cross extensor reflex”. Original one
is withdrawal/flexor because it involves the flexors.

Other important thing is if stimulus is painful your response is multi. It is causing

correction of flexor that is why it is called flexor reflex and sometimes it is called
polysynaptic reflex. (!!)

Question: is the same pain stimulus causing the reflex and the perception of pain?

Answer:We are talking about reflex, at the same time we have collateral tract here,
but it is painful of course if we go this direction it will cross. Again it will ascend through
the anterolateral tract to the brain. But we are talking about reflex. You are withdrawing
your hand before perceiving the pain.

SPINAL CORD TRANSECTION

Let us talk a few points about what happens if there is a complete transection in the
spinal cord. I think you are familiar now about the motor and sensory tracts. What
happens if there is hemisection in one side? How it affects motor and sensory activity. I
want to concentrate here on complete transection of the spinal cord and how it affects the
reflexes.

** Here just to give you an idea about what happens to the voluntary movement if
you get transection below cervical enlargement of the spinal cord. It means almost at the
level of C6/C7. So you will get paralysis of the lower part of the body leads to paraplegia
(paralysis of the lower part of the body).

If it is cervical transection -say at cervical segment 4/5- you will get maybe
quadriplegia because nerve fibers going to upper extremities will be there.

Transection in sacral region will cause paralysis of the lower limb similar to
paraplegia.

** With this actually you will get loss of all sensations because you are cutting all the
nerve fibers going up and down.

**The other thing you can see is that there is complete loss of all reflexes [somatic
(stretch reflex) and autonomic (vasomotor, blood pressure, sweating, bladder, defecation)
reflexes].

This “areflexia” (complete loss of reflexes) after transection is not well-explained.

But it seems that there is cutting of all fibers coming from the higher centers especially
from the brainstem and so on. This areflexia is called spinal shock. It lasts for a few
weeks. It depends on many factors.

Recovery:

Because we are talking about reflexes which are not correlated to the higher
centers. So it seems that the reflex must be there. Actually the reflex is retained back
gradually (after about four weeks).

First reflexes to recover are the bladder and rectal, after that maybe stretch reflex.
Not only recovering but also getting exaggerated. So, as it seems that the inhibitory impulse
comes (used to come) from the higher center. Cutting the inhibitory impulse leading to
stretch reflex alone, so it is exaggerated.

Mass reflex : activation of many reflexes at the same time in persons with spinal
cord transaction.

If you stimulate certain point the lower inner aspect of the thigh you will cause
excitation of all reflexes.

It will cause :

 Strong muscle contraction

 Evacuation of bladder and rectum
 Increased blood pressure
 Increased sweating

So, you are reversing all these things (areflexias) by mass reflexes and this is done
actually by some research when there is spinal shocks and after one week there is still no
evacuation of bladder or whatever, they do this mass reflex by excitation of somewhere.

You know what is LOWER MOTOR NEURON (LMN) or UPPER MOTOR NEURON (UPN)
lesion??

A student asked regarding respiratory muscles.

Doctor answered: if you cutting the fibers going to respiratory muscle, it means DEATH. If
you cut some maybe C3, C4 or C5 and there is some of respiratory nerve fiber it will be
affected.

But if you cut all the nerve that go to respiratory muscle it means DEATH.
LOWER MOTOR NEURON LESION

We have 2 types of motor neurons that come from the higher center.

 Pyramidal
 Extrapyramidal

They control all α motor neuron.

If you cut α motor neuron, this is called LMN lesion

If you cut higher center neurons, it is called UMN lesion

What happens if there is LMN lesion.

 Flaccid paralysis of muscle or paresis

 Muscle atrophy
 Appearance of spontaneous contraction (fasciculation or fibrillation)
 Absence or decrease in muscle stretch reflex
 Muscle involve individually.

EFFECT OF MUSCLE DENERVATION

 FASCICULATION
 FIBRILLATION
 MUSCLE ATROPHY

 FASCICULATION

Is spontaneous muscle contraction of group of muscles fibers

In the slide : visible spontaneous muscle contraction involved muscle fiber in motor
unit.
(The damage occured at middle of axon)

There is possibility that a spontaneous action potential will be started at this point
(refer to figure). So, it will be propagated to these muscle fibers.

That’s why fasciculation can be seen because the group muscle fibers depend on the
size of motor unit.

This is the one mechanism that leads to spontaneous muscle fiber contraction.

 FIBRILLATION

Involving single or individual muscle fiber, that is cannot be seen by naked eye.

In the slide :

Contraction (spontaneous) of individual muscle fiber, no visible because it is small

contraction, can be detected by EMG.

The mechanism (see slide)

If there is a cut in the nerve fiber and degeneration, then there is a possibility that
action potential will be liberated involving individual fibers and this is difficult to be
seen.
  MUSCLE ATROPHY

The muscle fiber is receiving trophic substances from the motor nerve. So if you cut this
one, you are depriving the muscle from these trophic substances. So the muscle fiber
will be atrophied.

Or if you don’t use muscle this will lead to muscle atrophy too.

In the slide: when motor fibers to a muscle are completely degenerated. This muscle
becomes silent and undergoes atrophy called denervation atrophy which is a very severe
atrophy.

As your colleague said, denervation will increase the sensitivity of the ACH receptor,
(compensation for what has been happened) cutting the nerve means there is no activity in
muscle fiber.

So, this leads to increased ACH sensitivity , if there is liberated ACH near muscle fiber this
will lead to

 Fasciculation ( involving many fiber)

 Fibrillation (one muscle only)

So, ACH receptors in large number.

If there is no ACH for a long time or certain time and no regeneration, this will silent the
ACH receptors and they will disappear.

Done by Faiz AFA.

Special thanks to Arif Hakimi and Faiq Nabil for helping me doing this tfree3’. By the way this is my first
one. Please forgive me for any mistake. And please, do correct me.

Thank you 