Spinal cord tracts and reflexes

Last updated: November 20, 2023

Summary

The spinal cord is part of the central nervous system and coordinates motor, sensory, and reflex signals. Anatomically, the spinal cord is located within the spinal canal and extends from the bottom of the medulla (at the first cervical vertebra C1) to the conus medullaris (between L1 and L2). Blood is supplied to the spinal cord from the branches of the vertebral artery and drains into the vertebral veins. Internally, the cord can be divided into gray matter centrally and white matter peripherally (unlike in the brain, where this division is inverted). The gray matter is composed of the anterior horn, which contains the cell bodies of motor neurons; the dorsal horn, which contains the cell bodies of sensory neurons; and the lateral horn, which contains the cell bodies of preganglionic sympathetic neurons. The white matter contains descending and ascending tracts. The descending tracts transmit motor signals to the periphery and the ascending tracts transmit sensory signals to the brain. Thirty-one pairs of peripheral spinal nerves arise segmentally from the spinal cord and conduct autonomic, motor, sensory, and reflex signals between the CNS and the body. Clinically relevant spinal reflexes include the patellar reflex, ankle reflex, biceps reflex, and triceps reflex. Each spinal nerve carries dermatomes, which are somatic sensory fibers that correspond with a specific and identifiable region of skin. Each dermatome is supplied by a single spinal cord level and is, therefore, useful in identifying specific levels of damage in spinal cord injuries. The development of the spinal cord begins around the third week of gestation during the process of neurulation. The spinal cord is derived from the neural tube. Conditions that affect the spinal cord include spinal shock (related to trauma), central cord syndrome, and multiple sclerosis.

Gross anatomy

Structures of the spinal cord

Structure	Anatomy	Function	Characteristic features
White matter	Bundles of the following nerve fibers: Anterior funiculus Lateral funiculus Posterior funiculus Anterior median fissure Posterior median sulcus: separates the posterior columns	Contains bundles of myelinated axons called tracts or fasciculi Axons ascend or descend in the spinal cord within the white matter to transmit signals between the CNS and periphery.	Surrounds the gray matter peripherally White appearance due to myelin Does not contain dendrites
Gray matter	Anterior gray column (ventral horn) Posterior gray column (dorsal horn) Lateral gray column (lateral horn)	Contains cell bodies, dendrites, and proximal axons of neurons For the function of each horn, see anterior horn, dorsal horn, and lateral horn in this table.	Centrally located, butterfly-like shape Surrounds the central canal Gray commissure crosses the midline.
Anterior horn	Contains cell bodies of motor neurons Alpha motor neurons: lower motor neurons (LMN) whose axons extend into the periphery and innervate extrafusal fibers of skeletal muscle Gamma motor neurons: innervate the intrafusal fibers of muscle spindles Renshaw cells: inhibitory interneurons in the anterior horn	Alpha motor neurons induce the contraction of skeletal muscle. Gamma motor neurons increase the stretch sensitivity of muscle spindles.	Contains Rexed laminae VIII–IX Organized somatotopically Medial motor neurons innervate proximal musculature (e.g., the trunk and shoulders). Lateral motor neurons innervate distal musculature (e.g., the hands and feet). Motor neurons that innervate flexors are located dorsally and those that innervate extensors are located ventrally.
Dorsal horn	Cell bodies of second-order sensory neurons	Transports sensory stimuli to the brain stem, cerebral cortex, or cerebellum Involved in spinal reflexes	Contains Rexed laminae I–VI Marginal nucleus (lamina I) Substantia gelatinosa of Rolando (lamina II) Nucleus proprius (laminae III, IV) Spinal lamina V Spinal lamina VI
Lateral horn	Extends from T1–L2 Clarke nucleus (posterior thoracic nucleus) at T1–L3	Contains preganglionic cell bodies of sympathetic neurons Clarke nucleus: relays unconscious proprioception (unconscious perception of relative position and movement of the body) to the cerebellum	Contains Rexed lamina VII
Spinal nerves	Composed of ventral and dorsal nerve roots and rami 8 cervical spinal nerves (C1–C8) 12 thoracic spinal nerves (T1–T12) 5 lumbar spinal nerves (L1–L5) 5 sacral spinal nerves (S1–S5) 1 coccygeal spinal nerve	Transport autonomic, motor, and sensory signals between the spinal cord and the body	There are 31 pairs of spinal nerves.
Nerve roots	Exit the spinal canal via the intervertebral foramina Cervical roots exit the canal above the vertebra that corresponds to the segment of the root (e.g., C8 spinal nerve exits above T1). Thoracic, lumbar, and sacral nerve roots exit below the corresponding vertebra.	Anterior roots carry motor (efferent) fibers that control skeletal and smooth muscle. Dorsal roots carry sensor (afferent) fibers that transmit somatosensory information.	Disk herniation is the most common cause of damage to the spinal nerve roots.
Dorsal root ganglia	Present on every dorsal nerve root Located in the intervertebral foramina outside the vertebral column	Carry sensory (afferent) fibers	Develops from neural crest cells Contains pseudo-unipolar neurons: sensory neurons in the peripheral nervous system containing an axon that splits into two branches
Ventral rami	Anterior part of the spinal nerve Branch from spinal nerves after leaving the intervertebral foramen	Innervate the skin and skeletal muscle of the anterolateral trunk and limbs	Mixed nerves (relay both sensory and motor information)
Dorsal rami	Posterior part of the spinal nerve Branch from spinal nerve after leaving the intervertebral foramen	Innervate: Skin of the back and dorsal neck Deep muscles of the back (e.g., erector spinae) The posterior vertebrae and facet joints Superficial ligamenta flava	Mixed nerves (relay both sensory and motor information)
Cervical region	Cervical enlargement at C5–T1 level	Forms the brachial plexus, which innervates the upper limb	Large anterior horn No lateral horn Both dorsal columns are present.
Thoracic region	Consists of 12 spinal segments (T1–T12); no enlargement at this level	Origin of the intercostal nerves, which innervate: Thoracic wall Parietal pleura of the lungs Abdominal wall Peritoneum	Small anterior horn Lateral horns are present. Dorsal columns vary.
Lumbar region	Lumbar enlargement at L2–S3 level	Forms lumbar and sacral plexuses, which innervate the lower limbs	Large anterior horn No lateral horn One dorsal column is present.
Conus medullaris	Caudal end of the spinal cord consisting of upper and lower motor neurons Origin of S2–S5 spinal nerves Ends at the L2 vertebral level (in adults)	Innervates lower extremities, bowel, and bladder	Tapered terminal end of spinal cord; directly attached to filum terminale
Cauda equina	Anterior and dorsal nerve roots of spinal nerves (L2–Co1) Lumbar Sacral Coccygeal	Innervates the lower limb, perineum, and pelvic organs Innervates the internal and external anal sphincter Provides parasympathetic innervation to the bladder	Bundle of tapered nerve roots resembles a horse's tail
Filum terminale	Thin extension of pia mater	Attaches the bottom of the spinal cord to the vertebral column	Slender, string-like appearance

Renshaw cells are inhibitory interneurons that secrete glycine. These are the neurons targeted by Clostridium tetani toxin.

Important structures of the spinal cord Structure of the spinal cord Cross section of the spinal cord Transverse sections of the spinal cord Segment of the spinal cord with spinal roots, nerves, and fibers Microstructure of the gray matter of the spinal cord

Blood supply of the spinal cord

Vertebral arteries
- Main source of blood supply to the spinal cord
- Arise from the subclavian artery
- Branches
  - Anterior spinal artery
    - Supplies the anterior two-thirds of the spinal cord and the lower medulla at the midline
    - Sits in the anterior median fissure of the spinal cord
    - Has penetrating and circumferential branches
  - Posterior spinal arteries; supply the posterior part of the spinal cord bilaterally. ;
  - Arterial vasocorona: anastomosis between spinal arteries
Segmental spinal arteries
- Enter the vertebral canal via intervertebral foramina at every level
- Arise from various arteries depending on anatomic location
  - Neck: vertebral and deep cervical arteries
  - Thorax: posterior intercostal arteries
  - Abdomen: lumbar arteries
- Branch to anterior and posterior radicular arteries in the intervertebral foramen and supply nerve roots and the spinal cord
  - Give rise to the great anterior radiculomedullary artery (artery of Adamkiewicz) in the lower thoracic region
    - Anastomoses with the anterior spinal artery
    - Supplies the spinal cord from T8 and below
Vertebral veins: See the vertebral column article for more information on the venous system of the spinal cord.

The great anterior radiculomedullary artery (artery of Adamkiewicz) is the dominant artery supplying the thoracolumbar region of the spinal cord.

Arterial blood vessels of a thoracic spinal cord segment Arterial supply territories of the spinal cord Arterial supply of a spinal segment

Spinal cord tracts

The spinal cord contains ascending and descending tracts. The primary ascending tracts use three neurons to relay peripheral sensory information to the brain. In contrast, the descending tracts transmit motor impulses from the cerebral cortex throughout the body. For more information on lesions of the spinal cord tracts see the incomplete spinal cord syndromes article.

Ascending (sensory) tracts ^[1]^[2]

Tract	Function	First-order neuron	Synapses	Second-order neuron	Trajectory
Conscious sensation
Spinothalamic tract	Anterior Pressure Crude touch Lateral Pain Temperature	Sensory nerve fibers (Aδ fibers and C fibers) have pseudounipolar cell bodies in the dorsal root ganglion. Axon enters the spinal cord and ascends or descends several segments in the posterolateral tract (Lissauer tract). Located at tips of dorsal horns Carries ascending sensory fibers one to two levels above before synapsing in the dorsal horn	Ipsilateral spinal cord in the substantia gelatinosa or nucleus proprius one to two segments below or above the 1^stneuron	Axon decussates within the anterior white commissure and then ascends contralaterally. In the lateral spinothalamic tract, cervical segments are medial and sacral segments are lateral.	To the 3^rdneuron in the ventral posterolateral nucleus of the thalamus → somatosensory cortex
Dorsal column	Proprioception Pressure Vibration Fine touch	Sensory nerve fibers have a pseudounipolar cell body in the dorsal root ganglion. Axon enters the spinal cord and ascends ipsilaterally Gracile fasciculus (sensation from lower limbs, T6 and below): located medially Cuneate fasciculus (sensation from upper limbs, T5 and above): located laterally	Ipsilateral medulla oblongata	Axon decussates to the contralateral side within the medulla. Ascends contralaterally in the medial lemniscus
Unconscious sensation ^[3]
Spinocerebellar tract	Proprioception	Sensory nerve fibers Cell body in the dorsal root ganglion	Ipsilateral posterior horn of the spinal cord	Axons arising from the posterior horn of the spinal cord to the cerebellum	Cerebellum (via inferior and superior cerebellar peduncles)
Spinoolivary tract	Proprioception	Sensory nerve fibers Cell body in the dorsal root ganglion	Ipsilateral posterior horn of the spinal cord	Axons arising from the posterior horn of the spinal cord to the olivary nuclei of the medulla	Third-order neurons to the cerebellum

Ascending conscious tracts of the spinal cord Spinocerebellar tracts Overview of the ascending and descending pathways of the spinal cord Cross section of the spinal cord Thoracic spinal cord

Descending (motor) tracts ^[1]^[2]

Tract	Function	First-order neuron	Synapses	Second-order neuron	Trajectory
Corticospinal tract (part of the pyramidal tract) ^[4]	Voluntary movement of the contralateral side	Upper motor neuron Cell body in the motor cortex (precentral gyrus) Descends ipsilaterally via the internal capsule (posterior limb) Lateral corticospinal tract (∼ 80% of fibers) Crosses in the caudal medulla (pyramidal decussation) Descends in the spinal cord contralaterally Cervical segments are medial and sacral segments are lateral. Anterior corticospinal tract (∼ 20% of fibers): Crosses at the same level of the spine as it innervates (not at the level of the medulla oblongata).	Anterior horn cells: motor neurons in the anterior gray column of the spinal cord	Lower motor neurons of the upper or lower limbs	To the neuromuscular junction (NMJ) of respective muscles
Extrapyramidal tracts	Regulate the action of motor neurons Involuntary movement (e.g., equilibratory reflexes, visual and auditory reflexes) Muscle tone Musculature responsible for facial expressions	Multiple projections and pathways Rubrospinal pathway Reticulospinal tract Vestibulospinal tract Tectospinal tract	Anterior horn cells of the spinal cord	Lower motor neurons	Varies depending on the tract

Tract

Function

First-order neuron

Synapses

Second-order neuron

Trajectory

Corticospinal tract

(part of the pyramidal tract) ^[4]

Voluntary movement of the contralateral side

Upper motor neuron
- Cell body in the motor cortex (precentral gyrus)
- Descends ipsilaterally via the internal capsule (posterior limb)
Lateral corticospinal tract (∼ 80% of fibers)
- Crosses in the caudal medulla (pyramidal decussation)
- Descends in the spinal cord contralaterally
- Cervical segments are medial and sacral segments are lateral.
Anterior corticospinal tract (∼ 20% of fibers): Crosses at the same level of the spine as it innervates (not at the level of the medulla oblongata).

Anterior horn cells: motor neurons in the anterior gray column of the spinal cord

Lower motor neurons of the upper or lower limbs

To the neuromuscular junction (NMJ) of respective muscles

Extrapyramidal tracts

Regulate the action of motor neurons
- Involuntary movement (e.g., equilibratory reflexes, visual and auditory reflexes)
- Muscle tone
- Musculature responsible for facial expressions

Multiple projections and pathways
- Rubrospinal pathway
- Reticulospinal tract
- Vestibulospinal tract
- Tectospinal tract

Anterior horn cells of the spinal cord

Lower motor neurons

Varies depending on the tract

Legs are represented Laterally in the Lateral spinothalamic and Lateral corticospinal tract.

Remember that fasciculus graciLis carries sensory information from the Lower limbs, and fasciculus cUneatus transmits information from the Upper limbs.

Pyramidal tract Overview of the ascending and descending pathways of the spinal cord Cross section of the spinal cord Findings in lower or upper motor neuron damage

Spinal cord reflexes

Reflex innervation of skeletal muscles ^[1]^[2]^[4]

Definition: Reflexes are involuntary, consistent reactions to specific stimuli.
Reflex arc
- Reflex arc consists of
  - Somatosensory receptors (e.g., muscle spindles, Golgi tendon organs)
  - Afferent nerve fibers (e.g., type Ia fibers and type II fibers)
  - Integrating center (e.g., the spinal cord in spinal reflexes)
  - Efferent nerve fibers (e.g., axons of alpha motor neurons)
  - Effector organs (mostly muscles)
- The reflex arc of spinal reflexes does not involve the brain or brainstem. However, upper motor neurons may modify the intensity of the reflex response. See upper motor neuron damage for more information.

Muscle proprioceptors

	Muscle spindle	Golgi tendon organ
Structure	Intrafusal muscle fibers (modified skeletal muscle fibers) and nerve fibers surrounded by a capsule	Collagen strands and nerve fibers surrounded by a capsule
Location	Within skeletal muscle; parallel to extrafusal muscle fibers	Within tendons of skeletal muscle
Perception	Muscle length and change of muscle length (e.g., muscle stretching)	Muscle tension and muscle force
Reflex arc	Myotatic stretch reflex Alteration of muscle length activates muscle spindles Afferent signals travel via type Ia fibers and type II fibers and the dorsal root ganglion to the spinal cord. Simultaneous activation of: Alpha motor neurons (LMNs) that innervate the agonist muscle (monosynaptic) Inhibitory interneurons that inhibit the alpha motor neurons of the antagonist muscle (disynaptic) See tendon reflexes for more information.	Inverse myotatic stretch reflex Tension of the muscle activates Golgi tendon organs. Afferent signals travel via type Ib sensory fibers and the dorsal root ganglion to the spinal cord. Activation of inhibitory interneurons that inhibit the alpha motor neurons of the agonist muscle (disynaptic) Relaxation of the agonist muscle (prevents exhaustive tension)
Purpose	Causes stretched muscle to contract	Controls tendon tension of activated muscle Causes muscle relaxation of agonist muscle before tendon damage occurs
Example	Tapping of reflex hammer on tendon	Sudden relaxation when a weightlifter uses extremely heavy weights

Muscle spindle Golgi tendon organ Receptors of proprioception

Clinically important reflexes

Deep tendon (stretch) reflexes are ipsilateral and only require one synapse (monosynaptic).

Afferent limb: a sensory neuron from muscle spindles that travels to the spinal cord
Efferent limb: a lower motor neuron that travels from the spinal cord to the neuromuscular junction

Reflex	Muscle tested	Spinal level
Biceps reflex	Biceps	C5–C6
Brachioradialis reflex	Brachioradialis	C5–C6
Triceps reflex	Triceps	C7–C8
Knee reflex (patellar)	Quadriceps	L3–L4
Ankle reflex (Achilles)	Gastrocnemius	S1–S2
Cremasteric reflex	Cremaster	L1–L2
Anal wink reflex	External anal sphincter	S3–S5

See tendon reflexes for more information.
See sensory receptors of the skin for more details on mechanoreceptors.

Think of this poem to remember which nerve roots correspond to which reflexes:
S1–S2
Buckle my shoe (ankle reflex),
L2–L4
Kick the door (knee reflex),
C5–C6
Pick up sticks (biceps and brachioradialis reflexes),
C7–C8
Lay them straight (triceps reflex),
L1–L2
Testicle move (cremasteric reflex),
S3–S5
Winking drive (anal wink reflex).

Stretch reflex Inverse myotatic stretch reflex

Dermatomes

Dermatomes are areas of cutaneous innervation that are supplied by a single spinal nerve or cord level (with the exception of cranial nerves V1–3). While there is some overlap in the general distribution of dermatomes, each individual spinal cord level supplies a distinct zone of skin. Testing touch or sensory perception in these areas can be used to localize lesions of the spinal cord to a specific cord level or spinal nerve. ^[2]^[5]

Head dermatomes

Dermatome	Distribution
Cranial nerve V1	Ophthalmic branch of the trigeminal nerve Upper face Dorsum of the nose Orbit (including conjunctiva and cornea) Forehead Upper eyelids
Cranial nerve V2	Maxillary branch of the trigeminal nerve Midface Lateral nose Anteroinferior part of the nasal septum Upper lip and cheeks Lower eyelids Anterior region of the temple (anterior to the ear)
Cranial nerve V3	Mandibular branch of the trigeminal nerve Lower face External auditory meatus (including the tympanic membrane) Preauricular area of external ear and tragus Lower lip and chin Posterior region of the temple (posterior to the ear) Chin area of the mandible Temporomandibular joint
C1–C4	From the cervical plexus Angle of the mandible External ear (posterior part) Inframandibular region (submandibular triangle) Occipital protuberance

Facial dermatome mapping Dermatomes and radicular sensory innervation

Body dermatomes

Dermatome	Distribution
C2	Posterior half of skull
C3	Upper neck, directly inferior to the mandible
C4	Above the clavicle, including upper shoulders and trapezius
C5	Below the clavicle, including lower shoulders bilaterally and medial biceps
C6	Lateral aspect of forearms and thumbs
C7	Middle triceps and mid-palm, including index and middle fingers
C8	Medial triceps and medial palm, including ring and small fingers
T4	Level of the nipples
T7	Xiphoid process
T10	Umbilicus
L1	Inguinal ligament
L4	Patella and large toe
L5	Dorsal web space between first and second toes
S2–S4	Penile and anal regions

Dermatome map

Referred pain in dermatomes

Referred pain is the perception of sensory information in a location that differs from the actual site of the stimulus. The pain is sensed from a particular spinal cord level but the CNS interprets this pain as coming from another location that is innervated by the same spinal cord level.

Spinal cord level	Organ	Area of referred pain
C3–C5	Diaphragm via phrenic nerve	Shoulder
T10	Appendix via greater splanchnic nerve	Umbilical region
T1–T4	Heart	Upper thorax and left arm
T5–T9	Foregut (organs supplied by the celiac trunk)	Lower thorax and epigastrium
T10–T12	Midgut (organs supplied by the superior mesenteric artery)	Umbilical region
L1–L2	Hindgut (organs supplied by the inferior mesenteric artery)	Hypogastrium and groin
T12	Kidneys and ureters	Lateral flanks and pubic region

To remember the segments that innervate the diaphragm, think of “C3–C5 keep the diaphragm alive.”

Embryology of the spinal cord

Neurulation begins during the third week of gestation, during which the neural plate folds over at the midline and fuses to form the neural tube. The neural tube then forms both the spinal cord and brain.

Neurulation derivatives

Structure	Characteristics	Derivatives
Notochord	Induces overlying ectoderm to differentiate into the neuroectoderm and form the neural plate (occurs on 18^th day of gestation)	Nucleus pulposus of the intervertebral disk
Neural plate	Located on the dorsal portion of the trilaminar germ disk Precursor structure for the process of neurulation	Neural tube
Neural folds	Grow dorsally toward the midline; fuse together to form the neural tube Occurs at the end of the 3^rd week (21^st day) of gestation Located on the free edges of the neural plate bilaterally during the elongation and folding process	Neural crest cells
Neural crest cells	Group of cells that arises from neural folds After the neural folds fuse and form the roof of the neural tube, neural crest cells transition from epithelial to mesenchymal.	Dorsal root ganglia Autonomic ganglia Schwann cells Adrenal medulla
Neural tube	Consists of two plates Alar plate (dorsal) regulated by proteins of the TGF-β family (e.g., bone morphogenetic protein) Basal plate (ventral) regulated by sonic hedgehog protein Formed by the fusion of neural folds, deepening of the neural groove, and elongation of the neural plate Has 3 primary vesicles, which develop into 5 vesicles Has rostral and caudal openings (neuropores) Rostral neuropore (anterior): closes by the 26^th day of embryonic development Caudal neuropore (posterior): closes by the 28^th day of embryonic development Failure of the neural tube to completely close results in neural tube defects.	Gives rise to the brain and the spinal cord Alar plate gives rise to sensory neurons. Basal plate gives rise to motor neurons.

See also “Neurulation” in embryogenesis for more information.

The rostral neuropore closes by day 26, the caudal neuropore closes by day 28. The failure of neuropores to completely close causes neural tube defects (e.g., spina bifida).

Neurulation Neurulation (∼ day 18) Embryonic spinal cord

Clinical significance

Complete spinal cord injuries

Spinal shock

Incomplete spinal cord injuries

Other spinal cord pathologies

Epidural hematoma
Multiple sclerosis
Degenerative disk disease
Syringomyelia
Myelopathy
Amyotrophic lateral sclerosis
Subacute combined degeneration
Cauda equina syndrome
Conus medullaris syndrome
Spina bifida
Anterior spinal artery syndrome
Posterior spinal artery syndrome: loss of function of the cord that is supplied by the posterior spinal arteries, namely the posterior (dorsal) columns, resulting in loss of proprioception and vibratory sensation at and below the level of the injury
Tabes dorsalis
Hereditary spastic paraplegia
Spinal muscular atrophy
Poliomyelitis

Spinal arteriovenous malformation ^[6]

Definition: congenital malformation of spinal blood vessels
Epidemiology: usually presents in younger patients
Pathophysiology: abnormal arteriovenous connections of spinal arteries to veins within the dura (intramedullary, mostly thoracic or lumbar) → arterialization of spinal veins → congestive myelopathy because of venous hypertension, stasis, and multi-segmental spinal cord lesions → mass effect and/or ischemia and/or hemorrhage into the cord
Clinical features
- Features of subarachnoid hemorrhage (e.g., headache, photophobia)
- Features of intraparenchymal hemorrhage (e.g., localized pain, distinct level of paresthesia and paraplegia, urinary and fecal incontinence)
- Mass effect of arteriovenous malformations (e.g., spinal cord compression)
Diagnostics
- MRI: cluster of low-intensity signal foci
- Spinal digital subtraction angiography (DSA)
Treatment: possibly endovascular embolization/occlusion or surgical resection (depends on type and localization) ^[7]
Complications: tetraplegia with motor and sensory loss

References

Rea P. Essential Clinical Anatomy of the Nervous System. Academic Press ; 2015
Blumenfeld H. Neuroanatomy Through Clinical Cases. Wiley-Blackwell ; 2010
Spino-Olivary Tract. https://www.revolvy.com/page/Spino%252Dolivary-tract. . Accessed: November 25, 2018.
Upper Motor Neuronal Tracts. https://www.csuchico.edu/~pmccaffrey/syllabi/CMSD%20320/images/Notes-UNIT10.html. . Accessed: November 25, 2018.
Chung KW, Chung HM. Gross Anatomy. Lippincott Williams & Wilkins ; 2012
Fujima N, Kudo K, Terae S, et al. Spinal Arteriovenous Malformation: Evaluation of Change in Venous Oxygenation with Susceptibility-weighted MR Imaging after Treatment. Radiology. 2010; 254 (3): p.891-899.doi: 10.1148/radiol.09090286 . | Open in Read by QxMD
Ducruet AF, Crowley RW, McDougall CG, Albuquerque FC. Endovascular management of spinal arteriovenous malformations. Journal of NeuroInterventional Surgery. 2012; 5 (6): p.605-611.doi: 10.1136/neurintsurg-2012-010487 . | Open in Read by QxMD

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