Dorsal column–medial lemniscus pathway

The dorsal column–medial lemniscus pathway (DCML) (also known as the posterior column-medial lemniscus pathway, PCML) is a

There are three groupings of neurons that are involved in the pathway: first-order neurons, second-order neurons, and third-order neurons. The first-order neurons are sensory neurons located in the dorsal root ganglia, that send their afferent fibers through the two dorsal columns – the gracile fasciculus, or gracile tract, and the cuneate fasciculus, or cuneate tract.^[3] The first-order axons make contact with second-order neurons of the dorsal column nuclei (the gracile nucleus and the cuneate nucleus) in the lower medulla. The second-order neurons send their axons to the thalamus. The third-order neurons are in the ventral nuclear group in the thalamus and fibres from these ascend to the postcentral gyrus.

Sensory information from the upper half of the body is received at the cervical level of the spinal cord and carried in the cuneate tract, and information from the lower body is received at the lumbar level and carried in the gracile tract. The gracile tract is medial to the more lateral cuneate tract.

The axons of second-order neurons of the gracile and cuneate nuclei are known as the internal arcuate fibers and when they cross over the midline, at the sensory decussation in the medulla, they form the medial lemniscus which connects with the thalamus; the axons synapse on neurons in the ventral nuclear group which then send axons to the postcentral gyrus in the parietal lobe. All of the axons in the DCML pathway are rapidly conducting, large, myelinated fibers.^[2]

Structure

The DCML pathway is made up of the axons of first, second, and third-order

The gracile fasciculus carries sensory information from the lower half of the body entering the spinal cord at the lumbar level. The cuneate fasciculus carries sensory information from the upper half of the body (upper limbs, trunk, and neck) entering the spinal cord at the cervical level.[4] The gracile fasciculus is wedge-shaped on transverse section and lies next to the posterior median septum. Its base is at the surface of the spinal cord, and its apex directed toward the posterior gray commissure. The gracile fasciculus increases in size from inferior to superior.

The cuneate fasciculus is triangular on transverse section, and lies between the gracile fasciculus and the posterior column, its base corresponding with the surface of the spinal cord. Its fibers, larger than those of the gracile fasciculus, are mostly derived from the same source, viz., the posterior nerve roots. Some ascend for only a short distance in the tract, and, entering the gray matter, come into close relationship with the cells of the dorsal nucleus, while others can be traced as far as the medulla oblongata, where they end in the gracile nucleus and cuneate nucleus.

The two ascending tracts meet at the level of the

First-order neurons

Periphery and spinal cord

When an

First-order neurons secrete substance P in the dorsal horn as a chemical mediator of pain signaling. The dorsal horn of the spinal cord transmits pain and non-noxious signals from the periphery to the spinal cord itself. Adenosine is another local molecule that modulates dorsal horn pain transmission ^[3]

Second-order neurons

Brainstem

The neurons in these two nuclei (the

The medial lemniscus rotates 90 degrees at the pons. The secondary axons from neurons giving sensation to the head, stay at around the same place, while the leg axons move outwards.

The axons travel up the rest of the brainstem, and synapse at the thalamus (at the ventral posterolateral nucleus for sensation from the neck, trunk, and extremities, and at the ventral posteromedial nucleus for sensation from the head).

Third-order neurons

Thalamus to cortex

Axons from the third-order neurons in the ventral posterior nucleus in the thalamus, ascend the posterior limb of the internal capsule. Those originating from the head and the leg swap their relative positions. The axons synapse in the primary somatosensory cortex, with lower body sensation most medial (e.g., the paracentral lobule) and upper body more lateral.

Function

Discriminative sensation is well developed in the fingers of

The sensory neurons in this pathway are pseudounipolar, meaning that they have a single process emanating from the cell body with two distinct branches: one peripheral branch that functions somewhat like a dendrite of a typical neuron by receiving input (although it should not be confused with a true dendrite), and one central branch that functions like a typical axon by carrying information to other neurons (again, both branches are actually part of one axon).

Clinical significance

Damage to the dorsal column-medial lemniscus pathway below the crossing point of its fibers results in loss of vibration and joint sense (proprioception) on the

Damage to either of the dorsal column tracts can result in the permanent loss of sensation in the limbs. See Brown-Séquard syndrome.

Additional information

The cuneate fasciculus, fasciculus cuneatus, cuneate tract, tract of Burdach, was named for Karl Friedrich Burdach. The gracile fasciculus, the tract of Goll, was named after Swiss neuroanatomist Friedrich Goll (1829–1903).

References