Purpose of review: This article reviews the neuroanatomical arrangement of the white matter pathways and gray matter columns of the spinal cord and explores how injury to the spinal cord leads to a typical constellation of symptoms and signs depending on the cross-sectional and longitudinal extent of the lesion.
Recent findings: As refined imaging techniques and novel biomarkers help identify spinal cord diseases more readily, familiarity with the classic spinal cord syndromes and localizing principles remains essential for prompt recognition of spinal cord involvement and efficient diagnostic testing in order to direct therapy and avoid permanent injury.
Summary: Spinal cord disease can progress rapidly and cause debilitating deficits, making prompt recognition and treatment crucial. Knowledge of the organization of these pathways and cell columns, along with their surrounding structures and blood supply, allows the clinician to localize processes within the spinal column. This, in turn, can suggest the type of pathologic process involved and direct further evaluation and management.