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					Cottage	
  Health	
  System	
  Dr	
  Alan	
  Moelleken	
  MD	
  Spine	
  Orthopedics	
  Center	
  Santa	
  
Barbara.	
  	
  Doctor	
  Moelleken	
  study	
  expert	
  lawsuit	
  anti-­‐trust	
  witness	
  case	
  law	
  terms	
  	
  
Cottage	
  Hospital	
  400	
  West	
  Pueblo	
  Street,	
  Santa	
  Barbara,	
  California	
  93105	
  
Dr	
  Alan	
  Moelleken	
  MD,	
  Cottage	
  Hospital	
  Santa	
  Barbara,	
  California	
  
Dr	
  Alan	
  Moelleken	
  MD	
  educational	
  medical	
  legal	
  law	
  case	
  terms	
  worldwide	
  for	
  
Planet	
  Generation	
  
	
  
Spinal Cord Somatosensory organization




Spinal cord tracts.
Somatosensory organization is divided into the dorsal column-medial lemniscus tract (the
touch/proprioception/vibration sensory pathway) and the anterolateral system, or ALS (the pain/temperature
sensory pathway). Both sensory pathways use three different neurons to get information from sensory receptors at
the periphery to the cerebral cortex. These neurons are designated primary, secondary and tertiary sensory
neurons. In both pathways, primary sensory neuron cell bodies are found in the dorsal root ganglia, and their
central axons project into the spinal cord.


In the dorsal column-medial leminiscus tract, a primary neuron's axon enters the spinal cord and then enters the
dorsal column. If the primary axon enters below spinal level T6, the axon travels in thefasciculus gracilis, the
medial part of the column. If the axon enters above level T6, then it travels in the fasciculus cuneatus, which is
lateral to the fasiculus gracilis. Either way, the primary axon ascends to the lower medulla, where it leaves its
fasiculus and synapses with a secondary neuron in one of the dorsal column nuclei: either the nucleus gracilis or
the nucleus cuneatus, depending on the pathway it took. At this point, the secondary axon leaves its nucleus and
passes anteriorly and medially. The collection of secondary axons that do this are known as internal arcuate fibers.

Cottage	
  Health	
  System	
  Dr	
  Alan	
  Moelleken	
  MD	
  Spine	
  Orthopedics	
  Center	
  Santa	
  
Barbara.	
  	
  Doctor	
  Moelleken	
  study	
  expert	
  lawsuit	
  anti-­‐trust	
  witness	
  case	
  law	
  terms	
  	
  

Cottage	
  Hospital	
  400	
  West	
  Pueblo	
  Street,	
  Santa	
  Barbara,	
  California	
  93105	
  
Dr	
  Alan	
  Moelleken	
  MD,	
  Cottage	
  Hospital	
  Santa	
  Barbara,	
  California	
  
Dr	
  Alan	
  Moelleken	
  MD	
  educational	
  medical	
  legal	
  law	
  case	
  terms	
  worldwide	
  for	
  
Planet	
  Generation	
  	
  
	
  
	
  
Cottage	
  Health	
  System	
  Dr	
  Alan	
  Moelleken	
  MD	
  Spine	
  Orthopedics	
  Center	
  Santa	
  
Barbara.	
  	
  Doctor	
  Moelleken	
  study	
  expert	
  lawsuit	
  anti-­‐trust	
  witness	
  case	
  law	
  terms	
  	
  
Cottage	
  Hospital	
  400	
  West	
  Pueblo	
  Street,	
  Santa	
  Barbara,	
  California	
  93105	
  
Dr	
  Alan	
  Moelleken	
  MD,	
  Cottage	
  Hospital	
  Santa	
  Barbara,	
  California	
  
Dr	
  Alan	
  Moelleken	
  MD	
  educational	
  medical	
  legal	
  law	
  case	
  terms	
  worldwide	
  for	
  
Planet	
  Generation	
  
The internal arcuate fibers decussate and continue ascending as the contralateral medial lemniscus. Secondary
axons from the medial lemniscus finally terminate in the ventral posterolateral nucleus (VPL) of the thalamus,
where they synapse with tertiary neurons. From there, tertiary neurons ascend via the posterior limb of the internal
capsule and end in the primary sensory cortex.


The proprioception of the lower limbs differs from the upper limbs and upper trunk. There is a four-neuron pathway
for lower limb proprioception. This pathway initially follows the dorsal spino-cerebellar pathway. It is arranged as
follows: proprioceptive receptors of lower limb -> peripheral process -> dorsal root ganglion -> central process -
> Clarke's column -> 2nd order neuron -> medulla oblogata (Caudate nucleus) -> 3rd order neuron -> VPL of
thalamus -> 4th order neuron -> posterior limb of internal capsule -> corona radiata -> sensory area of cerebrum.
The anterolateral system works somewhat differently. Its primary neurons axons enter the spinal cord and then
ascend one to two levels before synapsing in the substantia gelatinosa. The tract that ascends before synapsing is
known as Lissauer's tract. After synapsing, secondary axons decussate and ascend in the anterior lateral portion
of the spinal cord as the spinothalamic tract. This tract ascends all the way to the VPL, where it synapses on
tertiary neurons. Tertiary neuronal axons then travel to the primary sensory cortex via the posterior limb of the
internal capsule.


It should be noted that some of the "pain fibers" in the ALS deviate from their pathway towards the VPL. In one
such deviation, axons travel towards the reticular formation in the midbrain. The reticular formation then projects to
a number of places including thehippocampus (to create memories about the pain), the centromedian nucleus (to
cause diffuse, non-specific pain) and various parts of the cortex. Additionally, some ALS axons project to
the periaqueductal gray in the pons, and the axons forming the periaqueductal gray then project to the nucleus
raphes magnus, which projects back down to where the pain signal is coming from and inhibits it. This helps
control the sensation of pain to some degree.
	
  




Cottage	
  Health	
  System	
  Dr	
  Alan	
  Moelleken	
  MD	
  Spine	
  Orthopedics	
  Center	
  Santa	
  
Barbara.	
  	
  Doctor	
  Moelleken	
  study	
  expert	
  lawsuit	
  anti-­‐trust	
  witness	
  case	
  law	
  terms	
  	
  

Cottage	
  Hospital	
  400	
  West	
  Pueblo	
  Street,	
  Santa	
  Barbara,	
  California	
  93105	
  
Dr	
  Alan	
  Moelleken	
  MD,	
  Cottage	
  Hospital	
  Santa	
  Barbara,	
  California	
  
Dr	
  Alan	
  Moelleken	
  MD	
  educational	
  medical	
  legal	
  law	
  case	
  terms	
  worldwide	
  for	
  
Planet	
  Generation	
  	
  
	
  
	
  

				
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Description: Dr Alan Moelleken MD, Moelleken, Expert witness, anti-trust, lawsuits, cottage hospital, spine, orthopedic, various medical terms for educational inquiry purposes only. Not a final determination of medical or legal terms.
About Board Certified and Fellowship Trained Orthopedic Surgeon Specializing in Surgeries of the Spine Dr. Moelleken attended SUNY Albany as an undergraduate student. He graduated number one in his class with a Double Honors’ Degree and was inducted into Phi Beta Kappa as a junior. He subsequently enrolled in the University of Pennsylvania School of Medicine in Philadelphia, where he received his medical training and graduated with an M. D. degree in 1983. He then preformed a year of orthopedic surgery research at the University of Pennsylvania School of Medicine. He was then accepted into a prestigious orthopedic residency program at the University of California at Los Angeles (UCLA). After completion of his residency, he attended New York University (NYU), New York, for special fellowship training in neurosurgery and orthopedic spine surgery. His mentors included some of the most famous neurosurgeons, spine surgeons, and experts in scoliosis. While at NYU, he served as an assistant professor and an attending physician teaching neurosurgery and orthopedic residents at Bellevue Hospital Medical Center in New York and at the Department of Veterans’ Affairs Medical Center in New York (affiliated with NYU Medical Center). Dr. Moelleken is a member of a variety of academic and scientific organizations, such as the American Association of Orthopedic Surgeons (AAOS), the North American Spine Society (NASS), and the American Medical Association (AMA). He has authored numerous scientific publications and presentations. For the past nine years, he has been the chairman of the monthly Tri-County Spine Conference. He maintains his cutting-edge knowledge and expertise as a spine surgeon by regularly attending national and international spine conferences and by constantly familiarizing himself with the latest research in the fields of orthopedic surgery and neurosurgery, especially as it pertains to disorders of the spine.