The spinoreticular tract utilizes four levels of neurons, unlike most ascending tracts which have first- through third-order neurons. The tract begins with first-order neurons, which immediately synapse with second-order neurons in the posterior horn of the spinal column. These neurons decussate to the opposite side (anterolateral), and travel up the spinal column. It terminates in the brainstem at the medullary-pontine reticular formation. Information is sent from there to the intradmedian nucleus of the thalamic intralaminar nuclei. The thalamic intralaminar nuclei project diffusely to entire cerebral cortex where pain reaches conscious level and promotes behavioral arousal.
It is still undetermined if the spinoreticular tract possesses ipsilateral fibers in addition to those that decussate. It is hypothesized that during development the tract was bilateral, but that the ipsilateral synapses became ineffective during development.