The axons of the tract cells cross over (decussate) to the other side of the spinal cord via the anterior white commissure, and to the anterolateral corner of the spinal cord (hence the spinothalamic tract being part of the anterolateral system). Decussation usually occurs 1-2 spinal nerve segments above the point of entry. The axons travel up the length of the spinal cord into the brainstem, specifically the rostral ventromedial medulla.
Traveling up the brainstem, the tract moves dorsally. The neurons ultimately synapse with third-order neurons in several nuclei of the thalamus -- including the medial dorsal, ventral posterior lateral, and ventral medial posterior nuclei. From there, signals go to the cingulate cortex, the primary somatosensory cortex, and insular cortex respectively.
The types of sensory information transmitted via the spinothalamic tract are described as affective sensation. This means that the sensation is accompanied by a compulsion to act. For instance, an itch is accompanied by a need to scratch, and a painful stimulus makes us want to withdraw from the pain.
There are two sub-systems identified:
Direct (for direct conscious appreciation of pain)
Indirect (for affective and arousal impact of pain). Indirect projections include
Spino-Mesencephalic-Limbic (for affective impact of pain).
Unilateral lesion usually causes contralateral anaesthesia (loss of pain and temperature). Anaesthesia will normally begin 1-2 segments below the level of lesion, affecting all caudal body areas. This is clinically tested by using pin pricks.