Reticulospinal tract axons arise from the reticular formation in the pons and medulla. The axons of the pontine and medullary reticulospinal tracts descend ipsilaterally through the length of the spinal cord in the anterior white matter and synapse with interneurons in the anterior horn gray matter. They are believed to function in regulating voluntary movements in reflex activity and autonomic outflow (eTables 9.5 and 9.6).