Case 14 - Spinal cord and back pain

Question 1

Cervical vertebrae features?

Answer 1

• Bifid spinous processes (SP bifurcates) - Foramina transversarum - Intervertebral joints of Luscka - Bertebral foramen is triangular

Question 2

Thoracic vertebrae features?

Answer 2

• Costal facets on transverse process - Downwards sloping spinous processes - Demi-facets articulating with rib head

Question 3

Lumbar vertebrae features?

Answer 3

• Large vertebral body and transverse process - No characteristic features like the others

Question 4

Sacral vertebrae features?

Answer 4

• 5 fused vertebrae - No vertebral arch so coccyx doesn’t transmit spinal cord

Question 5

Name the different ligaments in the spinal cord: One of them has a different name at the cervical region, what is the function of the ligament at the cervical region?

Answer 5

1. Anterior Longitudinal Ligament
2. Posterior Longitudinal Ligament
3. Ligamentum flavum
4. Interspinous ligament
5. Supraspinous ligament * Known as Ligamentum nuchae in cervical region > prevents excessive neck flexion

Question 6

What is the pathology in this MRI and where does it occur most often?

Answer 6

Prolapsed disc - occurs most often at the lumbar region due to load bearing and motion, also genetic factors are involved

Question 7

Name the two parts of the intervertebral disc

Answer 7

1. Inside: Nucleus pulposus
2. Outside: Annulus Fibrosis

Question 8

Anterior cord syndrom features?

Answer 8

• Complete motor paralysis below level of lesion as lesion interrupts corticospinal tract
• Loss of pain/temperature at and below level of lesion as lesion interrupts spinothalamic tract
• Retained proprioception/ vibration sensation as lesion doesn’f affect dorsal horn in ANTERIOR CORD SYNDROME

Question 9

Posterior cord syndrome features?

Answer 9

• Loss of proprioception and vibration sensation as dorsal horn affected by lesion
• Bladder and bowel dysfunction

Question 10

What is central cord syndrome and what are its features?